i bc27f85be50b71b1 (251 page)

pain, edema, erythema, or tenderness.

�

Notify the nurse if signs are present.

il

oc

o

-

Table lli-A.6. Continued

00

o

N

Device

Description

Clinical Implications

g

Peripherally inserted

Purpose: provides long-term administration of TPN,

• Wait for x-ray results before

'"

central venous

medications or fluid.

mobilizing the patient to confirm

n

>-

'"

catheter (Plcq

Consists of: a catheter placed via the cephalic or basilic veins,

proper placement of the line.

m

terminating in the superior vena cava. This is the only

• Improper placement can break the

:t

>central line placed by a nurse.

line; cause a hematomaj pierce the

Z

o

lung, causing a pneumothorax; or

g

terminate in a vessel other than the

"

vena cava.

(3

'"

• Do not usc a blood pressure cuff on

�

:t

the involved extremity.

-<

�

• Encourage range of motion of the

�

involved extremity.

r

• Use of axillary crutches may be

;!

contraindicated.

;l

>

�

Rectal pouch/tube

Purpose: temporarily collects bowel drainage and protects

• Both arc easily dislodged.

�

fragile skin from contact with feces.

• Use a draw sheet when moving the

Consists of: a pouch placed externally or a tube placed

patient in bed.

internally in the rectum.

• Keep the collection bag below [he

level of insertion.

Suprapubic catheter

Purpose: drains the bladder temporarily after some bla.dder

• Keep the collection bag below the

surgeries , or permanently in cases of blocked urethra due

level of the bladder.

to a tumor, periurethral abscess , or a severe voiding

•

The collection tubing may be taped ro

dysfunction.

the patient's thigh.

Consists of: a catheter pla.ced in the bladder through a

• Avoid pressure over the insertion site.

surgical incision in the lower abdominal wall.

,.

Surgical drain

Purpose: removes blood or fluid from a surgical site that

•

Be aware of the location of the

:;:

�

would otherwise collect internally.

drain when moving the patient.

z

"

Surgical drains are of two basic rypes: passive or active. Pas·

•

The rubing may be taped or pinned to

X

s;ve drainage is accomplished by gravity or capillary

the patient's skin or clothing to

action. Drainage is further facilitated by rransient increases

prevent tugging.

�

in intra·abdominal pressure, as with coughing. Passive sur

•

Check with the nurse before

T

"

gical drains include Penrose, Foley, Malecot, and Word

disconnecting a drain from suction.

�

catheters. Active drainage is accomplished by suction from

oJ"

a simple bulb device or a suction pump. These systems

c

may be closed, like the Hemovac and Jackson·Pratf (JP)

Ei

drains.

2

Texas catheter

Purpose: noninvasively drains and collects urine from the

• It is easily dislodged.

.8

penis.

• It may be held in place with a Velcro

c

�

Consins of: a condom·like flexible shearh that fits over the

strap.

penis ro drain urine into a collection bag. This noninvasive

•

The drainage bag should always be

�

method of collecting urine has a much lower risk of

below [he level of the bladder to

z

infection and irritarion than does an indwelling catheter

allow drainage by graviry.

:;!

and is often the preferred method of managing male

'"

•

Keep the collccrion bag off the Ooor.

urinary incontinence.

• Secure the collection bag or catheter

rubing to patient's leg, clothing, or

�

assistive device to prevent the patient

�

from tripping or becoming tangled in

i::

the tubing during mobiliry activities.

� z C)

00

o

'"

Table lli-A.6. Continued

00

o

...

Device

Description

Clinical Implications

>

Totally implantable

Purpose: surgically implanted catheter used for long�term

�

•

Once healed, physical activity is not

intravascular device

chemotherapy, TPN, or other long�teIm infusion therapy.

limited.

!2

(Port-A-Cath,

Consists of: a completely implanted catheter, usually placed

'"

•

Patients can usuaUy swim or bathe

'"

MediPort)

in the subclavian or jugular vein, terminating in the

without limitation.

J:

)superior vena cava. Access to the catheter is obtained

Z

"

through a tunneled portion attached to a poct that is

1')

o

implanted in a subcutaneous pocket in the chest wall,

"

usually below the clavicle. The subcutaneous titanium,

o

'"

plastic, or stainless steel port has a reservoir with a selfi

sealing septum that is accessed by a special noncoring

-<

�

needle through imact skin. The tunneled ponion is

�

anchored to a muscle or subcutaneous tissue with sutures.

r

Tunneled central

Purpose: surgically implamed cameter used for long-term

i

•

The tailed portion should be taped

venous catheter

chemotherapy. TPN. or other long-term infusion therapy.

down to prevent dislodging.

�

(Hickman, Broviac,

May be used for months to years.

�

•

Do not perform manual techniques

�

Groshong, Silasric,

Very similar to the totally implamable intravascular device

directly over the tail.

and Quinton

(previously described); however, access is obtained through

•

Patients are allowed to shower once

catheters)

a "tailed" portion, which exits the skin from the amerior

the insertion site is hea led; howevex;

chest wall superior to the nipple. A Dacron cuff surrounds

tub bathing and swimming are

the tunneled portion just inside the exit site. The cuff

usually limited.

causes a subcutaneous inflammatory reaction to occur

aher insertion, which , when healed, provides fixation and

a barrier to infection within 1 to 2 wks of implamation.