Nursing Technology

olanjones's version from 2016-04-08 15:03

IV Catheters

Question Answer
How do central line access and peripheral access differ?Nurses insert peripheral (limbs) IVs and physicians insert central (neck/trunk) catheters per their scopes of practice
What is a benefit of central line placement?During immediate need for venous access, the jugular and subclavian veins are easy to find, access, and to put in a large gauge needle (allows for faster delivery), shorter distance for corrosive meds (chemo) to travel
What is a Groshong tip?A 3 way valve end that opens with either negative or positive pressure, when no pressure is applied it remains closed. Decreased risk of clot, does not need to be flushed.
How is a Groshong catheter inserted?Surgically inserted - central line with a 3 way valve tip, that is usually tunneled under the skin. Placement is verified by fluoroscopy. Can be used for long-term IV treatment.
What is a central line multi-lumen catheter?Central catheter with 3 (sometimes more) lumens , short term use to monitor central venous pressure, sample blood, and administer meds/fluids.
What is a Swan-Ganz catheter and what is it used for?A flow-directed balloon-tipped pulmonary artery catheter (also called a PAC), feed through the right atria and ventricle to sit in the pulmonary artery, monitors heart function and blood flow
What is a hep-lock?Now referred to as an IV lock, allows for intermittent IV access. Saline is most commonly used to flush the line (previously heparin was used = "hep-lock")
Advantages of tunneling a catheter to a distant venipuncture site?may decrease infection due to tip of catheter being further from insertion site (skin)
Who inserts a PICC line and what is it?specially trained nurses; Peripherally inserted central catheter
When would an interosseus line be placed?Emergency, if cannot get a line another way, vascular collapse

Needles & Syringes

Question Answer
How large is a TB syringe and what can it be used for?1 cc (measured in tenths and hundredths), small doses, pediatric patients. MAY NOT BE USED WITH INSULIN
What sizes do insulin syringes come in and how are they measured?30, 50, 100 Units. Use smallest syringe that will allow dosing (e.g. 4 unit dose in a 30 unit needle). ONLY USE WITH INSULIN
What are the calibrations on a 3cc syringe, what type of injections are they used for?tenths of milliliters, hypodermic
What is a Luer-Lok tip?Screw tip on syringe, IV, catheter to attach needle, IV set, etc (Benefit: Needle can’t stay in arm when pulling out after injection)
What is a filter needle and when is it used?The hub contains a filter disc to filter out glass/particles to protect patient from possible injection of foreign bodies. Used to draw up meds from glass ampules or with particles from reconstitution
What does the gauge of the needles represent?The diameter of the shaft. The larger the number, the smaller the needle
Most common gauge needle used for sub-q injection?25 Gauge for subcutaneous
Most common gauge needle used for IM injection?21 Gauge for intramuscular
What length of needles are most often used for IM injection?1 - 1.5” most common for IM, must be long enough to reach the muscle at a 90 degree angle
What length of needles are most often used for sub-q injection?5/8” most common for sub-q, administered at a 45 degree angle
What is the benefit of needle-less cannulas?Prevents needle-sticks, and is compatible with ports on IV sets (Y ports) and injection sites on bags and IV locks

Drains & Chest/Airway tubes

Question Answer
What is the benefit of using a Hemavac drain?It is a closed-wound drainage system = PROMOTES HEALING TIME, prevents microorganisms from entering the line.
How does a Hemavac drain work?Inserted in/near surgical wound site via tube, the blood and fluids are drained into a spring loaded, gravity-fed reservoir. Squish down on device to create vacuum (careful- too much suction pressure = tissue damage)
What is a Jackson-Pratt drain?Closed-wound drainage system with a bulb at the end - Bulb is squeezed flat to create suction to pull fluid from wound (bulb shown in class can hold up to 100 cc of fluid)
What is the main function of a chest tube?Drain air, fluid, and/or blood in the pleural space to restore the negative pressure in the lungs. Because air rises, chest tubes for pneumothorax are placed in the upper anterior thorax, to drain blood and fluid generally are placed in the lower later chest wall
What danger is associated with manipulation or clamping of a chest tube?Tension pneumothorax
How does the chest tube water system work?When client inhales the water prevents air from entered the system, during exhalation air exits and bubbles up through the water. Comprised of suction control chamber, water-seal chamber, and closed collection chamber for drainage
What is a Heimlich chest valve?A waterless system that is comprised of a one way flutter valve, primarily used to treat pnuemothorax. Small so patients can be mobile. Blue, proximal end to patient’s chest tube, distal end to the environment for air, or to a collection bag if draining fluids. Inserted in the improper direction can cause tension pneumothorax
What is an ostomy bag?a 1 or 2 piece appliance usually used to collect fecal waste from a stoma. It is important to asses skin when appliance is changed (esp for ileostomy, which contains digestive enzymes)
What is the nurses role in regards to chest tubes, drains, ostomies?Nurses are responsible for care/management/pt education
What is the nurses role in regards to endotracheal (ET) tubes?to maintain airway (nurses do not insert), oral cavity care/assessment (suctioning, inner cannula care), incision site care/maintenance (twill tape or Velcro ties)

