Critical Care / ICU Questions and Answers
what are some elements of entry level safety in acute care
- integrate information from the medical record
- interpret info obtained from the medical chart review, patient self report, vitals monitoring
- consider, plan, and anticipate for possibilities that movement may compromise stability
- determine need to don/doff need for PPE prior to, during, and after PT session to protect the patient,
PT, and the environment survey the patient and environment for all barriers
- ID what role the line/tube is serving for the patient
- safely manage patient's lines and tubes
what are some examples of noninvasive hemodynamic monitoring tools
- BP cuff
- ECG
- pulse oximeter
what are some examples of invasive hemodynamic monitoring lines/leads/tubes
- A line or femoral line
- pulmonary artery catheter
what are the clinical implications of a Peripheral IV (PIV)
- can be capped
- avoid using BP cuff on involved extremity (if possible)
- watch for IV tubing kinks or occlusions
- position patient to avoid occluding flow
- observe patient for signs of phlebitis
- may experience pain at site of IV, wrist, or thumb when weight bearing or using an AD
- NOT medical emergency if dislodged
what is a peripheral IV (PIV)
line that provides temporary access for delivery of medication, fluids, electrolytes, nutrients, or blood
product transfusions
what are the clinical implications of an arterial line (A line)
- EMERGENCY if dislodged
- immediately provide direct pressure to site while calling for assistance
- damped waveform may indicate hypotension
what is an arterial line (A line)
line that provides direct and continuous monitoring of diastolic and mean arterial pressure (MAP)
- source for repeated ABGs
what is the normal waveform given to us by an A line
,biphasic sinusoidal curve
- has dichrotic notch marking end of systole and beginning of diastole
what are the clinical implications of a Central Venous Line
- leads to superior vena cava
- delivers drugs, fluids or blood
- allows blood draws
- used for emergency or long term treatment
what is a central venous line
Allows for long term delivery of medication and reading of central venous pressure
- access is usually through subclavian vein or internal jugular vein
- always terminates at superior vena cava
what are normal values for central venous pressure
0-8 mmHg
what are the clinical implications of a Peripherally Inserted Central Catheter (PICC)
- provides access to large central veins
- used to give medication or liquid nutrition
- can help avoid pain of frequent needle sticks, and reduce risk of irritation to the smaller veins in your
arms
what is a pulmonary artery catheter (Swan Ganz)
- used to monitor right heart function and blood floe in and around the heart
- provides capillary wedge pressure (increased values signal left ventricular failure)
what are normal values for pulmonary artery wedge pressure
4-12 mmHg
what is a nasogastric tube (NG tube)
- keeps stomach empty after surgery and rests bowel by limiting the passage of gastric contents
- reduce gastric pressure and prevents vomiting
- can provide feeding in certain cases
what are the clinical implications of a nasogastric tube (NG tube)
- irritates throat and can inhibit cough
- may hang in front of patients mouth hindering airway clearance
- can be dislodged easily (may need to pin down)
- can be temporarily disconnected from suction to mobilize patient (monitor for nausea and abdominal
distention, open end should be capped, tubing should be secured to prevent dislodging)
what are the clinical implications of an enteral feeding tube
, - aspiration precautions
- head of bed needs to be elevated a minimum of >25-30 degrees when feeding
- place feedings on hold when HOB is flat for an extended period of time to minimize risk of
regurgitation and aspiration
what is a Nasojejunal tube (NJ tube)
feeding tube that passes through the nose, throat, esophagus, continues through the stomach, and ends
in the first section of the small intestine
what is a percutaneous endoscopic gastronomy tube (PEG tube)
feeding tube directly inserted into the stomach
what is a jejunostomy tube (J tube)
feeding tube directly inserted into the jejunum
what is a Jackson-Pratt / Hemovac
surgical drains that remove excess air, blood, or fluid from surgical site that would other wise collect
internally
- need to empty prior to mobilization
- can be facilitates by gravity or negative pressure
what is patient controlled analgesia (PCA)
Analgesic that can be delivered to patient via IV or epidural placed into the arachnoid or subarachnoid
space
- portable
- patient must push button to deliver medication
- therapist / family CANNOT push button
- can get a bolus from the nurse
what is a lumbar drain
drains CSF from the subarachnoid space within the lumbar spine
what are the clinical implications of a lumbar drain
- transducer and drainage bag are set to a certain level in relationship to the patient (gravity dependent)
- drainage can be temporarily stopped to allow for mobilization
- any change in patient position must result in the nurse changing the height of the drainage bag and
transducer
- monitor for changes in neurological status
- avoid coughing, sneezing, straining, valsalva maneuver
