1740 exam 4 tubes and lines
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Created by:
amberfirmin on November 17, 2011
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184 terms
Terms | Definitions |
|---|---|
 where is an ETT desired position | Tip 5cm-7cm above carina |
| where is the desired position for the tracheostomy tube tip | halfway between the stoma and carina |
| whee is the desired position for the central venous catheter | tip in superior vena cava |
| where is the desired position for the PICC line | tip in superior vena cava |
| where is the desired position for the swann-Ganz catheter? | tip in proximal right or left pulmonary artery |
| where is the desired position for the pleural drainage tube | anterosuperior for pheumothorax; posteroinferior for effusion |
| where is the desired position for a pacemaker | tip at apex of right ventricle; others in right atrium and or coronary sinus |
| where is the desired position for the AICD | one lead in superior vena cava the other in right ventricle |
| where is the desired position for an NG tube | at least 10 cm of tube into stomach |
| where is the desired position for a feeding tube | tip in the duodenum |
| what is an AICD? | automatic implantable cardioverter-defibrillator |
| the tube is inserted thru the mouth into the trachea as a means of establishing or opening an airway on patients | endotracheal tube |
| what does endotracheal tube placement at the trachea assure | that the ET tube will be located below the larynx and above the mainstem bronchi |
| what will happen if the distal tip enters a mianstem bronchus? | that lung will be well aerated but the contralateral lung will undergo atelectasis |
| what is atelectasis | shrunken or airless state of the lung or a portion of the lung |
| what are complications with endotracheal tube insertion? | 1. unrecognized esophageal intubation with resultant hypoxic brain injury 2. airway trauma, dental injury, bleeding, vocal cord/tracheal injury 3. vomiting/aspiration 4. right mainstream intubation with resultant atelectasis |
| this may be caused by the endotracheal tube entering the right main bronchus effectively blocking the left bronchial tree and causing collapse of part or the entire left lung | atelectasis |
| what is always taken after intubation to confirm the proper placement of the ET tube | a chest x-ray |
| what percentage of ET tubes require repositioning? | 20 percent |
| what happens if the ET tube is too low? | usually enters the right bronchus causing a collapse of the left lung |
| what happens if the Et tube is too high? | it may cause air to enter the stomach, and cause regurgitation of gastric contents causing possible aspiration pneumonia |
| what holds the ET tube in place and what is inflated to keep its position | tape or soft strap hold the tube in place and cuff is inflated to keep it in position |
| what are endotracheal tubes used for? | 1. to attach a ventilator if you are unable to breathe on your own 2. to keep your trachea open 3. to allow the staff to remove mucus from your lungs that you are unable to cough up yourself |
| a surgical opening/incision into the trachea | tracheostomy |
| what is the purpose of a tracheostomy | to provide an artificial airway during upper airway obstruction such as cancer of the larynx, burns in the mouth and throat, or laryngospasm |
| what position is the patient in for a tracheostomy | fowler's position |
| is a tracheostomy a sterile technique? | yes |
| an opening into the trachea created surgically to relieve respiratory distress caused by an obstruction | tracheostomy |
| is a tracheostomy temporary or permanent | both |
| what should the RT do prior to imaging a patient with a tracheostomy? | speak with the patients nurse for any special considerations |
| why must the Rt use special care when moving the patient with a tracheostomy? | to avoid dislodgment |
| a patient who cannot breathe spontaneously or whose respiration is inadequate to oxygenate the blood are candidates for this | mechanical ventilator |
| what should you ask for when doing a radiograph of a patient with a mechanical ventilator | ask for assistance to avoid dislodgment |
| what are the 2 types of mechanical ventialtors | negative pressure and positive pressure |
| this type of mechanical ventilator is seen most often in the home | negative pressure |
| this is the most commonly used type of mechanical ventilator | positive pressure |
| what are the 3 categories of a positive pressure ventilator | pressure cycled time cycled volume cycled |
| you do this when the patient has profuse vomiting and the patient is unable to move voluntarily | emergency suctioning |
| do this when audible rattling or gurgling sounds are coming from the patients throat | emergency suctioning |
| what is done when the patient shows signs of respiratory distress | emergency suctioning |
