lines and tubes

IV pump purpose

used to deliver fluids and medications, for dehydration and meds like antibiotics, pain meds, cardiac meds, and anticoagulants

IV pump location

most commonly in UE, can also be in foot, neck and ankle, location changes at least every 7 days

IV pump mobility considerations

ensure site is secure and slack in the tubing, if with pole, ensure plugged back into wall at the end of session

arterial line purpose

provides continuous monitoring of systolic, diastolic, and mean arterial pressure. it allows easy access for blood draws (especially ABGs)

arterial line location

radial artery(most common), femoral artery, brachial artery or dorsalis pedis, dependent relative to transducer, ensure transducer is at heart level

transducer too low effect

BP read high

tranducer is too high effect

BP reads low

mobility with atrial line

ensure line is not kinked at entry site, if line becomes dislodged, apply firm direct pressure to the site

central line purpose

monitors central venous pressure and allows administration of meds/fluids/blood products/TPN, can also be used to obtain venous blood, long term

central line location

internal/external jugular vein, subclavian vein, antecubital vein, femoral vein

types of central lines

• Tunneled Catheters (Long Term)- Hickman

• Temporary Central Lines (Non-Tunneled Catheters)

• Port/Permacath

• Peripherally Inserted Central Line (PICC)

• Temporary Dialysis Catheters

• Pulmonary Artery Catheters- Swan Ganz(critical care)

PICC line purpose

provides a form of IV access that can be used for a prolonged period of time-chemo, TPN, or antibiotics

PICC line location

most commonly in upper arm

Mobility with PICC line

avoid lifting over 10 lbs with involved UE

tunnel catheters purpose

enters central vein, long term venous access for repeated blood draws, chemo, antibiotics, TPN, or blood products, can also be used for dialysis or plasmapheresis

tunneled catheters location

tunneled under the skin usually in peripheral chest

tunneled catheters mobility

ensure the line is taped down to prevent dislodgment, avoid valsalva/deep coughing

dialysis catherters purpose

non-tunneled catheter that provides direct access to the vein, used for short term dialysis

Dialysis catherters location

often at jugular, femoral, or subclavian veins

mobility with dialysis catehrters

if femoral: less flexible, could kink, literature supports mobility(except CRRT w/ femoral access)

ports purpose

used to provide IV medication access or fluids

ports location

placed in superior vena cava and sutured to tissue

mobility with ports

avoid direct pressure over site

gravity matters

foley→below bladder

chest drainage→below chest

tension matters

no pulling or dragging

location matters

dont put gait belt directly over ostomy/drain/tubes

suction matters

know whether device must remain on suction and whether portable suction is required

full bags matter

empty/manage before mobility when appropriate

foley catheter purpose

used to drain and collect urine from patients bladder

foley catherter location

inserted into bladder through urethra, held in place by a balloon

mobility with foley catheter

make sure its on same side, ensure enough slack, may have clip to prevent dragging, can hang bag on talker or iv pole(ensure lower than bladder)

texas catheter purpose

used of urinary incontience in males

texas catheter location

condom attaches to the penis and tube runs to “leg bag”

mobility with texas catherter

often comes off during

purewick external catheter purpose

used for female urinary incontinence

location of purewick external catheter

between legs/labia attached to suction tubing or cannister

mobility with purewick external catheter

usually needs to be removed for out of bed activity

supra-pubic catherters

urinary catherter inserted directly into the bladder via a surgical site

Ostomy bag purpose

waste material passes out of the body from the bowels or urinary tract

colostomy loaction

healthy end of colon

ileostomy location

ileum(brought to abdominal surface)

mobility with ostomy bag

be careful when donning a gait belt, dont apply excessive pressure, ensure not too full before mobilizing

rectal tube location

sealed to a rectum

rectal tube purpose

collect feces

mobility with rectal tube

avoid tension on catheter, avoid shearing forces to prevent dislodging of tube

PEG

percutaneous endoscopic gastrostomy tube

G tube

gastrostomy tube

J tube

jejunostomy tube

PEG/G/J tube purpose

provides long term nutrition to patients who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation/medications

Nasogastric tube

used for short or medium term nutritional support and for aspiration of stomach contents for decompression of intestinal obstruction

Dobhoff tube

used only for meds and nutrition

Drains

jackson pratt(surgical buld), hemovac, penrose

nephrostomy tubes

tube inserted into the kidney that shunts urine through a catheter into a bag

mobility for nephrostomy tube

be sure to not dislodge during functional mobility

cholecystostomy tube/drain

inserted into gallbladder, fluid will drain into a collection bag, temporary or permeanently

wound vac

applies negative pressure to the wound, connected to vacuum pump, removes edema fluid, greater blood flow → greater cell proliferation → promotes healing

chest tube purpose

drains blood post cardiothoracic surgery, pneumothorax, hemothroax, pleural effusions

chest tube to pleurovacs

collects fluids, may be more than one chest tube, underwater seal drainage, collection chamber for contents pulled from chest, suction chamber

suction

actively suctions air and/or fluid from chest cavity

water-seal

passively allows fliud and air to escape chest cavity by gravity

water-seal chamber

acts as a one way valve allowing air/fluid to escape by gravity by not to re-enter the chest cavity

clamped chest tube

simulates CT removal

if you ever see a patient s/p pneumonectomy

you should NEVER see a patient on suction

pneumothorax

used to create negative pressure in chest cavity and allows for the reexpansion of the collapsed lung

air leaks

leakage of air across the alveolar surface of the visceral plurea

prolonged air leaks

discharge with heimlich valve(one way valve must be able to stay on water seal), blood patch via pleurodesism endobronchial valves, return to OR for repain

5 rules of chest tubes

1. needs to be below the chest, gravity dependant

2. dont pull or kink tubing

3. know weather pt is on suction or water seal

4. dont independently clap the chest tube

5. if you are unsure whether suction can be interrupted for mobility ASK

external pacemakers

used for diagnosis and treatment of dysryhmias in acute p/o period after cardiac surery

how are external pace makers placed

surgically, temp, wires are placed on the right atrium and/or right ventricle after open heart surgery and may or may not bd attached to external pacemaker

external pacemakers can be set up to

pace or sense(back up mode)

mobility with external pacemakers

check for external pacemaker, ensure wires and pacemaker are secure prior to moving, complete heart block

telemetry

portable ECG kinda

sequential compression devices

on legs usually when patient is bedbound to keep nlood flowing, used for DVT prophylaxis

nasal cannula

most common low-flow device, usually 1-6 L/M, make sure to have enough tubing and enough portable O2

simple mask

covers nose and mouth, usually 5-10 L/M, make sure the tank isnt running low

venturi mask

mask and colored adapter, delivers a specified FiO2, make sure to match prescribed set-up/adaptor

non-rebreather mask

mask and reservoir bag, high O2 concentrations usually above 10 L/M, make aure resvoir is inflated and enough tank supply

HFNC/optiflow

large-bore heated humidifier system, high-flow, indepenantly set flow and FiO2, make sure the system can travel and check mobility plan

trach collar

O2/humidifier over tracheostomy, FiO2 prescribed, make sure the portable setup is understood