Boards

• Arterial Line

  thin catheter inserted into an artery and attached to an electronic monitoring system.
• Arterial Line - Function

  Used to measure arterial BP, obtain blood samples, or administer medications
• Arterial Line - Precautions

  No > 80 deg of hip flexion; if dislodge apply direct pressure
• Central Venous Pressure (CVP) Catheter

  Inserted into a large vein and often referred to as central line
• Central Line - Function

  Measure pressures in the right atrium or superior vena cava by means of an indwelling venous catheter and pressure manometer. Used to evaluate right ventricular friction, right atrial venous pressure, and circulating blood volume. Used to draw blood or infuse fluids
• Central Line - Precautions


  Avoid excessive movement to avoid disrupting line at the insertion site. Life-threatening emergency. Apply direct pressure and call for assistance. Risks include: infection, air embolism, or pneumothorax
• Hickman Line


  Catheter inserted through the cephalic or internal jugular vein and threaded into the superior vena cava to terminate in the right atrium
• Hickman Line - Function


  Used for long-term administration of substances into the venous system
• Hickman Line - Precautions


  Limited repeated ipsilateral shoulder movements. Limit aquatic therapy until exit site is fully healed. Avoid soft tissue mobilization and manual techniques over the access point.
• Intracranial Pressure (ICP) Catheter


  Types: Epidural, sensor, subarachnoid bolt, and intraventricular catheter
• Intracranial Pressure (ICP) Catheter - Function

  Used to measure the pressure exerted against the skull or pressure within the brain that can be increased by a closed head injury, cerebral hemorrhage, overproduction of CBS fluid, or a brain tumor
• Intracranial Pressure (ICP) Catheter - Precautions


  Notify nursing staff before starting any activity. Maintain head and neck in neutral position. Coughing, valsalva maneuvers, pain, and other noxious stimuli increase ICP. As well as, Trendelenburg position, lateral neck flexion, and excessive hip flexion
• Peripherally Inserted Central Catheter (PICC)


  Inserted into a vein in the upper extremity and terminating in the superior vena cava of the heart
• Peripherally Inserted Central Catheter (PICC) - Functions

  Used for long-term admin of meds and fluids
• Peripherally Inserted Central Catheter (PICC) - Precautions


  Avoid using BP cuff. ROM exercises of involved extremity are permitted. Use of axillary crutches is often contraindicated due to risk of occluding blood flow or causing a thrombus
• Swan-Ganz Catheter

  Flexible catheter inserted through a vein into the pulmonary artery
• Swan-Ganz Catheter - Function

  Used to provide continuous monitoring of pulmonary artery pressure
• Swan-Ganz Catheter - Precautions

  Disloding is LIFE-THREATENING. Limit excessive movements
• Nasal Cannula

  Capable of delivering six liters of oxygen per minute
• Patient Controlled Analgesia


  Electronically controlled pump that delivers a prescribed dosage of IV medication when the patient presses a button
• External Catheter


  Applied like a condom and held in place by a padded strap or tape to prevent accidental removal. The tube is connected to the condom fitted over the penis and drains urine into the collection bag
• External Catheter - Precautions


  Bag kept below pt's bladder. Use caution during transfers
• Foley Catheter


  Has a balloon attachment, which is filled with air or sterile water, must be deflated before the catheter can be removed
• Foley Catheter - Function

  Used to provide continuous drainage of urine from the bladder into a large collection bag hung nearby
• Foley Catheter - Precautions


  Bag kept below pt's bladder. Use caution during transfers
• Suprapubic Catheter


  Surgically inserted directly into the pt's bladder and attached to a collection bag. Performed under general anesthesia
• Suprapubic Catheter - Precautions


  Kept below level of pt's bladder. Keep insertion sites clean and dry and avoid placing gait or transfer belts over insertion sites
• Nasogastric (NG) tube


  Plastic tube inserted through a nostril that extends into the stomach
• Nasogastric (NG) tube - Function


  Used for short-term liquid feeding, medication admin, or to remove gas from the stomach
• Nasogastric (NG) tube - Precautions


  Position of tube can inhibit a cough or be irritating. Can be disconnected for mobility purposes. Positioned upright or semi-Fowler's for at least 30 minutes prior to supine activities
• Gastrostomy (G) tube


  A tube inserted through a small incision in the abdomen into the stomach. Aka percutaneous endoscopic gastrostomy (PEG) tube
• Gastrostomy (G) tube - Function


  Used for long-term feeding in the presence of difficulty with swallowing due to an antomic or neurologic disorder or to avoid risk of aspiration
• Gastrostomy (G) tube - Precautions


  Pt should not lie flat during feeding. Positioned upright or in a semi-Fowler's position during feedings
• Jejunostomy (J) tube


  A tube inserted through endoscopy into the jejunum via the abdominal wall. Aka percutaneous endoscopic jejunostomy (PEJ) tube
• Jejunostomy (J) tube - Function


  Used for long-term feeding for pts that are unable to receive food by mouth
• Jejunostomy (J) tube - Precautions


  Should not lie flat during feeding. Upright or semi-Fowler's position
• Neuromuscular Electrical Stimulation (NMES)


  facilitate skeletal muscle activity and return of controlled functional muscular activity or to maintain postural alignment until recovery occurs; electrodes placed parallel to allow current to travel direction of muscle fibers 
• Amplitude


  More forceful for general muscle strengthening
• Pulse duration


  Shorter for smaller muscles with greater amplitude, longer for larger muscles
• Frequency


  Tetanic contraction = 35-50 pulses per second, higher frequencies will not produce stronger contraction but rapid fatigue