Cardiopulmonary – Lines and Tubes – Flashcards
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What is the ultimate goal when working with lines and tubes?
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NOT to pull them out...
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What factors cause inaccurate readings for a pulse oximeter?
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Cold fingers, poor circulation, nail polish, dark skin, motion, cardiac arrhythmias
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What reading does a Pulse Oximeter giver us?
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SpO2 - approximation or indirect reading of SaO2
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What is the percentage of O2 in room air?
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21%
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What levels of oxygen are typically used with a nasal cannula?
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3-6 L/min
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If a pt needs more than 6 L/min, what should be used instead of a nasal cannula?
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Mask
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What is a non-rebreather mask?
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Mask with oxygen bag attached, usually used on pts that are more ill.
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What is a Nasopharyngeal Tube?
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Tube placed between nose and upper airway. Used to suction secretions in patients with poor cough.
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What is an Oropharyngeal Tube?
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Tube placed between mouth and airway. Prevents obstruction of airway by moving tongue anteriorly and facilitates suctioning.
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What are the two types of airways used for Mechanical Ventilation?
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Endotracheal Tubes (ETT) and Tracheotomy
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What is an Endotracheal Tube?
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Tube inserted through mouth, into trachea, when pt is in respiratory failure. Allows air to pass in and out.
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What is a Tracheotomy?
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Surgical procedure to make incision over tracheal rings in neck and insert a tube. Usually used in acute and chronic conditions to create a more permanent airway.
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What are some benefits of the Tracheotomy over an ETT?
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Decreased vocal cord and tracheal injury. Better for prolonged intubation. Pt can still talk with tracheotomy. More comfortable for pt.
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What is a Passy Muir Speaking Valve (PMSV)?
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Type of tracheotomy. Promotes use of upper airway. Assists with verbal communication and coughing. SpO2 > 90% to wear all day
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What is a Tracheotomy Collar?
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Pt wears collar around neck to secure tracheotomy tube.
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What are the advantages of artificial airways?
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Prevent airway obstruction Protect airway from aspiration Facilitate suctioning Provide closed system for mechanical ventilation.
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What are the disadvantages of artificial airways?
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Cough is less effective Reduced ciliary motion (so suction instead) Interferes with communication and nutrition Bypasses respiratory defense mechanisms Tracheal stenosis
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Is ventilation a contraindication to mobility and therapeutic intervention?
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NO!
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What should you do if a tracheal tube becomes unattached?
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Perform manual ventilation with an ambu bag and call for help.
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What are some important things to remember to do before, during, and after treatment of a pt with an artificial airway?
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They CAN participate in therapeutic interventions. Prior to treatment: ensure airway is stable, listen to breath sounds, note position of tube. During: Airway still stable? Listen to breath sounds, position of tube. After: Listen to breath sounds, position of tube.
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What are the three locations a chest tube might be placed?
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Pleural space, mediastinum, pericardium
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What are the indications for a chest tube in the Pleural Space?
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Pneumothorax, hemothorax, pleural effusion, empyema
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What are the indications for a chest tube in the Mediastinum or Pericardium?
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After open-heart surgery
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Where are chest tubes placed for the Pleural Spaces?
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Between ribs 4 and 5, along mid or anterior axillary line (posterior to lateral border of Pec Major)
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Can a pt participate in PT while he/she has chest tubes?
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Yes, provided chest tube drainage system kept below level of insertion site and suction is continued.
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What are the three types of Pacemakers?
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Epicardial Endocardial Temporary
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What is an Epicardial Pacemaker?
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Placed during open heart surgery - electrodes sewn or screwed into heart muscle.
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What is an Endocardial Pacemaker?
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Generator placed in infraclavicular pocket with leads attached to R atrium and ventricle
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What is a Temporary Pacemaker?
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Used in acute care after cardiac surgery. Sewn to outside of hear and wires exit below xyphoid process.
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What does ICD stand for?
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Automated Implantable Cardioverter - Defibrillator
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What does an ICD do?
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Shocks/defibrillates the heart during a lethal arrhythmia. Paces heart with regular or overdrive pacing.
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What should you know about a pt's ICD before you start therapy?
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What HR the device is activated so you don't go over it during treatment. HR must remain > 10 bpm below that point.
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What side would a pt have an internal pacemaker implanted via the subclavian vein and ICD?
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Non-dominant upper extremity.
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What are some contraindications if a pt has an implanted device such as a pacemaker or ICD through the Subclavian artery?
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No shoulder flexion or abduction past 90. No shoulder extension. Possible weight bearing restrictions. No axilla pressure.
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Why would an Intra-Aortic Balloon Pump (IABP) be used and what does it do?
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Inflated during diastole to direct blood flow into coronary arteries and deflated during systole to increase forward flow of blood and decrease after load.
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T or F: A patient with an IABP must be on bedrest with their head and upper torso elevated no more than 30 degrees.
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True, no sitting.
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What is a Swan Ganz Catheter or a Pulmonary Artery Catheter (PAC)?
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Flexible, balloon tipped catheter placed by PM into large periperhal veing and guided through right side of Pulmonary Artery. Designed for long term use in ICU.
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Why do we use a Swan Ganz Catheter or PAC?
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To evaluate cardiac function and volume status, and monitor response to fluids, diuretics, and vasoconstrictive drugs.
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What kinds of things can be measured through a Swan Ganz Catheter or a PAC?
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Hemodynamics Right arterial pressure Pulmonary artery pressure Pulmonary arter wedge pressure Cardiac output
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Can a patient be moved if they have a Swan-Ganz Catheter (PAC)?
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Yes, as long as they don't have Pulmonary Capillary Wedge Pressure being measured.
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What precautions should be taken when moving a patient with a Swan-Ganz Catheter (PAC)?
