PT 539: Advanced Life Support Devices, Lines, and Tubes in Acute Care

what is room air?

the air in the room

about 21% O2

78% nitrogen

what is a low flow nasal cannula?

a nasal oxygen delivery system with two prongs placed in the nostrils

what is the flow rate and approximate FiO2 of a low flow nasal cannula?

flow rate = 1-6 L/min

Flow Rate

Approximate FiO2

1 L/min 20%

2 L/min 24%

3 L/min 28%

4 L/min 32%

5 L/min 36%

6 L/min 40%

how do you monitor a low flow nasal cannula?

Pulse oximetry (SpO2)

Respiratory rate

Work of breathing

ABGs if needed

what are the precautions with using a low flow nasal cannula?

Dry nasal mucosa

Skin breakdown behind ears

Caution in COPD with excessive oxygen

what are the complications with using a low flow nasal cannula if mismanged?

Hypoxemia

Nasal irritation/epistaxis

Oxygen toxicity with prolonged excessive use

how do low flow nasal cannulas effect PT?

Usually portable and safe for ambulation

PT monitors SpO2 during activity

Can be temporarily disconnected only if medically approved

what is a simple face mask?

A mask covering the nose and mouth delivering moderate oxygen concentrations.

why would a pt need a simple face mask?

Moderate oxygen requirement

Mouth breathers

Short-term oxygen therapy

what is the flow rate and the FiO2 of a simple face mask?

6-12 L/min

FiO2 = 35-60%

what does a simple face mask monitor?

SpO2

Respiratory effort

Mask fit

what are precautions when using a simple face mask?

Minimum 5 L/min required to prevent CO2 rebreathing

Aspiration risk if vomiting

what are the complications with using a simple face mask?

CO2 retention

Skin irritation

Claustrophobia

what are the effects of PT on a simple face mask?

Portable during mobility

Monitor oxygen tubing and tolerance

what is a venturi face mask?

A high-precision oxygen mask delivering a controlled FiO2.

flow based on different color adapter chosen

why would a pt need a venturi face mask?

Precise oxygen delivery

COPD patients sensitive to oxygen levels

what is the flow rate and FiO2 of venturi mask?

Blue 24%

Yellow 28%

White 31%

Green 35%

Pink 40%

Orange 50%

what do venturi face masks monitor?

SpO2

ABGs

Respiratory status

what are the precautions when using a venturi face mask?

Ensure correct adapter

Do not obstruct air entrainment ports

what are the complications when using a venturi face mask?

Hypoxia if incorrect setup

Inaccurate oxygen delivery

what is the effect on PT of a venturi face mask?

Can ambulate if portable oxygen available

Monitor tubing carefully

what is a non-rebreather mask?

A face mask with reservoir bag delivering high oxygen concentrations.

why would a pt need a non-rebreather mask?

Severe hypoxemia

Trauma

Acute respiratory distress

what is the flow rate and FiO2 of a non-rebreather mask?

10-15 L/min

100% FiO2

what does a non-rebreather mask monitor?

SpO2

Reservoir bag inflation

Respiratory distress

what are the precautions when using a non-rebreather mask?

Bag should remain partially inflated

Tight seal required

what are the complications when using a non-rebreather mask?

Suffocation risk if oxygen disconnected

Skin breakdown

what is the effect on PT when using a non-rebreather mask?

Often limits aggressive mobility

Portable oxygen tank needed

what is a high-flow nasal cannula?

Heated, humidified high-flow oxygen delivery system.

why would a pt need a high flow nasal cannula?

Severe respiratory distress

COVID-19

Pneumonia

Post-extubation support

what is the flow rate and FiO2 of a high flow nasal cannula?

up to 60L/min

30-100% of FiO2

what does a high flow nasal cannula monitor?

SpO2

Respiratory rate

Work of breathing

Temperature/humidification settings

what are the precautions when using a high flow nasal cannula monitor?

Ensure proper humidification

Monitor for deterioration

what are the complications when using a high flow nasal cannula monitor?

Delayed intubation

Nasal irritation

what is the effect on the PT when using a high flow nasal cannula?

Mobility possible with portable equipment

Requires close monitoring during exertion

what is an oxygen humidifier?

Humidifies oxygen to reduce airway drying.

why would a pt need an oxygen humidifier?

Long-term oxygen use

High oxygen flow rates

what are the clinical uses of an oxygen humidifier?

Prevents mucosal drying

Improves secretion clearance

what does an oxygen humidifier monitor?

Water levels

Sterility

what are the precautions when using an oxygen humidifier?

Infection control

Use sterile water

what are the complications of using an oxygen humidifier?

Contamination/infection

what is a CPAP?

increasing atmospheric pressure at the pt's mouth

increases partial pressure and increases total pressure

continuous pressure

what is a BiPAP?

increases pressure when breathing in

decreases pressure when breathing out

two different levels

why would a pt need a CPAP/BiPAP?

Sleep apnea

COPD exacerbation

Pulmonary edema

what does a CPAP and BiPAP monitor?

