i bc27f85be50b71b1 (250 page)

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the drain is in place.

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•

Patients are often instructed to avoid

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coughing while practicing postoperative deep breathing exercises.

• Over-drainage or under-drainage

complications include tension

pneumocranium, central herniation

of the brain, compression of the brain

stem. and subdural hematoma.

• Monitor the patient for any changes

in neurologic status. Notify nursing

inunediately if any changes arc noted.

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Midline catheter

Purpose: delivers i.v. medications or fluids for up to 4-6 wks.

•

Do not use blood pressure cuff on

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Cannot be used co draw blood.

the involved extremity.

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Consists of: a 3- to 8-in. peripheral catheter placed via the

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antecubital fossa intO the basilic or cephalic vein.

Nasoenteric feeding

Purpose: placed for enreral feedings when patients are unable

•

The position of the tube in the nostril

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rube (Dobbhoff

to rake in adequate nutrition by mouth.

and the back of the throat can be

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rube)

Consists of: a small-diameter, -26 mm or No. 7-10 French,

irritating to the patieor and may

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cube inserted via the nostril, through the esophagus into

inhibit a cough.

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the stomach or duodenum. and held in place with tape

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•

The rube often hangs in fronr of the

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across the nose.

parienr's mouth and may also hinder

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airway clearance.

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•

The patient may be more comfortable

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if the tube is positioned away from

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his or her mouth and raped to the

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forehead or cheek.

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•

The rube can be dislodged easily.

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Check that the tape is secure.

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Notify rhe nurse i f rhe tube

becomes dislodged.

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•

Patients may be on aspiration

precautions.

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•

Place feedings on hold when the head

of the bed is flat to rnjnimize the risk

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of regurgitation or aspiration.

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Table lli-A.6. Continued

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o

Device

Descri ption

Clinical Implications

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•

This small-diameter rube can clog

easily; some facilities require that

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feeding rubes be flushed with water

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when placed on hold for > 15 mins to

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minimize the risk of clogging.

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Nasogastric tube

Purpose: keeps the stomach empty after surgery and rests the

1.)

•

See above (Nasoenteric feeding tube)

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(NGT)

bowel by preventing gastric contents from passing through

for positioning tips.

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the bowels. Some NGTs allow access to the stomach for

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Ask me nurse il me tube may be

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medications or tube feedings (see Nasoenteric feeding rube).

disconnected from suction for

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Consists of: a rube inserted via the nostril, through the esophmobilization of the patient.

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agus, and into the stomach. Often attached to low-level

•

When disconnected from suction, cap

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suction pressure. Held in place with tape across the nose.

the open end.

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Nebulizer

Purpose: delivers inhaled medications, usually bronchodi

•

Treatment time is usual1y 10-20

lators and mucolytics.

mms; however, the medications are

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Consists of: a hand-held chamber with a mouthpiece through

usually effective lor 3-6 hrs.

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which pressurized air aerosolizes medications that are then

•

Patients may be bener prepared for

inhaled. May deliver medications through ventilator or

mobility activities or airway clearance

tracheostomy rubing.

after nebulizer treannentS.

•

These treatments are often referred to

as nebs.

Percutaneous

Purpose: provides long-term access for nourishment to

•

Place tube feedings on hold when the

endoscopic

patients who are unable to tolerate food by mouth. May

head of the bed is flat to minimize the

gastronomy!

be used to supplement nutrition taken by mouth.

risk of regurgitation/aspiration.

jejunostomy tube

Consists of: a feeding tube placed by endoscopy into the

•

PEj tube is considered postpyloric;

(pEG/PE]) tube

stomach or jejunum through the abdominal wall.

therefore, the risk of aspiration from

is minimiz.ed.

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• This small-diameter rube can clog

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z

easily; some facilities require thar

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feeding rubes be flushed with water

x

when placed on hold for > 1 5 mins

to minimize the risk of dogging.

3:

Percutaneous sheath

Purpose: dilates a vein to provide a channel for introduction

•

The patient may be mobilized with

..,.,

51

introducer (Cordis)

of pulmonary catheter.

the sheath in place once the

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Consists of: a Teflon sheath that often has a port for

,..

I.V.

pulmonary cameter has been

access.

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removed.

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• A secure dressing should cover the

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sheath during any mobilization, as

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me large bore opening of me shearh

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can allow air into the venous system

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if rhe shearh is dislodged.

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Peripheral intravenous

Purpose: provides temporary access for delivery of medi

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•

Avoid using blood pressure cuff on

line

cations, fluids or blood transfusions. Cannot be used to

the involved exuemity.

2:

draw blood.

•

Watch i.v. rubing for kinks or

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Consists of: a short catheter, 0.75-1.00 in. long, inserted into

occlusions.

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a small peripheral vein.

•

Position the patient to avoid

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occluding flow.

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•

Observe the patient for signs of

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infiItrared i.v. or phlebitis: localized

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