| is suctioning within the RT scope of practice? | no, but you may be asked to assist |
| what are the items necessary for suctioning? | 1. a wall outlet or a working portable suction machine 2. adapters for wall outlets 3. clean gloves 4. tubing |
| this tube is inserted through the nasopharynx into the stomach, the duodenum or the jejunum | nasogastric tube (ng tube) |
| what is an NG tube made of | polyurethane, silicone, rubber |
| what does the NG tube contain that allows its tip to visualized on images in fluoro | a radiopaque tip |
| what will be obtained to verify correct placement of the NG tube | a radiograph |
| what is the purpose of the NG tube? | 1. keep the stomach free of gastric contents and air 2. for healing purposes before or after surgery 3. for diagnostic examinations 4. administration of meds, feedings, treat intestinal obstruction and control bleeding |
| these are used before and after surgery to keep the gastric tract free of gastric contents and gas until healing takes place and also for diagnostic exams to administer food or medications, to treat intestinal obstructions, and to control bleeding | gastric tubes |
| where does a gastric tube enter and then where does it pass? | enters through the nasopharynx and then is passed into the stomach, duodenum or small intestine |
| how is the patient with a gastric tube | in fowler's position |
| how do you initially check the position on an NG or NE tube for correct placement? then what must you chest the correct position by doing? | a radiograph or fluoroscopy\ then by aspirating the tube with a syringe |
| what are patients with gastric tubes not allowed to do | eat or drink without specific orders from a physician |
| what are the gastric tubes connected to | a suction device on the wall or a portable device and the maximum suction pressure is about 25 mm Hg |
| what is the maximum suction pressure for a gastric tube | 25 mm Hg |
| what must you do to a gastric tube before transporting the patient? What do you use for double lumen and what is used for single lumen tubes | must clamp off the tube before transporting the patient ( use the plug only for double lumen tubes and can use clamping device or hemostats for single lumen tubes |
| what do you have to know to discontinue suction | the length of time that suction can be inerrupted |
| who removes and inserts NG tubes | registered nurse or physicians |
| removing the gastric secretions and gas from the stomach by suction | decompresson |
| what are the most common NG tubes that are used for decompresson | single lumen levin tube radiopaque double lumen - salem sump tube |
| one lumen serves as an air vent, and the other removes gastric contents | salem sump tube |
| when is a nasogastric tube used to prevent distention of the stomach and vomiting resulting from reduced stomach peristalsis from general anesthesia | post surgically to introduce liquids into the stomach |
| what are the types of nasogastric tubes | levin tube, salem-sump tube, nutriflex, moss, sengstaken-blakemore esophageal tube (S-B) |
| what are the most common type of NG tubes | levin and the sump |
| what are the 3 types of NE tubes | cantor harris miller-abbott |
| this type of NE tube relieves the obstruction in the small intestine | Cantor |
| This type of NE tube is for gastric and intestinal decompression | Harris |
| this type of NE tube is used for decompression | Miller-Abbott |
| this is inserted through the nasopharynx and into the stomach; peristalsis advances it into the small intestine | Nasoenteric Tubes (NE tubes) |
| what are the 2 functions of the NE tube | 1. decompresses the intestinal tract and relieves distention, removes gas and fluid as a result of bowel obstruction 2. radiographic examination of the small intestine |
| a double lumen tube, one for drainage and one for balloon. Used for decompression | Miller-Abbott tube |
| a single lumen tube for drainage; relieves obstructions in the small intestines | cantor tube |
| a single lumen tube for drainage; used for gastric and intestinal drainage | harris tube |
| what should you check before transporting a patient with an NE tube | check with the nurse to see if the suction is intermittent or continuous, make sure to place the correct suction pressure when transferring the patient and never clamp a double lumen NG tube because this may destroy the effect |
| what is the function of a small bore nasogastric tube | to provide nutrition to pts who are unable to feed themselves or who cannot maintain adequate oral nutrition (CA, sepsis, trauma, comatose) |
| what is an example of a small-bore nasogastric tube | hobbhoff |
| what is the function of a PEG tube | safer, faster, method to provide nutrition to pts. unable to swallow for a long period of time or who cannot tolerate NG tubes |
| What has to be done if Pt is given Barium through the PEG tube? | the patients head must be elevated during the procedure and at least 30 minutes afterward to prevent regurgitation and aspiration |
