Invasive Lines & Devices — Study Charts

Objectives

Goal	Focus
Awareness	Understand what patients experience during insertion, use, and removal of invasive devices
Safety	Recognize complications & patient safety issues (especially post-transfer to med-surg)
Education	Teach patients what to expect & how to stay safe

Arterial Line

Section	Key Points	ATI/NCLEX Tips
Indications	Continuous BP monitoring, frequent ABG draws	Arterial line ≠ med administration
Pre-insertion	Allen test (radial site)	If poor collateral flow → do not insert
Positioning	Align thumb metacarpal with radius; support with kerlix	Keep wrist immobilized
Post-insertion	Aspirates blood easily, check distal perfusion, site for bleeding/hematoma, dressing intact	Distal perfusion = fingers warm, pink, good cap refill
Use & Management	Transducer level at phlebostatic axis, flush with heparinized saline, no meds, dressing q7 days	Level & zero transducer to prevent false readings
Complications	Poor flow, arterial spasm, thromboembolism, hematoma	Loss of pulse → notify provider
Removal	Slide catheter out, apply firm pressure ×5 min (longer if anticoagulated), pressure dressing 24 hrs	Always check perfusion after removal

Central Venous Catheter (CVC)

Section	Key Points	ATI/NCLEX Tips
Indications	Meds, resuscitation, TPN, pressure monitoring	CVC = central access, not arterial
Insertion	Follow bundle (sterile barrier), sedation, Seldinger technique	Sterility = infection prevention
Post-insertion	Aspirate/flush ports, verify blood return, auscultate lungs (pneumo/hemothorax risk)	Absent breath sounds or back pain = pneumothorax
Use & Management	Dedicated port for TPN, blood products, thrombolytic therapy for occlusion, push–pause flush, dressing weekly/PRN	No blood return = check placement, thrombolytics
Removal	Patient Valsalva, remove, apply pressure	Risk of air embolism if not done correctly

Intraosseous (IO) Line

Section	Key Points	ATI/NCLEX Tips
Indications	Emergency vascular access, cardiac arrest, trauma	Quick access when IV impossible
Sites	Long bones (tibia, humerus)	Marrow vasculature = stable even in shock
Check Placement	Aspirate marrow	Same as CVC confirmation
Contraindications	Local infection, fracture near site	Don’t insert through broken bone
Use	Bolus meds (with flush), blood, IV fluids	Adenosine less effective in IO route

Endotracheal Intubation

Section	Key Points	ATI/NCLEX Tips
Indications	Airway protection, resp failure, ↓ LOC	“Airway first” in emergencies
Insertion	Sniffing position, pre-oxygenation, sedation + paralytic, Sellick maneuver, monitor SpO₂	Always have suction & ambu bag ready
Post-insertion	Confirm with breath sounds, ETCO₂, CXR, lip depth, monitor VS, ABG in 20–30 min	Right mainstem intubation = absent left breath sounds
Management	Secure tube, sedation/pain control, daily sedation holiday	Sedation holiday = neuro check
Extubation	Stop paralytic, reduce sedation, suction, high Fowler’s, monitor for stridor (give epi neb), hoarseness common	Stridor = EMERGENCY (airway closing)

Chest Tubes

Section	Key Points	ATI/NCLEX Tips
Indications	Remove air, fluid, or both	Air = pneumothorax, fluid = hemo/empyema
Insertion	Sedation/local anesthesia, sterile technique	Always sterile gown for provider
Post-insertion	Monitor breath sounds, drainage, CXR	Document output, bubbling, dressing
Collection Device	3 chambers: suction, water seal, drainage	Bubbling: Pneumothorax = yes, Hemothorax = no
Transport	Collection system to gravity or Heimlich valve, never clamp	Clamping = risk of tension pneumo

Dialysis/Pheresis Catheter

Section	Key Points	ATI/NCLEX Tips
Indications	Bedside RRT, plasmapheresis	ONLY for dialysis/plasmapheresis
Insertion	Like CVC	Sterile bundle
Post-insertion	Assess like CVC, ports clamped/packed with high-dose heparin	NEVER use for routine meds or fluids

Cardioversion vs. Defibrillation

Feature	Cardioversion	Defibrillation
Use	Shockable rhythm WITH pulse & symptoms (AFib, SVT, VT w/pulse)	Pulseless VT/VF
Timing	Synchronized with R-wave	Unsynchronized
Sedation	Yes (painful)	No (patient unresponsive)
Safety	“Clear” before shock	Same safety

🧠 Memory Tips

Arterial line = “ART = ABGs, Read BP, but NO meds.”
CVC = “Central = Central meds + nutrition.”
IO = “In the bone, when no tone.” (for shock/cardiac arrest)
ET tube = “Check chest, check CO₂, check CXR.”
Chest tube bubbling → “Air = bubbles, Blood = no bubbles.”
Extubation stridor = EMERGENCY.
Cardioversion vs Defib: “Cardio = Conscious; Defib = Dead.”