814 Final: lines and tubes

PT procedures for ICU

- Connect to transport monitor before leaving beside.

- Ask nurse or family member to follow with a wheelchair.

- Take resting vital signs.

Common sites of peripheral IV's

- Antecubital

- Dorsum of hand or foot

- Radial aspect of wrist

Precautions of IV

- Joint ROM may be restricted.

- Contact nurse if dislodged and apply pressure.

- Watch for edema and leaking fluid.

What are central lines?

- Used for large central venous access (subclavian, femoral or internal jugular)

- May be connected to medication bags or CVP monitor.

- May be double, triple, or quadruple lumen.

Central line precautions (subclavian vs femoral)

- Subclavian: limit shoulder flexion and abduction to 90

- Femoral: limit hip flexion to 90. NO IR AND EX

What are PICC lines?

- Peripherally inserted central catheters used for long term access to medications.

PICC line precautions

- Limit shoulder flexion to 90

- Alert nurse if tender or swollen.

What are arterial lines used for?

- Continuous monitoring of system blood pressure

- Systolic or dysolic BP (MAP)

o Radial, femoral, dorsalis, pedis and brachial artery's

How to know if it is an arterial line?

- TRANSDUCER PRESENT at level of right atrium

What happens if the transducer is too high vs too low.

- Too high: low measurement

- Too low: high measurement

Arterial line precautions radial vs femoral

- Radial: limit extreme wrist ROM

- Femoral: limit hip flexion to 30

What is a Pulmonary artery catheter?

- Cather that travels through venous catheter to right atrium and ventricle to pulmonary artery

- Monitors cardiopulmonary pressure.

Pulmonary artery catheter precautions

- PAP waveform should be present if PAwP is displayed contact nursing.

- Watch shoulder ROM

ECG monitoring

- Measuring heart rate and rhythm to detect heart blocks and arrythmias.

- 5 leads on adults and two on children

ECG lead colors

- RIGHT: white on top of green

o Snow on mountains

- Left: black on top of red

o Smoke over fire

- Brown in the middle

ECG precautions

- ECG electrodes may become disconnected (replace)

- Transport with you to monitor out of bed activities.

Pulse oximetry function

- Measured oxygen saturation

Common pulse oximetry sites

- Finger

- Earlobe

- Toes

Pulse oximetry precautions

- If reading low try to move it, if it still reads low contact nursing.

What is a foley catheter used for?

- Urine output of the bladder

Foley catheter precautions

- Must be below level of the bladder.

- Contact nursing in pt. reports extreme discomfort

What is a rectal drain used for?

- Used to contain frequent loose stool.

- Collection bag or vacuum

What are post operative drains used for?

- Use following abdominal and thoracic surgery to collect fluid and blood.

o Jackson Pratt (bulb) or hemovac

Post operative drain precautions.

- Secure drain before transfers and ambulation to avoid dislodging or occluding the drain.

o Safety pin

What is wound vac used for?

- Promotes tissue formation and removes infection from chronic and acute wounds.

Wound vac precautions

- Check seal.

- Avoid tensioning tube.

What are NG tubes used for?

- Used to decompress the stomach and empty stomach contents.

- Can be used for short-term feeding and drug administration.

NG tube precautions

- Do not allow tube to hang.

- Ask nursing to reposition tube if needed and disconnect from suction for ambulation.

What is a chest tube used for?

- To remove air or fluid from the lungs or mediastinal spaces after trauma or surgery

o Typically sutured and taped down to skin.

Chest tube precautions

- Chest trap must be maintained upright and below chest.

- Look for bubbles in the trap.

- Make sure tube is secure before ambulation and ask nursing to disconnect wall suction.

What is an endotracheal tube used for?

- Short term airway management for ventilation

- Tube can be inserted orally or nasal.

EET tube precautions

- Ensure tube is stabilized before transfer.

- Keep circuit tubing bellow so it does not empty into the airway.

What is a tracheostomy?

- Used for Long term airway ventilation.

- Allows access to upper airway and allows for easier suctioning.

Tracheostomy precautions

- Ensure tube is stable before transfers.

- Keep tubing below trachea, so it does not empty into airway.

What is the function of airway suctioning?

- Replaces the cough mechanism.

- Removes secretions.

BiPAP vs CPAP

- BiPAP: blows air at high pressure for inhaling and low pressure for exhaling.

- CPAP: flow of air creates enough pressure when you inhale to keep airway open.

o Sleep apnea

Two types of airways equipmemt

- Nasal cannula (nares)

- Face mask

What does a non-rebreather indicate?

- Acute hypoxia

o Transplant

Dubhoff feeding tube.

- Introduced through nose to stomach.

- Used for short term feeding.

Dubhoff feeding tube precautions.

- Keep head out of bed more than 30 degrees with feeding.

Gastrostomy and jejunostomy tubes

- Placed through abdominal wall.

- Used for long term feeding

Gastrostomy and jejunostomy tube precautions

Ensure tube is stabilized prior to transfers.

Intra-aortic balloon pump function

- Decreased myocardial oxygen demand while increasing cardiac output.

- FEMORAL ARTERY

Intra-aortic balloon pump precautions

- Typically on bed rest

- Check lower limb circulation.

- NO HIP AND KNEE ROM

Ventricular assist device function

- Mechanical pump to assist the right and left ventricles in delivering blood to the body.

- Used for patients with heart failure or waiting for transplants.

Ventricular assist device precautions

- Closely monitor vital signs

- Keep hand pump near and know all emergency procedures.

Extracorpeal membrane oxygenation (ECMO) details

- Used to treat respiratory failure.

- Bridge to recovery and transplants

Intracranial pressure monitor details

- Placed after head trauma to monitor to the pressure on the brains.

- Intraventricular catheter allows for drainage.

o Make sure catheter is at level of external auditory meatus.

ICP precautions

- Decrease activities that increase ICP

- Watch for signs of headaches, nausea, visual disturbances, or lethargic behavior.

Dialysis precautions

- Check with nursing to see in patient is stable.

- Ensure catheter and tubes are stable.

- NO HIP MOVEMENT WITH FEMORAL CATHERTER

Temporary pacemaker precautions (noninvasive vs transvenous)

- Noninvasive: NONE but do not drop

- Transvenous: bed rest and limit to 90 degrees shoulder flexion and abduction

ABCDEF bundle

- Awake

- Breathing coordination

- Choice of sedatives

- Delirium monitoring

- Early mobility and exercise

- FAMILY

Early mobility screen

- Response to verbale stimulus

- FIO2: less than 0.6

- PEEP: less than 10 cm h2o

- No sign of heart attack for 24 hours

- NO increased vasopressor infusion in two hours