Exam 2: Lines, Tubes & Equipment

why is it important to accurately assess the patient's room and environment?

determine best mobilization strategy

look...

patient, room, monitor, equipment

trace...

lines from patient, tubing, device

plan...

where you are going, direction, what moves with you, who helps

move...

secure lines, manage slack, monitor patient

reassess...

patient, vitals, lines, devices, environment

considerations for surveying the environment

- type of equipment

- equipment in relation to patient

- detach for mobility

- slack on lines/tubes

- type of bed and height

where do you move if the patient is attached to a ventilator?

move towards the ventilator

which way do you move when there is a side of the bed with the majority of lines and tubes?

towards the side with the majority

what should you do before mobilizing a patient?

ensure all equipment, lines, tubes are moved to allow enough slack

what should be considered if there are no lines or equipment?

what the patient does at home

when should you ask for help in mobilization?

first time, ensuring security of tubes, need

what should you ensure is visible during mobility?

cardiac monitor and vitals

prepare for ultimate mobility goal...

dangling, out of bed to chair, ambulation

for any line on a patient consider...

- stability of line (sutured, taped, tunneled)

- when it is changed

- importance (removal)

- difficult to obtain access

- needle/catheter

- tension on the line or movement at insertion

- consequence of dislodge vs not treatment

- patient tolerance

catheter considerations

rigid plastic vs pliable flexible tubing

what should you know about every line?

where it starts, ends, and whether it has enough slack

when to notify RN

- leaking fluid, blood

- blood backing up into line

- redness, pain, swelling of site

- decrease pulse distal to line

- cool limb distal to line site

vascular access

peripheral IV, PICC, central line, arterial line

intravenous infusion (IV) pump

used to deliver fluid and medication

IV pump structure

small plastic tube inserted into patient's vein

what is the most common IV site?

upper extremity (can be in foot, neck, ankle)

how often should the IV pump be changes?

7 days to avoid infection

if no infusion is running through an IV what happens?

heplocked (not attached)

controlled infusion rate for IV pump

predetermined amount of fluid/medicine is delivered each hour

IV pump alarms

- infusion complete

- air in line or kink preventing flow

- silence alarm and notify RN

IV pump utilization

dehydration, IV medication (antibiotics, pain meds, cardiac meds, anticoagulants)

mobility considerations for an IV pump

can infusion be stopped, ensure site is secure with slack in tubing, if mobilizing with a pole ensure it is plugged back into the wall at the end of the session

catheter inserted into an artery and connected to a transducer via pressure tubing

arterial line

what are the pressure signals in an arterial line converted into?

electric stimulus which displays pressure and waveforms on an oscilloscope

purpose of an arterial line

monitoring systolic, diastolic, MAP, and blood draw for ABG

common insertion site for arterial line (most to least)

radial, femoral, brachial, doralis pedis

arterial line is position dependent relative to _______

transducer

what to do if an arterial line becomes dislodged?

apply firm and direct pressure to the site, call RN, and do not leave patient alone

where should the transducer be placed throughout a session to ensure accurate readings?

heart level

if transducer is too low...

BP reads high

if transducer is too high...

BP reads low

ensure the arterial line is not _____ at the entry site

kinked

what may you need to do for an arterial line in the radial artery to avoid kinks?

wrist extension

what should you do if the transducer is disconnected for ambulation?

ensure the RN is aware, reconnect and zero at the end of the session

long thin flexible tubes inserted into a large proximal vein, then threaded through the vein until it reaches the heart

central venous catheter (central line)

purpose of a central line

monitor central venous pressure and allow administration of medicine, fluid, blood products, TPN, or obtaining venous blood

common insertion sites for central lines

internal/external jugular, subclavian, antecubital, femoral

types of central lines

- tunneled catheters/hickman (long term)

- temporary central line (non-tunneled)

- post/permacath

- peripherally inserted central line (PICC)

- temporary dialysis catheter

- pulmonary artery catheter/swan ganz (critical care)

long and slender small flexible tubers that are inserted into a peripheral vein and advanced into a large vein in the chest

PICC lines

what is the most common PICC insertion site?

upper arm

purpose of a PICC line

IV access for prolonged time (chemo, TPN, antibiotics)

what are therapy implications for a PICC line?

