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pain, edema, erythema, or tenderness.
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Notify the nurse if signs are present.
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Table lli-A.6. Continued
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Device
Description
Clinical Implications
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Peripherally inserted
Purpose: provides long-term administration of TPN,
• Wait for x-ray results before
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central venous
medications or fluid.
mobilizing the patient to confirm
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catheter (Plcq
Consists of: a catheter placed via the cephalic or basilic veins,
proper placement of the line.
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terminating in the superior vena cava. This is the only
• Improper placement can break the
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>central line placed by a nurse.
line; cause a hematomaj pierce the
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lung, causing a pneumothorax; or
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terminate in a vessel other than the
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vena cava.
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• Do not usc a blood pressure cuff on
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the involved extremity.
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• Encourage range of motion of the
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involved extremity.
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• 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.
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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
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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.
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Surgical drain
Purpose: removes blood or fluid from a surgical site that
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Be aware of the location of the
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would otherwise collect internally.
drain when moving the patient.
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Surgical drains are of two basic rypes: passive or active. Pas·
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The rubing may be taped or pinned to
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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.
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in intra·abdominal pressure, as with coughing. Passive sur
•
Check with the nurse before
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gical drains include Penrose, Foley, Malecot, and Word
disconnecting a drain from suction.
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catheters. Active drainage is accomplished by suction from
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a simple bulb device or a suction pump. These systems
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may be closed, like the Hemovac and Jackson·Pratf (JP)
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drains.
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Texas catheter
Purpose: noninvasively drains and collects urine from the
• It is easily dislodged.
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penis.
• It may be held in place with a Velcro
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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
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method of collecting urine has a much lower risk of
below [he level of the bladder to
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infection and irritarion than does an indwelling catheter
allow drainage by graviry.
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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
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assistive device to prevent the patient
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from tripping or becoming tangled in
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the tubing during mobiliry activities.
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Table lli-A.6. Continued
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Device
Description
Clinical Implications
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Totally implantable
Purpose: surgically implanted catheter used for long�term
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Once healed, physical activity is not
intravascular device
chemotherapy, TPN, or other long�teIm infusion therapy.
limited.
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(Port-A-Cath,
Consists of: a completely implanted catheter, usually placed
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Patients can usuaUy swim or bathe
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MediPort)
in the subclavian or jugular vein, terminating in the
without limitation.
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)superior vena cava. Access to the catheter is obtained
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through a tunneled portion attached to a poct that is
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implanted in a subcutaneous pocket in the chest wall,
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usually below the clavicle. The subcutaneous titanium,
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plastic, or stainless steel port has a reservoir with a selfi
sealing septum that is accessed by a special noncoring
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needle through imact skin. The tunneled ponion is
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anchored to a muscle or subcutaneous tissue with sutures.
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Tunneled central
Purpose: surgically implamed cameter used for long-term
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The tailed portion should be taped
venous catheter
chemotherapy. TPN. or other long-term infusion therapy.
down to prevent dislodging.
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(Hickman, Broviac,
May be used for months to years.
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Do not perform manual techniques
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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.