Aseptic and Non-aseptic

This is known as an area free of microorganisms

Sterile field

How is a sterile field obtained?

by placing a sterile drape or by using a sterile pack or tray

When should a sterile field be created?

as close to the time of use as possible

T/F: the sleeves on a gown are considered sterile

True

T/F: anything below the level of the waist is considered unsterile

True

What qualifications must a pack have to be considered sterile?

• clean and dry

• unopened

• has not expired

What is the purpose of a surgical scrub?

to remove debris and microorganisms from the hands, nails, and forearms

T/F: the back of a gown is sterile

False, it is unsterile

How should 2 sterile people pass each other

back-to-back

T/F: before gloves are touched, they are considered sterile

true

Where must sterile gloves be kept?

above the waist

______ is the insertion of a tube into the bladder using aseptic technique

urinary catheterization

What are the 2 types of urinary catheters and explain how they differ?

• Foley - remains in place with a retention balloon

• Straight - in and out since it does not remain in place

What is urinary catheterization used for?

• empty the bladder

• relieve urine retention

• introduce drugs or contrast

• measure urine output

• relieve incontinence

Where should a urine collection bag be kept?

below the level of the bladder

____ is defined as a break in the continuity of the visceral pleura

pneumothorax

What 3 things can cause a pneumothorax

• ruptured bleb

• fractured rib

• central line insertion error

A ___ pneumothorax is caused by a ruptured bleb and may absorb naturally

simple or spontaneous

A ____ pneumothorax is caused by complications of parenchymal disease or by central venous catheter insertion

secondary

Where do hemothorax and pleural effusion typically accumulate in the lungs and what does this mean for chest tubes?

near the base which means chest tubes are lower

Where does a pneumothorax typically accumulate in the lungs and what does this mean for chest tubes?

higher since air rises which means the chest tube is higher

What is a chest tube connected to?

a water seal drainage unit that contains sterile water or saline

Where does the end of a chest tube have to remain?

below the water level to maintain a seal

What does a water seal do?

prevents air from reentering the chest tube

T/F: you should clamp chest tubes

No, they should never be clamped

If the water seal chamber is bubbling, what should you do?

call the nurse

What were central venous lines originally used for?

• chemotherapy

• parenteral nutrition

Now, what are central venous lines used for?

• drug administration

• managing fluid volume

• blood transfusions

• monitoring cardiac pressures

Where should a central venous line be inserted to?

SVC 2-3cm above the right artrial junction

What does PICC stand for?

Peripherally Inserted Central Catheters

Where are PICC lines inserted?

into the subclavian vein in the antecubital area

____ is also known as a pulmonary arterial line

swanz-ganz catheter

Which type of catheter has a small electrode on the end to monitor pulmonary arterial pressure

swanz-ganz

What is the only catheter line that should be inserted past the SVC?

Swanz-ganz

What type of patients would need implanted ports?

patients with long-term illnesses that require frequent medications or transfusions

Where are implanted ports put?

in the subcutaneous tissue in the chest

How is an implanted port accessed?

by using a Huber needle

__ of ports are inserted incorrectly

1/3rd

What are some major complications of ports being inserted incorrectly?

pneumothorax and hemothorax

____ are electromechanical devices used to regulate the patients heart rate

pacemakers

Which type of patients typically use a pacemaker?

patients with brachycardia

A ____ is a surgical opening in the trachea to provide an airway

tracheostomy

T/F: tracheostomy suction should only be performed by a trained professional

true

Where are tissue drains placed?

at or near would sites when large amounts of drainage are expected

What are the 3 most common tissue drains?

• Hemovac

• Jackson-Pratt

• Penrose

A ____ drain is used to pull excess fluid by constant suction

jackson-pratt

What type of tissue drain is an open drain?

penrose

A ____ drain is a surgical device placed in a wound

penrose

Where is a T-tube placed?

common bile duct

Where is a cecostomy tube placed?

in the cecum

Where is a nephrostomy tube placed?

in the kidney

____ tubes are plastic or rubber and are inserted through the nasopharynx into the stomach

NG tubes

What is the purpose of an NG tube?

• decompress or remove fluid

• feeding/nutrition

• diagnostic purposes

Who can insert an NG tube?

physician or nurse

What are the 2 types of NG tubes and what lumen are they?

Levin: single-lumen

Salen-sump: double-lumen

How can HG tube placement be confirmed?

by x-ray or fluro

T/F: after insertion of an NG tube, the patient should not eat or drink

true

Which type of lumen can be clamped, single or double?

single can be clamped

Who uses urinals?

males who are spine, on their side, or in Fowlers

Who uses bedpans?

non-ambulatory females and males

T/F: when using urinals and bedpans, try to protect the patients modesty as much as possile

True

A cleansing enema is used to promote ____

defecation

When is a cleansing enema used?

prior to a barium enema

T/F: for a barium enema to demonstrate a pathological condition, the colon must be clear and free of decal matter

True

What are the 3 types of cleansing enemas?

• tap water (hypotonic)

• hypertonic

• saline

Which type of cleaning enema is safest since it is the same osmolarity as the interstitial spaces?

saline

___ enema promotes peristalsis and defecation but produces mild irritation

soapsuds

___ enema permits administration of a small volume to be absorbed by the stool and should be retained for one hour if possible

oil retention

What are some ways to prep the bowel for an enema?

low-residue diet, laxatives, and overhydration

Drinking only clear liquids for 24 hours before a barium enema is knonw as

overhydration

____ are used to diagnose pathologic conditions of the large bowel or lower GI tract

barium enemas

T/F: barium absorbs fluid from the bowels so dehydration is possible

true

T/F: after a barium enema, the patients stool is often white

true

T/F: after a barium enema, the patient should increase their fluid intake and fiber

true

A ____ is the formation of a mouth from the bowel to the outside of the body

colostomy

When are permanent colostomies used?

when a portion of the bowel is removed

When are temporary colostomies used?

to heal or rest a diseased portion of the bowel

A ___ is a procedure used to evaluate the large or small bowel that has been connected to the skin with a ostomy

loopogram

What may be needed for patients who cannot independently use a restroom?

urinals and bedpans

What is a stoma?

an artificial opening created between the intestines and the outside of the body

What is a possible complication of a barium enema?

leakage if there is a break in the mucosa

Which type of cleansing enema should not be reguraly repeated due to toxicity or overload

tap water

Is a salem-sump NG tube radiopaque or radiolucent

radiopaque

List in order how an NG tube is inserted

Nose → nasopharynx → esophagus → stomach

Which type of line has a peripheral insertion site but a central destination?

PICC

Broviac, Hickman, Leonard, and Groshong are all examples of…..

central venous catheters or lines

Which intercostal space is a chest tube placed for a pneumothorax?

2nd or 3rd

Which intercostal space is a chest tube placed for a hemothorax?

5th or 6th

A central venous port is typically inserted into which vein?

subclavian/jugular