| a surgical creation of an opening into the stomach | gastrostomy |
| through the surgical opening for a gastrostomy a tube is placed from the inside of the stomach to where and why? | to the external abdominal wall for the purpose of feeding a patient who cannot tolerate oral food intake |
| what is done to the gastrostomy tube after the pt has been fed | the tube is closed off with a clamp or a plug in adapter to prevent leakage of gastric fluid or food |
| what may the patient be grieving about with a gastrostomy tube | owing the change in his or her body image because of a chronic illness |
| a catheter inserted through the thorax to remove fluid or air that has accumulated in the pleural space | chest tubes |
| what are chest tubes inserted to remove | fluid or air |
| what does a chest tube consist of | a tube placed within the pleural cavity and connected to a suction device through a drainage receptacle |
| what do chest tubes that are inserted through the anterior superior chest wall do | remove air which rises |
| what are chest tubes that are inserted through the posterior inferior chest wall do | drain fluid which collects at the base of the pleural space |
| when a lung is collapsed by either air or fluid a chest tube is inserted to treat what 3 conditions | phneumothorax homothorax pleural effusion |
| condition where air enters the pleural cavity causing the lung to collapse | phneumothorax |
| collection of blood or fluid in the pleural cavity that prevents expansion of the lungs | hemothorax |
| fluid build up in the pleural cavity | pleural effusion |
| how is a water sealed drainage system established? | by connecting the chest tube that originates in the pleural cavity to a clear tube that ends in a chamber containing sterile water or sterile normal saline solutions |
| why is the tube that is leading from the chest tube kept below water levels at all times | to maintain the seal |
| what are the function of a chest tube? | 1. promotes fluid drainage after chest or lung surgery 2. preventy air, blood, or fluid from entering the pleural space 3. used to re-expand/reinflate a lung after chest surgery (thoractomy or open heart surgery), chest trauma, and for pheumothorax and hemothorax |
| collapsed lung | atelecstasis |
| blood in the thorax | hemothorax |
| air in the thorax | pneumothorax |
| this collects any fluid leaving the lung on a chest tube | collection chamber |
| this prevents air from atmosphere from entering the cavity through the chest tube | water seal chamber |
| this contains water which regulated the amount of suction on a chest tube | suction control chamber |
| some chest tubes may have a fourth chamber what is this for? | a water seal, vented to the atmosphere to prevent potential pressure build up |
| why is the chest tube connected to a suction device or an underwater seal | to re-expand the lung quickly or to an underwater seal to create a vacuum that prevents any air or fluid from entering the pleural space |
| where do you want to keep the drainage device for a chest tube | below the level of the pt's chest |
| what can happen if the chest tube is dislodged or if the tube is disconnected from the bottle | air may enter the pleural space and may cause one or both lungs to collapse. Have pt. exhale as much as possible to cough |
| what type of patients are chest tubes used on | patients with hemothorax, pneumothorax, or any transudate or exudate within pleural space |
| an electromechanical device that regulates the heart rate by providing low levels of electrical stimulation to the heart muscle | pacemakers |
| what is the purpose of a pacemaker | to treat conduction defects |
| how is a pacemaker inserted? what is done after insertion? | done under fluoroscopy a chest radiography is done after insertion |
| what do you want to avoid after insertion of a pacemaker? For how long? What does this prevent? | avoid abducting or elevating that patients left arm for at least 24 hours after surgery to prevent dislodging the pacemaker and catheter |
| what are the types of tissue drainage? | T-Tube (common bile duct) Cecostomy (cecum) Cystostomy (urinary bladder) Nephrostomy (kidney) Hemovac Drain (wounds) Jackson-Pratt drain (wounds) Penrose Drain (wounds) Van Sonnenberg (abscesses) |
| these drains are placed at or near wound sites or operative sites when large amounts of drainage are expected | tissue drains |
| what are the 3 types of tissue drains that are placed when large amounts of drainage are expected | penrose drain jackson-pratt drain hemovac |
| what can easily happen to tissue drains while taking an x-ray | can easily be dislodged and cause infection |
| this provides fluids, electrolytes, parenteral nutrition, continuous medications and pain-controlled medications, blood products, chemotherapy | intravenous access lines (IVs) |
