Triple Lumens, Ports & PICCs.. Oh My!
What is the frequency of central line dressing changes, including triple lumens, ports and PICC lines?
Every 7 days or whenever the dressing is compromised?
Nurses should never do this unless ordered, as this can cause a tension pneumothorax.
Clamping the tube.
To have a PCA, your patient must be physically and mentally able to do this.
Push the button.
What is the maximum amount of sterile water to instill in a Flexiseal?
45 mL
The gold standard of NGT placement confirmation is:
A chest x-ray.
What supplies are needed for a port dressing change?
A port dressing change kit, Sterile Saline Flush, Huber needle, needleless access device and swab caps.
What is crepitus or subcutaneous emphysema?
The leakage of air into the subcutaneous tissues surrounding the insertion site.
How often should vitals, pain and RASS be assessed and documented?
Every 15 minutes for the first hour, every 30 minutes for the second hour, every hour for 4 hours, then every 4 hours while on the PCA OR with any changes to settings.
What are indications of a flexi-seal?
Liquid stool, pressure injury,
True or False: A facial fracture is not a contraindication to an NGT insertion.
False- An NGT should never be inserted in a patient with facial or nasal bone fractures / trauma.
All patients with a central line must be bathed daily using this.
A CHG bath.
What will you see in the water-seal chamber if a patient has an air-leak?
Constant bubbling in the water seal chamber.
What is needed during PCA initiation, settings change and handoff between outgoing and incoming RN?
A Two RN independent check.
29 days.
When should a nurse assess placement of a patient's NG tube?
With every assessment and prior to using (before meds, before starting tube feeds).
When should the needless access device be changed?
Every 96 hours, when there is residual blood or debris that cannot be cleared and when contaminated.
What are causes of no tidaling in the water seal chamber?
A clot, tube dislodgment from the patient's chest, a kink in the tubing or disconnection from the chest tube chamber.
What are the components in a PCA order?
Your patient is s/p a rectal tumor resection 6 months ago. He has a stage 3 pressure injury and has developed diarrhea as a complication of antibiotics. The phyisican orders a rectal tube be inserted to prevent wound contamination. What is the appropriate next step you should take?
When a patient has an NGT, it is important to maintain the HOB at least ______ degrees.
30
When removing a central line dressing, the dressing should be removed this way.
Away from the hub and towards venipuncture site.
When would you call an RRT for your patient with a chest tube?
If your patient with a chest tube experiences respiratory distress, there is an increase in bloody drainage in the chamber, the chest tube gets dislodged or your patient becomes unstable.
You notice your patient on a PCA pump is more somnolent than normal and the respirations are 6 breaths per minute. What do you do?
Pause the PCA, get a set of vitals, inform the provider / Call an RRT !
Rectal medication administration (ie- rectal vancomycin for c.diff).
A patient receiving tube feeds via an NGT starts to cough up tan secrections. What is your next step?
Hold the tube feeds, notify LIP, replace tube & get chest xray, monitor patient status.