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Acute Care Equipment Name Purpose Blood Pressure Cuff Monitors blood pressure ECG/EKG Monitoring Used for measuring heart rate and rhythm, detecting heart blocks, arrhythmias, and ischemic events Location/Access Route Picture/Diagram Hemodynamic Monitoring Common locations to monitor: Arm Forearm Lower leg Typically 5-lead on adults Precautions/Considerations Normal blood pressure reading: 120/80 Avoid taking blood pressure in an extremity with a PICC line or history of mastectomy/lymphedema Leads may become disconnected from electrode during bed mobility or transfers, or electrodes may lose contact with skin. Ask for assistance if unsure of how to reconnect Nursing may want ECG monitored during OOB activity via a transportable monitor Joint ROM may be restricted Blood may back up into line with activity- ask nurse to flush the line If IV becomes dislodged: apply pressure, clamp IV tubing, contact nurse Contact nurse if you notice: edema, erythema, or fluid leakage near/at IV site or if patient complains of tenderness Subclavian: limit shoulder flex/abd to 90*, avoid movements of head and neck that could disrupt or occlude the line Femoral: limit hip flexion to 90*; no IR/ER Peripheral IV Central Line Arterial Line (“A line”) Common sites: antecubital dorsum of hand radial aspect of wrist dorsum of foot Used for central venous access, large volume fluid resuscitation, medication or TPN Catheters may be double, triple, or quadruple lumen Common sites: internal jugular subclavian femoral Used for continuous monitoring of systemic blood pressure, arterial blood sampling Common sites: radial femoral dorsalis pedis brachial Used for infusion of fluids, blood products, medications, and venous blood sampling. Introduced through the skin into vein with an angiocatheter Transducer is placed at the level of the right atrium; readings may be falsely high/low if transducer is below/above the level of the heart Radial: limit extreme wrist ROM Femoral: limit hip flexion- may roll onto opposite hip for supine to sit May ambulate with transducer disconnected or clamped to IV pole If A-line becomes dislodged- immediately apply firm pressure and call for nursing Name Peripherally Inserted Central Catheter (“PICC line”) Purpose Location/Access Route Used for long-term administration of intravenous medication (such as antibiotics, chemotherapy, or TPN nutrition) Considered a central line Inserted peripherally into a vein, typically in the upper arm, and threaded through larger veins until the tip rests in the distal superior vena cava. Balloon tipped, flow directed catheter Used for precise monitoring of cardiopulmonary pressures, flows and circulating volumes (cardiac output); administration of medication. Provides temporary cardiac assistance during heart failure Decreases myocardial oxygen demand while at the same time increasing cardiac output Introduced via central venous catheter, travels through the right atrium and ventricle to the pulmonary artery Temporary Pacemaker Used to regulate the patient’s heart rate when bradycardia occurs Usually placed during open heart surgery Intracranial Pressure Monitor (ICP) External Ventricular Drain (EVD) Monitors intracranial pressure Allows for drainage and sampling of CSF Normal ICP: 5-15 mmHg May appear as: Two wires placed outside the heart running externally; Two large pads on the chest connected to a bedside monitor May be inserted into the epidural, subarachnoid, subdural, or intraventricular space Pulmonary Artery Catheter (“Swanganz”) Intra-Aortic Balloon Pump (IABP) Introduced through the femoral artery, resides distal to the aortic arch Picture/Diagram Precautions/Considerations Same as central line Limit end-range shoulder flexion to avoid putting excessive tension on the line Avoid using blood pressure cuff on extremity with a PICC line PICC lines may be placed at bedside using ultrasound guided assistance; avoid entering a patients room when a PICC line is being placed to not disrupt the sterile field Shoulder and cervical ROM administered carefully to avoid occluding the catheter Clear out of bed mobility with nursing staff Patients are usually on bed rest and close attention should be paid to monitoring devices. Monitor for signs of ischemia in the lower extremity in which the catheter is inserted, check pedal pulses Hip and knee ROM of involved lower extremity is contraindicated Keep pacing wires dry Hold activity 1-2 hours after temporary pacer wires are removed Transducer should be positioned at the level of the external auditory meatus Drain should be clamped before any changes in bed position or mobility If possible, nursing should be present during treatment to monitor the position of the drain If the drain becomes dislodged, apply pressure and return to patient to a supine position with the HOB lowered Name Pulse Oximetry Oxygen Nasal Cannula Purpose Monitors oxygen saturation of the blood and heart rate Used to deliver supplemental oxygen Location/Access Route Picture/Diagram Respiratory Support and Oxygen Therapy Common location to monitor: Finger Toe Earlobe Forehead Red light is visible when sensor is connected Positioned in the nares Precautions/Considerations Oxygen Nonrebreather Mask Trach Mask or Collar Continuous Positive Airway Pressure (CPAP) Bilevel Positive Airway Pressure (BiPAP) Endotracheal Tube (ETT) Tracheostomy (“trach”) Nail polish, vasoconstriction, ambient light, and skin moisture limit accuracy If alarming, check for proper probe contact and limb perfusion SpO2 should improve with deep breathing. If O2 saturation does not improve, contact nursing- the patient may need supplemental O2 Normal O2 sat- 100% May mobilize patient with portable oxygen tank, monitor O2 saturation Do not adjust oxygen flow without nursing consent or without physician order- oxygen is considered a medication. May mobilize patient with portable oxygen tank, monitor O2 saturation Do not adjust oxygen flow without nursing consent or without physician order- oxygen is considered a medication. Ensure that tube is adequately stabilized prior to transfers Keep circuit tubing below trach level so that condensation does not empty into airway Used for delivery of supplemental oxygen Indicated with acute hypoxia Mask covers nose and mouth Used to deliver supplemental oxygen for patients with a tracheostomy Supplemental oxygen may be humidified Used for continuous respiratory support May be used for acute respiratory failure, COPD, sleep apnea or heart failure Collar is secured over trach