Professional Practice in Patient Care February 28th,2013 Lesson 7 Professional Practice in Patient Care February 28th,2013

Patients with Tubes or Tubing Common types of tubing: Intravenous (IV) infusion Nasogastric suction Urinary catheters Nasal catheters and cannulae

Intravenous Equipment IV tubing Is used to infuse fluids into the patient’s body The flow of fluid is measured by a drip meter. A clamp on the tubing regulates flow. Computerized infusion pumps may be used to regulate drip rate.

Intravenous Equipment Immediately report any of the following: Nausea, vomiting, rapid breathing, or an increase in pulse rate. No solution passing from the bottle into the tubing. The plastic drip chamber is completely filled with solution. Blood appears in the tubing at the needle end. Most or all of the solution is gone. The needle has come out. Pain, tenderness, inflammation at the needle insertion site. The tubing becomes disconnected, and the patient is bleeding freely from the connection site. Do not let bag drop lower than insertion site on patient.

Nasogastric Tube Nasogastric (NG) tube Terminates in the patient’s stomach or intestine Used for feeding, to obtain specimens, to treat intestinal obstructions, or to drain fluids from the patient’s stomach by suction Never pull on the tube when moving these patients or changing their positions.

Nasogastric Tube

Oxygen Therapy Large oxygen cylinders: Small oxygen cylinders: Used for patients requiring high flow rates or oxygen use over extended periods Have a metal cap screwed onto the top of the cylinder to protect the valve from damage Small oxygen cylinders: Used during patient transport or other short duration needs Have a rectangular valve (without a handle), which has three holes on one side

Oxygen Therapy Do not: Transport a high-pressure cylinder unless secured in a cylinder cart Allow a cylinder to stand free Transport patients on a stretcher with a cylinder lying next to them Place a cylinder near a source of heat Contact with any combustible material causes oxygen to ignite, burn or explode!

Oxygen Therapy Wall-mounted oxygen flowmeter.

Nasal Cannula

Nasal Catheter A piece of tubing longer than a cannula Inserted through the nostril into the back of the patient’s mouth Is used when the patient must have additional oxygen at all times Is fastened to the patient’s forehead or cheek by a piece of adhesive tape

Oxygen Face Mask

Partial Rebreathing Mask

Precautions For Working with Patients Receiving Oxygen Therapy Observe all fire regulations. Check the flowmeter. The water level in the humidifying chamber should be high enough so that it bubbles as the oxygen goes through it. The tubing connected to the oxygen source should be taped to the patient to keep it from being pulled when moving the patient. Be sure the tubing is not kinked and that the patient is not lying on it.

Urinary Catheters A urinary catheter is inserted through the urethra and into the bladder. May be used to obtain sterile specimens or to determine how much urine remains in a patient’s bladder after urination A retention, or indwelling, catheter is a system used to provide temporary or permanent drainage of urine.

Catheterization Equipment

Urinary Catheters Patients scheduled for ob/gyn sonography who cannot fill the bladder or maintain a full bladder for the duration of the examination must be catheterized. Bladder filling is not required for transvaginal examinations.

Foley Catheter Foley catheters have two tubes, one inside the other. Inner tube connected at one end to a small balloon After catheter is inserted into the urethra, the balloon is filled with water or air to hold it in place. Urine drains from the bladder through the outer tube and collects in a container attached to the patient’s bed or table. Clamping or unclamping the tubing controls the flow of urine. The catheter bag must always be lower than the patient’s urinary bladder. Catheterization is a sterile technique.

Wound Drains Plastic tubes that provide a way for fluid, blood, or air to drain out of the body. One end of a wound drain is placed within the wound and the other may be connected to a suction collection device. The fluid may be collected in a drainage bag, plastic bulb, or onto a dressing. Sonographers must avoid pulling or dislodging wound drains during patient positioning or transfer.

Colostomies and Ileostomies A colostomy is an opening into the colon. An ileostomy is an opening into the ileum. The colostomy or ileostomy opening (stoma) is covered by plastic disposable bags or pouches.

Colostomies and Ileostomies Use clean technique. Wear gloves at all times. Tape a folded gauze pad around the stoma to absorb any discharge and to protect the scanning surface during the examination. Use sterile technique if scanning near open wounds. If scanning over the open wound, apply sterile gel to the area and cover it with a protective thin plastic film. Apply another layer of sterile gel to the top of the film to ensure an airless contact with the transducer and the scanning surface.

Wound Dressings Covers wound to protect it from further injury or infection and to absorb drainage The sonographer must remove and replace dressings during an examination. Sterile dressing changes usually the responsibility of the nursing staff. Check before removing a dressing to see if wound isolation precautions are in effect.

Wound Dressings If wound isolation precautions are not required, perform the following steps: Wear gloves, wash hands or use sterile scanning media. Be careful not to dislodge scabs when removing a dressing. Be sure adhesive tape used to secure new dressings does not irritate the patient’s skin. Report anything unusual about the wound. Discard soiled dressings and gloves properly, and wash hands thoroughly.

Bedpans When handling bedpans and their contents, follow medical aseptic, Standard Precautions, and Bloodborne Pathogen Standards. If the patient is of childbearing age and experiencing heavy vaginal bleeding, inspect the contents for the presence of any products of conception. Report any unusual color, amount, or condition of the wastes to the charge nurse. You may be required to save the specimen for laboratory testing.

Urinals Male patients use urinals for voiding. Urinals have a cap on the top and a hook- like handle. The patient should stand to urinate. If patient cannot stand, he can sit on the side of the scanning table or bed or lie down on the bed.

Emesis Basins (K Basin) If patient feels nauseated, turn his or her head well to one side to prevent aspiration of vomit. Place an emesis basin under the patient’s chin. Observe the emesis for color, odor, and any undigested food. If the appearance resembles dark “coffee grounds,” it is evidence of undigested blood. You may be required to save a specimen for laboratory testing.