i bc27f85be50b71b1 (253 page)

Table lU-A.6. Continued

00

�

Device

Description

Clinical Implications

>

• Yankauer suctioning may stimulate a

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cough and help clear secretions in

�

patients who are unable to dear

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secretions independendy.

J:

�

• If a patient bites down on the

o

Yankauer, do not anempt to pull on

�

o

the device. Wait for the patiem to

'"

relax, then gendy slide the Yankauer

o

;0

from the patiem's mouth.

i:

AV

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= arteriovenous; CSF = cerebrospinal fluid; CVP = central venous pressure; TPN = total parenteral nutrition.

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>

• Listed in alphabetical order.

...

Sources; Data from RR Kirby, RW Taylor, JM Civena (cds). Handbook of Critical Care (2nd cd). Philadelphia: Lippincorr-Raven, 1 997; F Hal

:;I

derman. Selecting a vascular access device. Nursing 2000; 1 1 :59-61; DF Colixxa. Actionstat: dislodged chest rube. Nursing 1 995;25-33; I-IJ

m

Thompson. Managing patients with lumbar drainage devices. Crit Care Nurse 2000;20:60-68; and Guidelines for intensive care unit admission,

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discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med 1999;27:

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633--638.

APPENDIX III-A: MEDICAL-SURGICAL EQUIPMENT IN 11-IE ACllfE CARE SETTING

807

Figure [[I-A. I O. A chest drainage system has three mai" compartments from

left to right: (1) the suction control. (2) the water seal. (3) the collection

chamber. (Reprinted with permission from Genzyme Biosurgery.)

place (e.g., conract precautions) . Refer to Table 10-4 for a

summary of infection prevention precautions.

•

Practice universal precautions. The likelihood of

encountering bodily fluids is increased in the aCllte care

serring, especially in rhe ICU.

•

Discuss your planned intervention with the nurse.

Scheduled procedures may rake precedence over rhis intervention, or it may coordinate well with another planned

procedure.

•

On entering the patient's room, take inventory. Observe

rhe parient's appearance and posirion. Systemarically

observe rhe parient and verify rhe presence of all documenred lines. Develop a consistent method of surveying rhe room: lefr to righr, or rop of bed ro bottom of bed, ro

ensure rhar all lines and equipmenr are observed and con-

808 ACUTI CARE HANDBOOK FOR PHYSICAL THERAPISTS

side red in your treatment plan. Take note of all readings

on the monitors before intervention.

•

Anticipate how your intervention may change the

patient's vital signs and how this will likely appear on the

monitors. Be aware of which readings may change artificially owing to relative position change.

•

Using appropriate precautions, gently trace each line

from the patient to its source. Ask for assistance, if

needed, to untangle any lines or to free any lines that

might be under the patient.

•

Ensure that there is no tension on each line before

attempting to move the patient.

•

Never arrempt to free a line that cannot be completely

visualized!

•

Discuss with the nurse whether any lines can be

removed or temporarily disconnected from the patient

before your treatment.

•

Ask for appropriate assistance when mobilizing the

patient.

•

Most invasive monitoring systems have two alarm controls: one to silence or discontinue the alarm for a few

minutes, and another to disable or turn off the alarm. Do

not silence or disable an alarm without permission from

the nurse!

•

On completion of your tteatment, ensure that all appropriate alarms are turned on and that the patient is positioned with the appropriate safety and communication measures in place. Notify the nurse of any change in the

patient'S status.

References

1 . Anonymous. Guidelines for intensive care unit admissions, discharge, and

triage. Task Force of the American College of Critical Care Medicine,

Society of Critical Care Medicine. Crit are Med 1 999;27(3),633--j)38.

2. Kirby RR, Taylor RW. Oxygen Therapy. In RR Kirby, RW Taylor, JM

Civetta (cds), Handbook of Critical Care (2nd cd). I'hiladelphi., Lippincon-Raven, 1 997;254,260.