site Mask covers nose and mouth forming a tight seal May mobilize patient while on CPAP or BiPAP Coordinate with nursing ore respiratory therapist if settings are too sensitive to activity Used for short term airway management for mechanical ventilation Tube is inserted orally or nasally ETT’s are secured with tape or straps to the patient’s face Tube is inserted through an incision in the trachea below the level of the vocal cords Ensure that tube is adequately stabilized prior to transfers Keep circuit tubing below ETT so that condensation does not empty into airway Notify nursing if suctioning is indicated (audible/visible secretions, patient trying to cough, decreased SpO2) Ensure that tube is adequately stabilized prior to transfers Used for long term airway management for mechanical ventilation Allows access to upper airway, permits easier, safer suctioning, allows for vocalization Name Purpose Location/Access Route Picture/Diagram Precautions/Considerations Medical – Surgical Management Devices Hemovac Drain Jackson-Pratt Drain Nasogastric Tube (NG) Dobhoff Feeding Tube Gastrostomy and Jejunostomy Tubes (“G-tube/PEG”, “J-tube”) Pleural Chest Tube Mediastinal Chest Tube Commonly used following surgery to collect excessive drainage/blood May drain to either gravity or suction Commonly used following surgery to collect excessive drainage/blood May drain to either gravity or suction Used to decompress the stomach and to empty stomach contents May also be used for short term feeding and drug administration Inserted through the nares and passed through the esophagus into the stomach Used for short term enteral feeding Similar to NG tube, but typically thinner tubing is used Introduced through the nares, passed through the esophagus and into the stomach Used for long term supplemental feeding Placed through abdominal wall in to the stomach (Gtube) or small intestine (Jtube) Tube is inserted above the diaphragm into the pleural cavity Closed system connected to suction or clamp Tube is inserted above the diaphragm and lies on either side of the heart to drain excess blood from the surgical procedure Used to remove air or fluid from the pleural space after trauma or surgery Used to remove air or fluid from the mediastinal space after trauma or surgery Closed drainage system Similar to NG tube Secure drain collection device before transfers and ambulation to avoid occluding or dislodging the drain Contact nursing if drain collection device needs emptying or if drain appears to be leaking Secure drain collection device before transfers and ambulation to avoid occluding or dislodging the drain Contact nursing if drain collection device needs emptying or if drain appears to be leaking Do not allow tube to hang down- the tube should be affixed to the nose with adhesive tape. The tube may become dislodged and be uncomfortable for the patient if it is not secured. Nursing may need to disconnect tube from wall suction for ambulation or mobility. Tube is taped in place- can dislodge with tension Keep HOB >30 degrees during feeding to prevent aspiration Nursing can disconnect and flush tube prior to mobilization and ambulation Ensure that tube is stabilized prior to transfer to prevent dislodging Nursing can disconnect and flush tube prior to mobilization and ambulation Tubes are sutured to skin and taped down for stabilization Appropriate to ambulate patient- have nursing disconnect or clamp pleural chest tube Tubes are sutured to skin and taped down for stabilization Restrict out of bed activity to transfers only, preferably with nursing present; must have physicians order to ambulate Name Foley Catheter Colostomy/Ileosto my Rectal Tube Sequential Compression Devices (SCD’s) Portacath (“Port”) Wound Vac Purpose Used to measure urine output and to drain the bladder Used to collect waste from the colon Used to drain feces in patients who may be incontinent of bowels Used to prevent DVT’s after prolonged bed rest or surgery Mechanically compresses venous system to promote circulation Used to administer medications or blood draws, commonly used for hematology or oncology patients Used to promoted wound healing through negative pressure wound therapy; the device provides negative pressure (a vacuum) at the wound site that helps draw wound edges together, remove infectious materials and actively promotes granulation Location/Access Route Picture/Diagram Precautions/Considerations Inserted via the urethra into the bladder Supra-pubic catheter is inserted directly into the bladder surgically A stoma is created by attaching a portion of the colon through the abdominal wall; a colostomy bag is then attached to a stoma Flexible plastic tube inserted into the rectum, often held in place by adhesive wrapped around insertion Common locations: Feet Lower leg Surgically inserted in the upper chest, just below the clavicle The port is connected to a large vein for quick central access Sponge-like dressing in the wound bed covered with a sealed transparent film and drainage tube connected to the pump used to create the negative pressure; will typically have a drainage reservoir, power cord, and/or battery back up Collection bag must be below level of the bladder Contact nursing if patient reports extreme discomfort from the catheter Report output amount if the collection bag is emptied during a therapy session Avoid positioning gait belts or braces over the bag Contact nursing if the colostomy bag appears to be full and needs to be emptied The patient can often manage the colostomy bag independently May mobilize with caution Avoid shearing forces on tubing to prevent the tube from dislodging May disconnect pump or remove sleeves for transfers Reconnect sleeves following treatment If SCD’s are applied while patient is up in the chair, ensure the patient is instructed to not get up without assistance due to falls risk Avoid any modalities or pressure over the area of the port Do not disconnect the tubing. If the patient is ambulatory and can mobilize, simply unplug the device from the electrical outlet and take the whole machine (with battery back-up) with you. When the wound vac turns off or the tubing gets disconnected, the dressing loses its negative pressure and can result in a broken seal. Once the seal is broken, the dressing will likely need to be replaced which is often painful and increases the risk for infection. If you are concerned about the battery running out of power, or about the tubing disconnecting, engage the clamp on the tubing to maintain the seal (ask RN prior to mobilizing patient).