Intake & Output

Question Answer
What do NG, OG, NJ, OJ tubes accommodate?allow for short-term feeding (patient must have adequate gastric emptying) or suctioning by these routes - Naso-Gastric, Oro-Gastric, Naso-Jejunum, Oro-Jejunum (placement in jejunum best for GERD)
Why is NG feeding not advised for patients with no gag/cough reflex?without this reflex the tube may be accidentally placed into the lungs
How is appropriate length for an NG tube measured?from clients nose to earlobe to tip of xiphoid process (use imaging [preferred method], pH test, bilirubin test, or stethoscope before using to assure proper placement)
What technique can ease insertion of NG tube?have patient tip head back and drink water as you're moving the tube down into their stomach
What is a PEG (percutaneous endoscopic gastrostomy) and when is it used?surgical opening in stomach created using an endoscope to visualize placement. Used for long-term nutritional support >6-8 weeks, care of opening before it heals requires surgical asepsis
How do French catheters differ from most lumen-based sizing?The bigger the number the larger the diameter (opposite of needle sizing). French size = 3x’s the diameter in mm (e.g. Fr size 9 = 3 mm in diameter). Invented by Joseph Charriere
How many lumens does a straight urinary catheter have?Single lumen (with a small opening about 1.25 cm from insertion tip). Is inserted to drain the bladder and then immediately removed. Size determination based on age (children have smaller urethral canal) and gender (men have a longer urethra than women)
What are important characteristics of a Foley (indwelling) catheter?Double lumen catheter, one to drain the urine (larger lumen), the other to inflate the balloon that maintains placement (smaller lumen). Hold in place when inserting, may easily come out before balloon is inflated (e.g. if pt coughs, sneezes). Drains into a closed gravity drainage system (keep below pt to avoid backflow of urine)
Why is ultrasound the preferred method for measuring post-void residual (PVR) urine?noninvasive method – reduces risk of catheter-associated UTIs (CAUTI), can determine if intervention (med/cath) is needed. Normal PVR urine volume is 50-100 mL

Parenteral Medication & Safety

Question Answer
What is an ampule?A sterile glass container containing a single dose of medication. Because neck of vial must be broken to open, dispose of in sharps container, use a filter needle to withdraw med.
What is a vial?a container with a rubber stopper that must be punctured with a needle to withdraw med. Can be multi or single dose. CDC prefers single dose. Because vial contains a vacuum air must be injected into vial prior to drawing up dose.
What is a Tubex or Carpuject syringe?Devices that hold single dose cartridges of medication. Both are reusable and do not need to be sterilized between use.
What OSHA regulation is meant to prevent needle sticks?Needle-stick safety and prevention act 2001, designed to help protect the spread of blood-borne pathogens. Engineering controls are the primary means of eliminating or minimizing employee exposure and include the use of safer medical devices, such as needleless devices, shielded needle devices, and plastic capillary tubes
Needle disposal container guidelines?"Sharps containers" Never overfill, must be properly labeled to warn of contents. Must be FDA approved, made from leak-proof/puncture-proof plastic (a sharp is anything that can cut or stick the skin)
How is IV spiking and priming performed ?-Expose insertion site of bag, remove cap from spike and insert into bag
-Hang bag approx. 3 feet above pt’s head (gravity fed)
-Squeeze drip chamber until half full (prevents air in tubing)
-Prime line by releasing cap and allowing solution to flow until air bubbles are removed
-Reclamp tubing and replace cap in preparation for IV insertion
What is an electronic IV pump and how does it work?Pump powered by electricity or battery, uses positive pressure to provide accurate flow rate. Programed to regulate flow in either drops/ min or mL/hour, has alarms that signal problems with infusion
When is a piggyback IV used?to deliver a secondary bolus medication (often antibiotics) without additional injections to patient. Must be hung higher than primary IV bag for faster infusion, verify that piggyback med and primary IV are compatible solutions since the same line is being used.
Why is Y tubing used for blood transfusion?to keep vein open while starting blood transfusion and to flush line with normal saline before blood enters tubing.
-Has 2 spiked ends (1 for blood, 1 for saline) with clamps on both lines prior to the drip chamber (chamber contains blood filter) and a main flow rate clamp.
-Nursing role = prime line, start infusion, watch for adverse effects (observe for first 15 mins).
-Using solutions other than saline damages blood components