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Check with skilled pro to be sure ok to move. Keep transducer level to 4th intercostal space for accurate reading. Check position before and after moving patient.
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What are possible complications of a Swan Catheter?
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Infection, sepsis, thrombus, pulmonary infarct (rare) and pulmonary artery rupture (also rare)
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What is a pigtail catheter?
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Placed in heart or lung to drain fluid collections.
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Why are Arterial Lines and Catheters used in acute care?
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To monitor BP, draw blood for labs, and monitor arterial blood gases and PH
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What are some sites for an Arterial Line?
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Radial and Femoral Arteries Also sometimes, Brachial and Dorsalis Pedis artery
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Can a patient with an arterial line move freely?
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Depends on placement site and stability. If stable, pt can move in all PT interventions such as positioning, airway clearance, and bed mobility. If not stable, weight bearing and joint ROM may be restricted.
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When is a pt with an arterial line on strict bed rest?
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If the line or catheter is in a sheat - which helps it to be more secure and stable in its placement.
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What level should the transucer for an Arterial Line be kept at to ensure accurate readings?
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at level of 4th intercostal.
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What happens if the transducer is above or below the level of the heart?
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Above - BP falsely high Below - BP falsely low
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What are some complications of an Arterial LIne?
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Bleeding, infection, lack of blood flow to tissues
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What are the two types of Venous Cathethers?
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Peripheral Intravenous (IV) Central Intravenous (Peripherally Inserted Central Catheter (PICC))
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Why would you typically use a peripheral IV?
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Inserted into hand or forearm. Easily allows access for administration of drugs, fluids, and blood transfusions.
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What kind of blood is drawn from a peripheral IV?
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Venous blood.
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Who inserts an IV?
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Nurses
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What is a Central Venous Catheter?
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Flexible tube inserted into subclavian, internal or external jugural, or femoral vein? Stapled or Sutured into place.
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Why might a patient have a Central Venous Catheter?
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Provides diagnostic info by measuring Central Venous Pressure and gives access to easy blood draws Administration of meds that are caustic to peripheral veins Peripheral veins might not be available. Long term meds and TPN (parenteral nutrition) Hemodialysis or Plasmapheresis
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What is a PICC Line?
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Peripherally Inserted Central Catheter Long, slender, flexible tube inserted into peripheral vein that travels to Superior Vena Cava.
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Why might a PICC line be used over a CVC?
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Less invasive, decreased risks of complication and stays in place for longer. Less rate of infection then Suclavian and Femoral lines.
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What should you avoid doing on an arm with a PICC?
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No blood pressure readings or attaching anything to arm.
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What is a PCA Pump?
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Patient Controlled Analgesia Patient pressed button for pain control medication to be delivered via IV.
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Can anyone press the button on a PCA?
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NO! Only the patient.
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What is TPN?
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Total Parenteral Nutrition - feeding tube used for a patient who can't use GI tract.
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What is a Nasogastric (NG) Tube used for?
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Inserted into nostril, terminates in stomach. Used to empty stomach of gas and digestive fluids. Also used for feeding.
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What is a Dobhoff (Feeding) Tube used for?
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Inserted into nostril, terminates at small intestines. Pt has use of GI tract but unable to chew or swallow.
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What is a Percutaneous Endoscopic Gastrostomy/Jejunostomy (PEG/PEJ) Tube used for?
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Surgically placed in stomach or jejunum for long term nutrition.
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What are some precautions to take with a pt who has an NG tube?
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Check before discontinuing suction. Don't lie pt flat after feeding. If pt vomits, reattach NG tube.
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What are some implactions for the PEG/PEJ Tube?
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Sore around area after initial placement. Can be disconnected for mobility but reconnect properly afterwards.
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What is a Colostomy?
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Bag attached to abdomen that allows fecal matter to drain from colon via a stoma.
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What should we be wary of if a pt has a Colostomy?
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Gait belt placement.
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What are hemodialysis and plasmapheresis?
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Removal of toxic waist productes from blood stream in patients with renal failure. Maintains fluid, electrolyte and pH balance.
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Where do the Hemodialysis and Plasmapheresis units attach to a patient?
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Via a central line or Arteriovenous (AV) fistula.
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How often does a patient have dialysis?
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Every 3-4 days.
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Can BP be taken in an arm that has an AV shunt?
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NO
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If a pt is having dialysis the same day as PT treatment, what should you be wary of?
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Patient may be tired - low endurance.
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What is a Foley Catheter?
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Catheter placed directly into bladder to assist in evacuation of urine.
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What precautions should be taken with the drainage bag for the catheter?
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Do not tip it, used to measure. Bag must be below level of bladder to promote drainage and prevent back flow.
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What might you do with a patient with a foley catheter if you wanted to move them?
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Secure tubing to thigh or bag to gown.
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What is a External Ventricular Drain?
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Tube placed in ventricle to drain CSF and relieve pressure on brain due to acute injury, blockage, or infection.
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What level should a External Ventricular Drain be kept at?
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Level with external auditory meatus.
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What is an Intracranial Pressure Monitor?
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Measures pressure around the the brain (4-15 mmHG is normal). Hand in hand with External Ventricular Drain.
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What must be done to mobilize a pt with an EVD?
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Drain must be clamped. Intracranial pressure must be controlled before clamping drain.
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Is it ok to mobilize a pt with a Surgical drain?
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Yes, pin the drain to the gown. If drain is full, ask nurse to empty before mobilization.
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Can a pt be mobile with a wound vac?
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Yes, carries it with him without disconnecting. Can also be disconnected if ok.
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Why are compression boots used in acute care?
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Prevent DVTs
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Can compression boots be removed in acute care?
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Yes, for PT and ambulation.