avoid lifting >10 pounds with involved UE

a single or multi-lumen central line tunneled under skin prior to entering central vein and used for long term venous access, repeated blood draw, chemo, antibiotics, TPN, blood products, dialysis catheter, or plasmapheresis

tunneled catheter

what is a tunneled catheter used for?

long term venous access, repeated blood draw, chemo, antibiotics, TPN, blood products, dialysis, or plasmapheresis

brand names for tunneled catheter

hickman catheter, boviac catheter, quinton permacath

mobility restrictions for tunneled catheters

ensure that line is taped down to prevent dislodgment, avoid valsalva maneuvers and deep coughing

non-tunneled catheter that provides direct access to the vein with 2-3 lumens

dialysis catheters (temporary)

where are temporary dialysis catheters located?

jugular, femoral, subclavian veins

purpose of temporary dialysis catheters

short term dialysis or apheresis lines

mobility considerations for insertion of a temporary dialysis catheter

potential to kink, less flexible, and generally in place for less than 14 days, mobility supported

for which location point of a temporary dialysis catheter does literature not support mobility

femoral access

implantable venous access placed in superior vena cava that is sutured into tissue

ports

how to access the port reservoir?

needle

purpose of a port

used to provide IV medication access or fluid

therapy implication for ports

avoid direct pressure over port site

a ______ line does not automatically mean bed rest

femoral

when may mobility be appropriate for a femoral line?

depending on the device, patient stability, institutional policy, and team plan

peripheral IV provides...

meds and fluids

PICC/central line provides...

longer term central access

arterial line provides...

continuous BP and blood draws

dialysis catheter provides...

dialysis and access

nerve blocks

provide deliberate interruption of signals traveling along a nerve for pain relief

local anesthetic nerve block is a _____ term block, how long does it last?

short

usually lasting hours or days

what is injected into a nerve block onto or near a nerve?

anesthetic and corticosteroid

where does a foley catheter need to be?

below baldder

where does chest drainage need to be?

below chest

why should you not pull or drag tubes, drains, or bags?

tension matters

where should you avoid placing a gait belt?

directly over an ostomy, drains, or tubes

why does suction matter?

know whether a device must remain on suction or whether portable suction is required

when should full bags be emptied?

before mobility or when appropriate

soft rubber tubes inserted into an organ or near a cavity if fluid collection is anticipated

drains and tubes

what is attached to a distal end of a drain?

collection bag or dressing

what is used to attach the drain to the patient gown to prevent sliding?

safety clip or pin

tubes may be connected to ______ to create negative pressure

suction

what provides higher pressures (10-360 mmHg) that is more accurately regulated?

portable and wall vacuum systems

as the collection device fills, the pressure exerted by the vacuum _______

decreases

tube inserted into the bladder through the urethra and held in place by a balloon at the end filled with sterile water

foley catheter

purpose of a foley catheter

used to drain and collect urine from the patient's bladder

what is a foley catheter tube attached to?

drainage bag

where should the bag attached to the foley catheter be placed?

kept below bladder to prevent urine from backing up

which direction do you mobilize with a foley catheter?

towards the side the catheter is on

what should you do before mobilizing a patient with a foley catheter?

slack on tubing, anchor to a patient's thigh to prevent pulling

what can clipping the foley catheter to the patient during ambulation help prevent?

dragging or stepping on it

where can you hang the bag attached to the foley catheter during ambulation?

on a walker or IV pole as long as it's below the bladder

external catheter used for urinary incontinence in males

condom or texas catheter

how does a texas catheter work?

a condom attaches the penis to the rubber tubing that runs into a drain (removed during mobility)

used for females with urinary incontinence attached to suction tubing and cannister

purewick female external catheter

how long is the absorbent wick in a purewick designed for?

8-12 hours

why does a purewick catheter need to be removed during out of bed activity?

it will fall out

urinary catheter inserted directly into bladder through a surgical site

supra-pubic catheter

artificial opening on abdominal wall through which waste material basses out of the body from bowel or urinary tract

ostomy

stoma is formed by drawing the healthy end of the colon through an incision on the anterior abdominal wall and suturing it in place. the bad collects the waste

colostomy

are colostomies reversible or irreversible?

either depending on the circumstance

involves bringing the ileum to the abdominal surface

ileostomy