| what can cause loss of patency where solution does not infuse or blood clotting occurs in an IV? | improper IV height Patient movement |
| where should the IV fluid bag be in relationship to the height of the IV? What do you not want to do with the bag? | 18-24 inches above the IV site do not carry or lay down the bag; use an IV pole |
| electronically maintains set flow rate; operates by battery for transport | infusion pumps |
| how fast can the IV site occlude when the infusion pump is turned off or runs out of batteries? | 5 minutes or less-contact a nurse immediately for assistance |
| this signals problems with access lines, low batteries, infusion of too little liquid, or when the solution supply is low | an alarm |
| this also controls infusion rates, they should not be used to turn off an IV when using an access line for injecting medications and contrast media | Roller clamps |
| what are the 4 factors that affect IV flow rate | 1. solution height 2. size of IV needle or catheter 3. A knot or kink in tubing 4. position of the pt's extremity |
| when the needle is dislodged from vein and fluid flows into surrounding tissues | infiltration |
| what do you do if infiltration has occured? | stop IV have nurse remove the needle immediately to prevent phlebitis or infection elevate extremity to promote venous drainage and help decrease edema; circulation and reduce pain and edema |
| when contrast media causes surrounding tissues to dye and fall off | sloughing |
| these are used for pressure monitoring, administering meds, total parenteral nutrition, dialysis, blood and blood products, chemotherapy, obtaining blood specimens, and establishing long term venous access | central vascular catheters/access lines |
| where do the distal tips of the Central vascular line/access lines lie | in the vena cava near the right atrium |
| where are central vascular catheters/access lines inserted? | into subclavian, jugular, or femoral arteries for short term use and the superior vena cava at junction of right atrium for long term use |
| what are the 4 different things that a central venous catheter is used for? | 1. long term medication 2. frequent blood transfusions 3. hyperosmolar solutions 4. total parenteral nutrition |
| when may a patients receive partial or total nutrition by an intravenous route? | when a patient does not have an adequate nutritional intake and cannot tolerate nourishment by means of the GI tract |
| this type of short term non-tunneled external catheter is used to administer meds and to draw blood | PICC |
| a type of peripherally inserted central line, inserted into patients arm and advanced until tip lies in a central vein. (At the junction of the right atrium of the superior vena cava) | PIC |
| what is obtained to verify the correct placement of a PICC | a chest radiograph |
| this is used to monitor the pressure of the blood as it returns to the right atrium and aids in the evaluation of the right heart function | CVP |
| this type of long term tunneled catheter is used for long term parenteral nurtition | hickman |
| this type of long term tunneled catheter is used to administer meds or draw blood | groshong |
| a long term tunneled external catheter can be _____, _____, or _____ lumen and used for _____ | single double tripple dialysis |
| what are some examples of long term implanted infusion ports (venous access ports) | port-a-cath infusaport mediport lifeport |
| this is used for intermittent infusion of medications or chemotherapy, blood transfusions or sampling of blood from the superior vena cava; parenteral nutrition and dialysis | long term implanted infusion ports (venous access ports) |
| where are the long term implanted infusion ports usually put? What is the patient under? | implanted under the skin usually near the shoulder by a physician with the pt under local anesthesia in the OR |
| how can a venous access port be felt | under the patients skin |
| what is used to access the venous access ports self sealing infusion port | Huber needle |
| what has to be done to maintain patency of a venous access port | it must be heparinized |
| what are the 2 most common complications with a venous access port | infection clotting |
| how do you verify placement of a long term implanted infusion port (venous access port) | fluoroscopy or chest radiograph |
| what is a swan-ganz catheter? | a pulmonary artery flow-directed catheter |
| this is used to measure cardiac output; right heart pressures, and indirectly-left heart pressures, pulmonary artery pressure and pulmonary capillary wedge pressure | swan ganz catheter (balloon tipped catheter) |
| what is a swan-ganz catheter used to diagnose | right and left ventricular failure and monitor the effects of specific medication, stress, and exercise on heart function and also capable of measuring mixed venous oxygen saturation |
