Lecture/Workshop on Nursing Procedures on Patients With Contraptions

Lecture/Workshop on Dealing Patients With Contraptions- James Joseph B. Obispo RNWhen we finished nursing school, everyone has knowledge on every basic procedures using different kinds of contraptions and machines for patient care. But mastery on it depends on the availability on the mentioned above and how of often a nurse uses them.IntroductionTo be able to teach the participants the importance of stock knowledge with regards to basic nursing proceduresTo orient the audience when and how to use the hospitals machines and gadgetsTo let the participants experience handling different kinds of tools and machines in rendering patient monitoring and careTo know some of the trouble shooting methods for each contraptions Objectivescreation of a small incised opening, especially over a vein,to facilitate venipuncture and permit passage of a needle or cannula for withdrawal of blood or administration of fluids.Also called venostomy1. Cutdown

Venous Cutdown (Carotid Vein)Steps in Making a Cutdown

Sites for Venous Cutdown

IVF lineHydrationIV medication accessAdministration of IV dripsTPNBlood transfusionChemotherapyWithdrawing of blood samplesUses of CutdownMake sure consent is securedHealth teachingsPreparing patient and materialsSetting up and regulating IV lineWoundcare ODMonitoring and maintaining patency of IV lineAssisting in removalNursing ResponsibilitiesBlade 10Dressing kitOGT fr.5 and fr.8 IV fluid (D5W)MicrosetLidocaine3 way stopcock5 cc syringeSterile glovesMaterials Needed:But a venous cutdown is different from a CVP lineNurse ano pagkakaiba nun?

Central Venous Pressuredescribes the pressure of blood in the thoracic vena cava, near theright atriumof the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system.Normal value is 5-10cmH2O

CVPWith the CV line in place, position the patient flat.

Align the base of the manometer with the previously determined zero reference point by using a leveling device.

Because CVP reflects right atrial pressure, you must align the right atrium (the zero reference point) with the zero mark on the manometer.

To find the right atrium, locate the fourth intercostal space at the midaxillary line.

Mark the appropriate place on the patients chest so that all subsequent recordings will bemade using the same location.

If the patient cant tolerate a flat position, place him in semi-Fowlers position. When the head of the bed is elevated, the phlebostatic axis remains constant but the midaxillary line changes. Use the same degree of elevation for all subsequent measurements. Attach the water manometer to an I.V. pole or place it next to the patients chest. Make sure the zero reference point is level with the right atrium.How to Measure a CVP?Phlebostatic Axis

CVP is elevated by :overhydration which increases venous returnheart failure or PA stenosis which limit venous outflow and lead to venous congestionpositive pressure breathing, straining,CVP decreases with:hypovolemic shock from hemorrhage, fluid shift, dehydrationnegative pressure breathing which occurs when the patient demonstrates retractions or mechanical negative pressure which is sometimes used for high spinal cord injuries.

CVPWhat does a Modified Intermittent CVP Monitor Looks Like?

CVP Monitor Set-up

Peripherally Inserted Central CatheterMay be viable up to 4 weeksInserted up to the right atriumPICC LineSite of PICC

IVF lineHydrationCVP monitoringIV medication accessAdministration of IV dripsTPNChemotherapyWithdrawing of blood samplesBlood transfusionCVP readingUses of PICCAll Lines blocked

IV to Manometer

IV to Patient

Make sure consent is securedHealth teachingsPreparing patient and materialsSetting up and regulating IV lineWoundcare ODMonitoring and maintaining patency of IV lineMonitoring of CVP valuesAssisting in removalNursing ResponsibilitiesFlush with 10cc NSSAdminister low concentration of heparin as per doctors orderIf clogged:is a flexible plastic tube that is inserted through the chest wall and into thepleural spaceormediastinum. It is used to remove air (pneumothorax) or fluid (pleural effusion,blood), or pus (empyema) from the intrathoracic space. It is also known as a Blaudrainor an intercostal catheter.Safe zone (5th intercostal space slightly anterior to mid axillary areaChest Thoracostomy Tube

Patient with CTT

CTT PlacementCTT fr. 28 32Sterile glovesMinor setDressing kitLidocaineBlade 105 cc syringeCTT bottleGlass tubings with rubber stopperConnecting tubesLeukoplast

Materials:

Pleur-evacEksensa sa hospitalDoc: nurse pakiset-up si patient x ng 2 way bottle system tapos si patient y sa 3 way bottle systemNurse: naku doc di po ako marunong eDoc: ako din eh!

CTT and Bottle Set-upMake sure consent is securedHealth teachingsPreparing patient and materialsq shift monitoring of CTT outputWound care ODCTT bottle change OD

Nursing ResponsibilitiesInstruct patient to have several deep breaths then at the count of 3 instruct to exhale deeplyCover incision with sterile gauze with lubricantPack wound and dress accordinglyWhen removing CTT:Always monitor CTT output q1 at 1st 8hrs then as neededMonitor for the colour, amount, fluctuation, and bubblingNever allow CTT to drain more than 100cc per hourAlways keep CTT and lines secured and air tightAlways have a clamp and ready to wet gauze available

Nursing ConsiderationsWhat are you going to do is CTT output is not fluctuating?

Wag magpanic!

Immediately clamp CTTAssess patientCheck for patencyCheck if still in water sealed set-upGently aspirate CTT with a 50cc syringeMilk or strip

When not fluctuating:

Emerson Post-operative PumpWhat it actually looks like?

A suction device that uses negative pressure to drain extra fluid from the pleural spaceIt has a meter, calibrations, and modes used in specific types of suctioning

Emerson Pump CallibratorsOff time intervalOn time - duration

Pressure Meter

Pedia - 5-10 hp of intermittent suctioning at 15 minutes duration and 60 minutes interval Adult - 10-20 hp of intermittent suctioning at 15 minutes duration and 60 minutes intervalCommon set-upHow to set up:

A machine that measures and records patients vital signsPatient MonitorRecords Patients dataMeasures and records VS BPHRRRSPO2TempDrug calculationsECG Reading

Functions of the Patient Monitor

Sample of a Patient Monitor

Lead PlacementOur Hospitals Patient Monitor

Never treat the monitor!

Instead, treat the patient

A machine that delivers respirations and calibrated oxygen to patients via ET tube of tracheostomy tubeMechanical VentilatorNurse paset-up ng vent

VelaSIMV patients with spontaneous respirationsA/C patients with weak respiratory muscles or patients without spontaneous respirationsModes:Fio2 O2 percentage delivered to patientTidal Volume- amount of air delivered to patientBUR rate or cycle of respiration

Now we are done with the lecture, are there any questions?

If noneThank you very much for listeningReturn demo will commence in 5 mins