SpO2

Respiratory effort

ABGs

Mask seal

what are the precautions when using a CPAP/BiPAP?

Aspiration risk

Claustrophobia

Facial skin breakdown

what are the complications when using a CPAP/BiPAP?

Gastric distention

Respiratory failure

Pneumothorax

what are the effects of PT with using a CPAP and BiPAP?

Mobility may be limited

Often removed temporarily for therapy by respiratory therapy or nursing

what is an endotracheal tube?

Tube inserted into trachea for airway protection and ventilation.

why would a pt need an ET tube?

Respiratory failure

Surgery

Airway protection

what are the clinical uses for ET tubes?

Mechanical ventilation

Airway suctioning

what do ET tubes monitor?

Tube depth markings

Breath sounds

End-tidal CO2

Ventilator parameters

what are the precautions when using an ET tube?

Secure tube

Avoid accidental extubation

what are the complications when using an ET tube?

Hypoxia

Aspiration

Tracheal injury

what effects does PT have with an ET tube?

PT possible in ICU

Requires coordinated management with respiratory therapy and nursing

what is a mechanical ventilator?

Machine providing assisted or full breathing support.

why would a pt need a mechanical ventilator?

Respiratory failure

Surgery recovery

Neuromuscular weakness

what are the clinical uses of a mechanical ventilator?

Assist/control ventilation

Pressure support

what do mechanical ventilators monitor?

Tidal volume

Respiratory rate

FiO2

PEEP

ABGs

what are precautions when using a mechanical ventilator?

Alarm monitoring

Avoid disconnections

what are complications when using a mechanical ventilator?

Ventilator-associated pneumonia

Barotrauma

Pneumothorax

what are the effects on PT with using a mechanical ventilator?

Early mobilization common

Requires multidisciplinary coordination

must avoid neck movements, especially during flexion and extension

what is a chest tube?

Tube draining air/fluid from pleural space.

why would a pt need a chest tube?

Pneumothorax

Hemothorax

Pleural effusion

what does a chest tube monitor?

Drainage amount/color

Air leaks

Suction status

what are the precautions when using a chest tube?

Keep below chest level

Avoid kinks

what are the complications when using a chest tube?

Tension pneumothorax

Infection

what is the effect on PT with using a chest tube?

Mobility encouraged

Keep drainage system upright

what are IV pumps and IV lines?

Devices and catheters delivering fluids/medications intravenously.

why would a pt need an IV?

Fluids

Medications

Antibiotics

what do IVs monitor?

Infusion rate

Site assessment

Signs of infiltration

what are the precautions when using IV pumps?

Prevent pulling lines

Maintain sterility

what are the complication when using IV pumps?

Infection

Infiltration

Air embolism

what is the effect on PT with using IV pumps?

Portable with IV pole

PT manages tubing during mobility

what is a PICC line?

Long peripheral catheter terminating in central circulation.

why would a pt need a PICC line?

Long-term IV therapy

Chemotherapy

TPN

what do PICC lines monitor?

Dressing integrity

Infection signs

Catheter patency

what are the precautions when using a PICC line?

Avoid BP on arm

Sterile care required

what are the complications when using a PICC line?

Infection

Thrombosis

Embolism

what are the effects on PT with a PICC line?

Usually safe for mobility

Avoid excessive traction

what is a central line?

Central venous catheter inserted into major vein

- subclavian

- external jugular

- femoral

why would a pt need a central line?

Central venous pressure monitoring

Vasopressors

Rapid fluid administration

what does a central line monitor?

CVP

Site condition

Blood return

what are the precautions when using a central line?

Infection prevention

Air embolism prevention

what are the complications when using a central line?

Pneumothorax

Sepsis

what is an arterial line?

Catheter placed in artery for continuous BP monitoring.

why would a arterial line be needed?

Frequent ABGs

Hemodynamic monitoring

what does an arterial line monitor?

Waveform quality

Blood pressure

Limb perfusion

what are the precautions when using an arterial line?

Avoid dislodgement

Maintain pressure bag

what are the complications when using an arterial line?

Bleeding

Ischemia

what effect on PT does an arterial line have?

need to be very careful with

what is a swan-ganz catheter?

Pulmonary artery catheter for advanced hemodynamic monitoring.

directly measures the pumping force of the heart

enters arm and exits from pulmonary artery

why would a swan-ganz catheter be needed?

Cardiac output monitoring

Severe cardiac illness

used for pulmonary hypertension due to heart failure

what does a swan-ganz catheter monitor?

Cardiac output

Pulmonary artery pressures

Mixed venous oxygen saturation

what are the precautions when using a swan-ganz catheter?

Highly specialized line

Avoid migration

what are the complications when using a swan-ganz catheter?

Arrhythmias

Pulmonary artery rupture

what is a foley catheter?

Indwelling urinary catheter.

when is a foley catheter needed?

Urinary retention

Accurate output measurement

what is a foley catheter monitoring?

Urine output/color

Catheter patency

what are the precautions with foley catheters?

Keep bag below bladder