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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.
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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
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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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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
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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
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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
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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
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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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easily; some facilities require thar
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feeding rubes be flushed with water
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when placed on hold for > 1 5 mins
to minimize the risk of dogging.
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Percutaneous sheath
Purpose: dilates a vein to provide a channel for introduction
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The patient may be mobilized with
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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
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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
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cations, fluids or blood transfusions. Cannot be used to
the involved exuemity.
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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.
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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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