Prophylactic Technology

Question Answer
Incentive spirometer is commonly used on limited mobility patients for what?-prevent atelectasis/pneumonia (often post-surgery to counteract effects of anesthesia)
-Gives incentive for inhalation
-Nurse teaches use
Sequential Compression Devices (SCD’s)-helps prevent thrombosis or edema by promoting venous return to the heart
-Pts will feel compression from the bottom up
-Pts will have them taken off during bathing, toileting or ambulating
-Stay on continuously/ most of the time
Oxygen flow-meter use and settings-Indicates gas flow in liters per minute
-Required for wall-outlet systems
-Placement of silver ball indicates flow (either above or mid-ball depending on brand)
-Turn knob to adjust ball placement
Suction machine – intermittent or continuousFrequency of suctioning depends on client’s health and how recently intubation was done. Done to facilitate ventilation, remove secretions that may obstruct airway, prevent infection from accumulated secretions
T/F: Sterile technique is recommended for all suctioning.T. Even though upper airways are not sterile, sterile technique is recommended for all suctioning
Complications of suctioninghypoxemia, trauma to airway, nosocomial infection, cardiac dysrhythmia (related to hypoxemia)
Suction catheter - Yankhauer - shape of tip?Catheter with SPECIAL KNOB ON TIP that prevents entry into airway
Where is Yankhauer Suction catheter used?Used in oropharyngeal cavity for withdrawal of fluid (tracheostomy site)
Pulse oximeterMeasures oxygen sat of hemoglobin (Sp02)/pulse (w/ laser light)
Disadvantage of pulse oxproblems w/accuracy- nail polish, some ethnicities, anemic pts, shock, hypothermia
Doppler ultrasound may be used to monitor:
a) pulse (radial, carotid)
b) fetal heart tones
c) arteries, such as carotid
d) all of the above
D (dog) :)
What are the benefits of Pyxis (automated medication/supply dispensing system)
-Reduces turnaround time from written order to patient delivery
-Requires security code/password to access
-Ensures proper billing of supply use
-Reduces medication/handwriting errors
What is the difference between surgical gloves and exam gloves?Surgical are sterile/have numbered sizing, exam gloves are non-sterile/sized as sm, med, large, (etc).
-Both can be made from latex or nitrile (Some people have latex allergies).
-Size is determined by measuring around your hand or from tip of index finger to base of hand to get numerical sizing. Glove size = Length in inches

Wound care & Pain management

Question Answer
A 50mL Catheter tip syringe might be used to:
a) irrigate wounds or tubes,
b) add medications to IV solutions
c) administer oral medication
d) administer medication IM
e) all of the above
A & B
PCA pump – describe & used for-Patient-controlled analgesia
-Can only be administered by the patient (has lockout setting to prevent overdose)
-Mainly acute care.
Nursing role when PCA pumps are used-monitor vital signs
-assure patient knows how to use the device
-educate pt that they are unable to OD/has lockout
Epidural pump-describe & use-Used for pain management
-only placed by anesthesiologists or nurse anesthetists (usually in lumbar region – L3/L4)
-3 Modes of administration: bolus, continuous infusion, continuous plus intermittent bolus
How would tubing be routed and marked if it is an epidural line?tubing generally comes up over shoulder, should be marked with tape to designate it is epidural
Considerations to remember in suture and staples removalSutures are cut as close to the skin as possible, suture material that is visible to the eye is in contact with bacteria and should not be pulled beneath the skin during removal, clean incision before and after removal, apply dressing (if ordered)



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