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AI'I'ENDIX III-A: ,"IEDICAL-SURGICAL EQUIPMENT IN THE ACUTE CARE SETTING

781

Figure IlI-A.S. Nonrebreather mask. (Maersk Medical, Respiratory and

Anesthesia Product Catalog, McAllen, TX.)

flowing as indicated, and that the cannula or mask is properly

positioned .

•

The 0, system may need added humidification, as supplemental 0, may be drying to the nasal mucosa and lead to nosebleeds (epistaxis); however, added humidification is contraindi-cated in

several systems, as indicated in Table III-A.] and Table III-A.2.

•

Provide extra lengths of 0, tubing if functional mobility will

occur farther than 5 or 6 ft from the bedside (i.e., the wall 02

source).

782 ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Aerosol

Hood

Figure [I]-A.6. Air e"trainment mask or venturi mask. (Maersk Medical, Resptratory and Anesthesia Product Catalog, McAllen, TX.)

•

Ensure that portable 02 tanks are rurned on and have sufficient

levels of 02 before use. Have back-up tanks available.

•

Observe masks for the accumulation of mucus or clogging.

Clear or change the cannula or mask if needed.

•

Monitor the patient's skin for potential breakdown due to pressure from the cannula or mask. Provide appropriate padding without interfering with the fit of the cannula or mask.

•

Document the type and amount of supplemental 02 used during

physical therapy intetvention.

AI)I)ENDIX III-A: MEDICAL-SURGICAL EQUIPJ'"tENT IN THE AClITE CARE SETTlNC

783

Hemodynamic Monitoring

Monitoring hemodynamic events provides information about the

adequacy of a patient's circulation, perfusion, and oxygenation of

the rissues and organ sysrems. The goal of hemodynamic moniroring

is to maintain rhe balance berween oxygen demand and oxygen

delivery.' Hemodynamic monitoring can be accomplished using

noninvasive (Table III-A.3) or invasive (Table III-A.4) merhods.

Noninvasive, or indirect, hemodynamic monitoring provides

physiologic information without the risks of invasive monitoring

and can be used in many serrings; however, the accuracy of the

dara obrained is affected by the applicarion of rhe device and the

comperence of rhe clinician gathering the data.s

Invasive, or direct, measurements are obtained by penetration

of the skin and insertion of a cannula or carheter into a blood vessel, chamber of rhe heart, or borh. The cannula or catheter is attached to a monitoring system, which consists of a transducer,

amplifier, and oscilloscope for rhe display of rhe vascular waveforms and pressure measurements.9 Direct monitoring can provide continuous, accurate data; however, thrombosis, infections, air

embolisms, and trauma are potential complications.s

During invasive hemodynamic moniroring, the level of rhe righr

atrium is the standard zero reference point and is identified by the ph/ebosratic axis-the intersection of rhe midaxillary line and the fourth inrercosral space (see Figure In_A.7).'O The nurse will zero the system

using a level to align the patient's phlebostatic axis with the transducer.

Repositioning the patient may artificially alter waveforms by applying

pressure to the catheter, shifting the catheter or stopcock, or shifting the

phlebostatic axis relative ro the transducer. I I

General Physical Therapy Considerations with

Hemodynamic Monitoring

•

Raising rhe level of the phlebostaric axis relarive to rhe transducer gives false high readings; lowering rhe phlebosratic axis gives false low readings."

•

If a waveform changes during treatment, in the absence of other

clinical signs, reposition the patient or limb (if an arterial line is in

place) and reassess. If rhe waveform does nor rerum to baseline,

rhen notify the nurse.

Table ill-A.3. Noninvasive Medical Monitoring

....

00

...

Device

Description

Clinical Implications

>

g

BP cuff (sphygmomanometer)

P urpose: indirectly measures arterial

•

Do not use a BP cuff on an extremiry with an

'"

Normal adult values: systolic

blood pressure.

arterial line, lymphedema, AV fistula or graft,

�

�

'"

100-J 40 mm Hg, diastOlic

'"

�

Consists of: an inflatable cuff, usually

or blood clot, or in an extremity ipsilateral CO a

60-90mm Hg

placed 2.5 em proximal to the

mastectomy. Try to avoid measuring SP in an

J:

>

z

antecubital space, attached to a

extremiry with a peripheral or central intra

"

pressure monitoring device.

venous line. Look for signs posted at the

1')

o

Auscultate for Kororkoff's sounds

patient's bedside stating whether the use of a BP

"

(refer to Table 1-8) with a

cuff on a particular extremity is contrindicated.

o

'"

stethoscope over an artery, usually

•

Use an appropriately sized cuff. The cuff

:t

the brachial artery.

bladder should be no less than 80% of limb

-<

�

circumference. A cuff that is roo small

r;;

overestimates SP.

r

J!

•

The cuff may be placed on the upper extremity

distal to the elbow with auscultation of the

iii

>

�

radial artery.

�

•

Alternative sites for measurement in the lower

extremiry are proximal to the popliteal space

with auscultation of the popliteal artery or

proximal to the ankle with auscultation of the

posterior tibial artery.

•

Avoid contact between stethoscope tubing and

the cuff robing to minimize extraneous sounds.