| where is the swan-ganz catheter usually inserted? | in the subclavian vein, internal or external jugular, or femoral vein and advanced into the right atrium, right ventricle and then the pulmonary artery |
| what are pulmonary arterial lines also known as? | swan-ganz catheters flow directed catheters (FDC) |
| what is at the distal end of the pulmonary arterial lines to monitor pulmonary arterial pressures | a small electrode at the distal end |
| what are pulmonary arterial lines used to estimate | left ventricular end-diastolic pressure |
| this provides intermittent venous access for the administration of medications or fluids or for drawing blood | saline/heparin locks |
| what type of patients are saline/heparin locks used on | patients who do not require continuous IV fluid therapy |
| what are the pluses of saline/heparin locks? | cost effective reduces the number of needle sticks used to inject CM |
| what must a heparin/saline lock be flushed with | heparin or normal saline |
| where is the endotracheal tube? | C7 to T2 |
| where is the umbilical artery catheter | L3-4 |
| where is the umbilical vein catheter? | IVC near RA |
| this is used to introduce drugs and fluids into the body | umbilical vein catheter |
| this is used to monitor blood pressure and obtain blood samples | Umbilical artery catheter |
| used to provide for drainage, irrigation, or instillation of solutions, to assist incontinent pts with urinary retention, to provide for bladder evaluation, and to keep the bladder empty while tissues heal from surgical procedures | urinary catheter |
| what is the hazard of a urinary infection? What does it require | infection sterile technique |
| what are the 3 different types of urinary catheters? | retention/indwelling (foley) straight/plain french Alcock catheter |
| this type of urinary catheter is used for continuous drainage. It has a double lumen with inflatable balloon at one end | retention/indwelling (foley) |
| this type of urinary catheter has three lumens for the passage for irrigation solution and used for continuous bladder irrigation | alcock catheter |
| what are the 2 types of rad exams that require insertion and removal of a urinary catheter? | cystogram VCUG |
| what is the equipment needed for the insertion of a urinary catheter | prepared catheter tray antiseptic solution for cleansing area cotton balls for cleaning lubricant syringe specimen bottle emesis basin for drainage of urine closed system drainage set for foley sterile drapes sterile gloves sterile forceps drape |
| the antiseptic solution for cleaning the are for the insertion of a catheter is for cleaning the males _____ and the females ______ | penis perineum |
| what is required for the removal of a urinary catheter? | orders |
| what are the materials needed for the removal of a urinary catheter? | scissors/syring to deflate balloon clean gloves several paper towels disposable bag emesis basis |
| what is the procedure for removing a urinary catheter? | deflate the balloon by removing water from valve, allow the water to drain into the basin, remove the catheter |
| when transporting patients with a urinary catheter where should you keep the drainage bag | below the level of the bladder to maintain gravity flow and prevent infection-contamination due to backflow of urine |
| how long can you keep a urinary catheter clamped off | never leave it clamped off for more than an hour |
| what are 2 alternative methods of urinary drainage? | suprapubic catheter (cystocatheter) Condom (texas) catheter |
| where is a suprapubic catherter (cystocatheter) placed | directly into the bladder by means of abdominal incision |
| what is the suprapubic catheter attached to | a closed urinary drainage system |
| what is a suprapubic catheter secured with? | sutures, tape, or body seal system |
| what is a suprapubic catheter used to divert | the flow of urine from urethral route after gynecological surgery, urethral injuries, prostatic obstructions, chronic incontinence, loss of bladder control |
| a suprapubic catheter is a long term method of drainage and what are the 2 perks | reduces the risk of infection facilitate normal urination after surgery |
| what is the 3 important things for caring for a suprapubic catheter | avoid tension keep drainage bag below bladder level must be emptied before moving the patient |
| this is an externally applied drainage device | condom (texas) catheter |
| when are condom (texas) catheters used on male patients? | when they are prone to UT infections, incontinent, comatose, their bladder continues to empty spontaneously |
| what do you want to avoid when dealing with a condom (texas) catheter? | avoid dislodging catheter from drainage tube or twisting condom and causing pain or skin irritation |
| when the heart position is reversed | dextracardia |
| when all the organs are reversed | situs inversus |
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