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Level II Fieldwork: Acute Care 101

Managing Lines
Common lines and devices seen in acute care
 Peripheral IV:
o Short catheter inserted to a peripheral vein (usually in the arm
or hand).
o Used for pts to receive fluid and/or medication and is usually
connected to the IV pump. You can unhook the IV pole from the
wall for easier mobility.
o Watch out for:
 Make sure the IV is not kinked or tangled, the alarm will
sound if kinked.
 Make sure that if you unplug the IV pole, you always plug
it back in.
 ROM testing might be painful in arm or hand with the IV.
 Art Line:
o Catheter that is inserted into an artery, usually in the wrist,
groin, armpit, or foot.
o Used to monitor blood pressure and obtains samples for arterial
blood gas measurements. You can mobilize pts with art lines,
just be careful.
o An artline (ideally) should be level with the pt’s heart. Try not to
make the line fall to the floor. The art line and it’s transducer will
usually be tied with a red band to the side of the bed. You can
untie them, but make sure to hold the line level or tape it to the
pt’s gown.
 Vas cath
o Typically placed in the groin or the jugular.
o Used for hemodialysis
o Check with the nurse or MD if placed in groin for LE ROM
restrictions, there are no restrictions if in jugular.
 EVD (External ventricular drain)
o Placed when there is fluid on the brain, thereby lowering
intracranial pressure.
o The MD uses a twist drill to gain intracranial access and the drain
is placed in the ventricle.
o The EVD MUST be clamped by the nurse before we mobilize the
pt.
o If pt is in restraints, keep a close eye on them reaching for EVD
during mobilization.
 EEG (Electroencephalogram)
o Test that is used to detect electrical activity of the brain using
small electrodes attached to the scalp.
o This test is usually performed for pts who are suspected to have
seizure activity.
o A therapist can perform therapy if pt is on continuous EEG
(attached to them for long period of time without direct
monitoring).
o A therapist cannot perform therapy session if EEG is planned and
not continuous.

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 Chest tube
o Tube inserted through the side of the chest and into the pleural
space. It is connected to a box/container that can be set to
suction.
o Pts with chest tubes usually have an accumulation of fluid, air, or
blood in the plural space.
o Avoid knocking over the chest tube. If the chest tube is knocked
over, contact nursing immediately. Also, keep in mind that the
pt might be in pain around where the tube is inserted.
 NG (Nasal Gastric tube)
o Carries food and medicine to the stomach through the nose.
o When feedings are running (identify on the monitor) pt must be
sitting in bed in at least 30 degree angle to decrease risk of
aspiration.
o If needing to lay pt flat, put feedings on “hold” by pressing the
button on the monitor.
 Endotracheal tube
o Inserted through the mouth and into the trachea.
o Primary purpose is to protect and maintain pt’s airway and
ensure adequate exchange of oxygen and carbon dioxide.
o Make sure to keep tubing in neutral position to prevent pulling
or strain on the tube.
o Always transfer the pt to the side of the ventilator.
 LVAD (Left Ventricular Assist Device)
o Battery operated mechanical pump-type device that is surgically
implanted through a sternotomy. The device helps the heart
pump effectively. Pt has to have special training in order to
operate the device.

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 Jackson Pratt drain (JP drain)
o Closed suction drain that draws out fluid that collects under your
incision. A pt can mobilize with these drains, but it is best to
have them supported during the process so they are not just
hanging.
o Try to avoid pts rolling or sitting on the drains.
 Wound Vac
o A type of system that helps wounds heal more quickly. They can
drain excess fluid, reduce swelling, reduce bacteria in the
wound, keep the wound warm and moist, and help increase
blood flow to the wound.
o The wound vac must have enough slack during mobilization and
must be carried with you, as it is attached to the pt. Most wound
vacs have a battery, so they do not have to be plugged in at all
times, but once you leave the pt, make sure it is plugged back
into the power source.
 Prophylaxis
o Will most likely be seen in every room. This machine compresses
the calves to prevent DVTs.
o You can unplug the cords from the machine and keep the
stockings on the pt. If the pt is getting back in bed after the
session, then make sure to plug the stockings back into the
machine.

