i bc27f85be50b71b1 (249 page)

Table UJ-A.6. Medical Management Devices·

>-

"l

m

Device

Description

Clinical Implications

S

x

AntithromboIytic

Purpose: provides intermittent pressure to ehe lower extremi

•

Usually worn when the patient is in

boots (pneumatic

eies to promote venous return and prevent deep vein ehrombed, but can be worn when sitring

so

compression stockbosis secondary to prolonged or postoperative bed rest.

in a chair.

m

o

ings/Venodyne

Consists of: inflatable sleeves, applied to the lower legs,

•

Reapply when patient returns to bed.

§

boots)

which interminenrly inflate and deflate. In some cases, the

•

Discontinued when the parient is

<;"

sleeve is applied to the leg from the ankle to midthigh.

ambuJating on a regular basis.

�

'"

AV graft or AV fistula

Purpose: provides access for hemodialysis.

• Elevate and avoid weight bearing on

Cl

§

Consists of: The graft is an artificial blood vessel, usually

the involved extremity for 24 hrs

....

made of Gore-Tex or Dacron. used to join an artery and

after surgical procedure.

.0

vein when a patient's own vessels are not viable for an AV

s

•

Do nOt use blood pressure cuff on the

i

fistula. The {istula is ehe surgical joining of an artery and

involved extremity.

vein, allowing arrerial blood to flow directly to a vein.

• Avoid pressure over the site.

�

Usually located in the forearm.

•

Palpable ntrbulence is normal in the

2

graft or fisrula, which will have a

J!

m

raised, rope-like appearance.

>-

Central (venous) line

Purpose: provides vascular access for up to 2-4 wks for TPN,

• Do not use a blood pressure cuff on

g

Normal value,

repeated blood sampling, or administration of drugs or fluid.

an extremity with a cenrral line.

m

CVP

\!

= 0-8 mOl Hg

May measure CVP (see Pulmonary artery catheterization in

f;:

Table m-A.4), May be used to place a temporary pacemaker

�

or a vena cava filter or for hemodialysis.

Consists of: a single- or multiple-lumen intravenous line

placed in the subclavian, basilic, jugular, or femoral vein,

terminaeing in the right atrium.

.....

'"

'"

Table ill-A.6. Continued

�

Device

Description

Clinical l mplications

Chest tube

Purpose: removes and prevents the re-entry of air (pneumo�

�

•

Chest rubes may cause discomfort,

thorax) or fluid (hemothorax, pleural effusion, empyema, or

which may inhibit a cough, deep

g

'"

chylorhorax) from the pleural space or mernasrmai space and

breath, or mobility.

'"

provides negative intrapleural pressure.

:t

•

The patient may benefit from pre

)

Consists of: rube(s) placed in the pleural or mediastinal space

medication for pain before treat

Z

"

that exit the chest and are usually connected (0 a drainage

ment.

5

o

system (Figure III-A.IO). The placement of [he tubes is

• The drainage system should be below

'"

determined by indication. Mediasrinal chest tubes, placed

the level of chest rube insenion.

o

'"

to drain the pericardium after surgery, exit the chest

•

Avoid tipping the collection reservoir.

i

directly below the sternum. Apical chest tubes drain air,

The reservoir may be hung &om rhe

�

which typically collects in the apices of the pleural spaces.

side of the bed or raped to the floor to

(?

Fluid tends to collect near the basesj in these cases, tubes

prevent tipping.

r

are placed more inferiorly near the fluid collection.

•

If the reservoir is overturned, return

PostOperatively, rubes often exit the chest through the

the drainage container [Q the upright

!

surgical incision. If chest rubes are placed in a nonsurgical

position and notify the nurse.

�

situation, they are often placed along the midaxillary line at

• If the chest tube itself becomes

the appropriate level. Tubes usually connect to a drainage

dislodged, StOp activiry and notify the

system with three compartments: the drainage coUection

nurse immediately. If possible, place

chamber, the water seal chamber with a one-way valve that

the patient in an upright sitting

prevents air or fluid from re-entering the drainage

position, and monitor the patient'S

collection chamber, and the suction chamber, which

breath sounds, viral signs, and

decreases excess pressure in the pleural space.

respiratOry rate and pattern for

Tubes may be connected ro a small one-way valve (Heimlich

possible signs of tension

valve) that allows air or fluid to escape from the pleural

pneumothorax.

space while preventing re-entry.

•

Prevent kinks in the line.

>

•

The presence of a chest tube should

:;

m

nor, in and of itself, limit activity.

Z

"

Position changes and mobility can

X

facilitate drainage.

:>

•

Ask the nurse or doctor whether the

;:

chest rube may be temporarily

8

disconnected from suction during

�

mobiury activities. If the suction must

';"

�

remain connected, additional lengths

c:

"

of tubing may be added, or a portable

"

suction device may be used during

� r

mobility activities.

B

c:

•

The occlusive dressing, usually a

petrolatum gauze dressing to prevent

�

the influx of air, should remain imact.

§

Do not apply pressure over the

z

insertion site.

J!

m

Esophagogastric

Purpose: to compress hemorrhaging esophageal varices.

•

Patiems with this device are typical1y

>

tamponade rube

The tube, which is passed by moU[h through the esophagus

very ilJ and unable to participate in

(Blakemore tube,

into the stomach, has a proximal (esophageal) cuff, which

mobility activities.

�

Sengstakencompresses esophageal varices, and a distal (gastric) cuff,

�

Blakemore tube,

which compresses gastric varices. Channels allow

�

Minnesota tube)

aspiration of gastric contents. The balloons typically

�

remain in place for up to 24-72 hrs, as longer duration

Z

may cause tissue necrosis or ulceration.

Cl

�

Table IU-A.6. COl/til/tied

"

'"

00

Device

Description

Clinical Implications

g

Lumbar drainage

Purpose: continuous drainage of CSF from the subarachnoid

• The position of the pacicot, the

."

device (LDD)

space in the lumbar spine. For the treatment of CSF leaks

position of the transducer (if any),

�

'"

or shunt infections or to reduce intracranial pressure.

and the position of the collection bag

."

Consists of: a spinal catheter inserted in L4-5 subarachnoid

3rc determined by the rationale for

:t

>

Z

space, advanced ro an appropriate level, and connected to

the LDD intervention.

"

3 sterile closed CSF collection system.

•

Changes in me patient's position, in

1')

o

the level of the collection bag, or in

"

the intrathecal pressure impact the

o

'"

amount and fate of drainage.

�

:t

•

Note any restrictions in the

-<

�

medical record or posted in the

�

patient'S room.

r

• Patienrs are usually on bed rest whiJe