i bc27f85be50b71b1 (251 page)

pain, edema, erythema, or tenderness.


Notify the nurse if signs are present.

il

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Table lli-A.6. Continued

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Device

Description

Clinical Implications

g

Peripherally inserted

Purpose: provides long-term administration of TPN,

• Wait for x-ray results before

'"

central venous

medications or fluid.

mobilizing the patient to confirm

n

>-

'"

catheter (Plcq

Consists of: a catheter placed via the cephalic or basilic veins,

proper placement of the line.

m

terminating in the superior vena cava. This is the only

• Improper placement can break the

:t

>central line placed by a nurse.

line; cause a hematomaj pierce the

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o

lung, causing a pneumothorax; or

g

terminate in a vessel other than the

"

vena cava.

(3

'"

• Do not usc a blood pressure cuff on


:t

the involved extremity.

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• Encourage range of motion of the


involved extremity.

r

• Use of axillary crutches may be

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contraindicated.

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>


Rectal pouch/tube

Purpose: temporarily collects bowel drainage and protects

• Both arc easily dislodged.


fragile skin from contact with feces.

• Use a draw sheet when moving the

Consists of: a pouch placed externally or a tube placed

patient in bed.

internally in the rectum.

• Keep the collection bag below [he

level of insertion.

Suprapubic catheter

Purpose: drains the bladder temporarily after some bla.dder

• Keep the collection bag below the

surgeries , or permanently in cases of blocked urethra due

level of the bladder.

to a tumor, periurethral abscess , or a severe voiding


The collection tubing may be taped ro

dysfunction.

the patient's thigh.

Consists of: a catheter pla.ced in the bladder through a

• Avoid pressure over the insertion site.

surgical incision in the lower abdominal wall.

,.

Surgical drain

Purpose: removes blood or fluid from a surgical site that


Be aware of the location of the

:;:


would otherwise collect internally.

drain when moving the patient.

z

"

Surgical drains are of two basic rypes: passive or active. Pas·


The rubing may be taped or pinned to

X

s;ve drainage is accomplished by gravity or capillary

the patient's skin or clothing to

action. Drainage is further facilitated by rransient increases

prevent tugging.


in intra·abdominal pressure, as with coughing. Passive sur


Check with the nurse before

T

"

gical drains include Penrose, Foley, Malecot, and Word

disconnecting a drain from suction.


catheters. Active drainage is accomplished by suction from

oJ"

a simple bulb device or a suction pump. These systems

c

may be closed, like the Hemovac and Jackson·Pratf (JP)

Ei

drains.

2

Texas catheter

Purpose: noninvasively drains and collects urine from the

• It is easily dislodged.

.8

penis.

• It may be held in place with a Velcro

c


Consins of: a condom·like flexible shearh that fits over the

strap.

penis ro drain urine into a collection bag. This noninvasive


The drainage bag should always be


method of collecting urine has a much lower risk of

below [he level of the bladder to

z

infection and irritarion than does an indwelling catheter

allow drainage by graviry.

:;!

and is often the preferred method of managing male

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Keep the collccrion bag off the Ooor.

urinary incontinence.

• Secure the collection bag or catheter

rubing to patient's leg, clothing, or


assistive device to prevent the patient


from tripping or becoming tangled in

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the tubing during mobiliry activities.

� z C)

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Table lli-A.6. Continued

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...

Device

Description

Clinical Implications

>

Totally implantable

Purpose: surgically implanted catheter used for long�term



Once healed, physical activity is not

intravascular device

chemotherapy, TPN, or other long�teIm infusion therapy.

limited.

!2

(Port-A-Cath,

Consists of: a completely implanted catheter, usually placed

'"


Patients can usuaUy swim or bathe

'"

MediPort)

in the subclavian or jugular vein, terminating in the

without limitation.

J:

)superior vena cava. Access to the catheter is obtained

Z

"

through a tunneled portion attached to a poct that is

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o

implanted in a subcutaneous pocket in the chest wall,

"

usually below the clavicle. The subcutaneous titanium,

o

'"

plastic, or stainless steel port has a reservoir with a selfi

sealing septum that is accessed by a special noncoring

-<


needle through imact skin. The tunneled ponion is


anchored to a muscle or subcutaneous tissue with sutures.

r

Tunneled central

Purpose: surgically implamed cameter used for long-term

i


The tailed portion should be taped

venous catheter

chemotherapy. TPN. or other long-term infusion therapy.

down to prevent dislodging.


(Hickman, Broviac,

May be used for months to years.



Do not perform manual techniques


Groshong, Silasric,

Very similar to the totally implamable intravascular device

directly over the tail.

and Quinton

(previously described); however, access is obtained through


Patients are allowed to shower once

catheters)

a "tailed" portion, which exits the skin from the amerior

the insertion site is hea led; howevex;

chest wall superior to the nipple. A Dacron cuff surrounds

tub bathing and swimming are

the tunneled portion just inside the exit site. The cuff

usually limited.

causes a subcutaneous inflammatory reaction to occur

aher insertion, which , when healed, provides fixation and

a barrier to infection within 1 to 2 wks of implamation.

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