what is an Extra-Ventricular Drain (EVD)
what are some elements of entry level safety in acute care
- integrate information from the medical record
- interpret info obtained from the medical chart review, patient self report, vitals monitoring
- consider, plan, and anticipate for possibilities that movement may compromise stability
- determine need to don/doff need for PPE prior to, during, and after PT session to protect the patient,
PT, and the environment survey the patient and environment for all barriers
- ID what role the line/tube is serving for the patient
- safely manage patient's lines and tubes
what are some examples of noninvasive hemodynamic monitoring tools
- BP cuff
- ECG
- pulse oximeter
what are some examples of invasive hemodynamic monitoring lines/leads/tubes
- A line or femoral line
- pulmonary artery catheter
what are the clinical implications of a Peripheral IV (PIV)
- can be capped
- avoid using BP cuff on involved extremity (if possible)
- watch for IV tubing kinks or occlusions
- position patient to avoid occluding flow
- observe patient for signs of phlebitis
- may experience pain at site of IV, wrist, or thumb when weight bearing or using an AD
- NOT medical emergency if dislodged
what is a peripheral IV (PIV)
line that provides temporary access for delivery of medication, fluids, electrolytes, nutrients, or blood
product transfusions
what are the clinical implications of an arterial line (A line)
- EMERGENCY if dislodged
- immediately provide direct pressure to site while calling for assistance
- damped waveform may indicate hypotension
what is an arterial line (A line)
line that provides direct and continuous monitoring of diastolic and mean arterial pressure (MAP)
- source for repeated ABGs
what is the normal waveform given to us by an A line
,biphasic sinusoidal curve
- has dichrotic notch marking end of systole and beginning of diastole
what are the clinical implications of a Central Venous Line
- leads to superior vena cava
- delivers drugs, fluids or blood
- allows blood draws
- used for emergency or long term treatment
what is a central venous line
Allows for long term delivery of medication and reading of central venous pressure
- access is usually through subclavian vein or internal jugular vein
- always terminates at superior vena cava
what are normal values for central venous pressure
0-8 mmHg
what are the clinical implications of a Peripherally Inserted Central Catheter (PICC)
- provides access to large central veins
- used to give medication or liquid nutrition
- can help avoid pain of frequent needle sticks, and reduce risk of irritation to the smaller veins in your
arms
what is a pulmonary artery catheter (Swan Ganz)
- used to monitor right heart function and blood floe in and around the heart
- provides capillary wedge pressure (increased values signal left ventricular failure)
what are normal values for pulmonary artery wedge pressure
4-12 mmHg
what is a nasogastric tube (NG tube)
- keeps stomach empty after surgery and rests bowel by limiting the passage of gastric contents
- reduce gastric pressure and prevents vomiting
- can provide feeding in certain cases
what are the clinical implications of a nasogastric tube (NG tube)
- irritates throat and can inhibit cough
- may hang in front of patients mouth hindering airway clearance
- can be dislodged easily (may need to pin down)
- can be temporarily disconnected from suction to mobilize patient (monitor for nausea and abdominal
distention, open end should be capped, tubing should be secured to prevent dislodging)
what are the clinical implications of an enteral feeding tube
, - aspiration precautions
- head of bed needs to be elevated a minimum of >25-30 degrees when feeding
- place feedings on hold when HOB is flat for an extended period of time to minimize risk of
regurgitation and aspiration
what is a Nasojejunal tube (NJ tube)
feeding tube that passes through the nose, throat, esophagus, continues through the stomach, and ends
in the first section of the small intestine
what is a percutaneous endoscopic gastronomy tube (PEG tube)
feeding tube directly inserted into the stomach
what is a jejunostomy tube (J tube)
feeding tube directly inserted into the jejunum
what is a Jackson-Pratt / Hemovac
surgical drains that remove excess air, blood, or fluid from surgical site that would other wise collect
internally
- need to empty prior to mobilization
- can be facilitates by gravity or negative pressure
what is patient controlled analgesia (PCA)
Analgesic that can be delivered to patient via IV or epidural placed into the arachnoid or subarachnoid
space
- portable
- patient must push button to deliver medication
- therapist / family CANNOT push button
- can get a bolus from the nurse
what is a lumbar drain
drains CSF from the subarachnoid space within the lumbar spine
what are the clinical implications of a lumbar drain
- transducer and drainage bag are set to a certain level in relationship to the patient (gravity dependent)
- drainage can be temporarily stopped to allow for mobilization
- any change in patient position must result in the nurse changing the height of the drainage bag and
transducer
- monitor for changes in neurological status
- avoid coughing, sneezing, straining, valsalva maneuver
what is an Extra-Ventricular Drain (EVD)