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 Foley Catheter
o A thin sterile tube inserted into the bladder through the penis or
urinary meatus to drain urine.
o Make sure that the catheter is on the same side of the bed as
the pt is exiting and has plenty of slack when mobilizing.
o Always keep catheter below pt’s waist to prevent back flow.

 Other lines:
o PICC line: used when intravenous access is required for long
period of time. Typically used for chemo therapy, or extended
antibiotic therapy.
o Central line: located in superior or inferior vena cava. Used when
medications need to go directly to the heart and distributed
quickly.
o Oxygen and HR monitor: very common lines in all pts in the ICU.
Typically, they are both okay to unplug for mobility. If a pt’s
oxygen saturation decreases quickly, or they are
tachycardic/bradycardic, you might consider leaving them
plugged in while mobilizing in room.

Supplemental Oxygen Delivery


o Nasal Cannula (NC, BNC)
o Carries 1-6 L of oxygen per minute.
o For mobilization, pt can be hooked to portable oxygen tank that
is set on the same setting that they are on in the room. In
documentation, document how many liters the pt is on.
o High Flow Nasal Cannula
o Can give up to 15 L of oxygen.

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o Venturi Mask (venti mask)
o Delivers constant FiO2 regardless of changes in ventilation
pattern.
o Can be increased to maximum of 50%. In documentation,
document the percentage the pt is on.
o Nonrebreather (NRB)
o Inhalation of pure 02, 100%.
**Therapist should never change the oxygen supply of the pt without
notifying and getting approval from RN. If pt is on high flow of 02,
keeping the oxygen monitor on would be beneficial. Allow plenty of rest
breaks to recover, and try to keep oxygen 88-100%.

Common Contraindications for Therapy


 In the ICU, the therapist must always get approval from the RN to
complete an evaluation or therapy session. If a RN wants to hold off
on therapy for the day, the therapist just documents that the pt was
unavailable due to change it status, or what the RN reports.
 Tpa -a medication that dissolves blood clots. It is a thrombolytic agent
that is used to treat an ischemic stroke. The idea is to restore blood
flow to the brain by dissolving the clot. Therapy must hold for 24
hours after tPA administration.
 Femoral sheath-pt is placed on bedrest, must check with nursing or
MD to see when bedrest is up and therapy is okay to mobilize.
 Chest tube pulled- the pt will most likely be on bed rest, check with
MD or RN for clarification.
 INR >4
 Unknown weight-bearing status, call RN or MD to get confirmation.
 Other contraindications can be found in the new employee handbook

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When to Terminate Treatment Session
 Oxygen becomes 85% or less without successful recovery
 HR becomes greater than Max HR (220-age)
 Pt with extreme fatigue to the point of not being able to participate
 Pt refusal
 MAP (mean arterial pressure) less than 60
 Pt becomes diaphoretic (excessive sweating, pale, increased breathing
rate)

Common tests and procedures


Angiography or Angiogram- helps detect the narrowing or obstruction of a
blood vessel or artery in the head, neck, or brain. The test takes 1-2
hours to complete. Catheter is inserted into the artery (usually the leg)
and threaded up through the abdomen and chest until in neck. The
contrast dye is injected and x-ray takes pictures of the artery.
CT (Computed tomography) scan: can clearly show the small bones in the
body, as well as surrounding blood vessels and muscles. It is used to
locate brain damage, detecting clots or bleeding, brain tumors, enlarged
ventricles, and detecting spinal stenosis. CT usually takes 10-15 min to
complete and is fast and painless.
MRI (Magnetic Resonance Imaging): 3D pictures of body structures. Used for
detecting brain and spinal tumors, detecting strokes, and diagnosing
nervous system disorder.
PET (Positron Emission Tomography: a nuclear diagnostic test that can
detect and stage cancer. It can determine if a tumor is benign or
malignant. It can also detect subtle metabolic changes.
Echocardiogram (ECHO): A test that examines the graphic outline of the
heart’s movement. A probe is placed on the chest and it sends

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ultrasound waves that provides pictures of the hearts valves and
chambers so the action of the heart can be studied.
Electrocardiogram (EKG)- records electrical impulses in the heart. Electrodes
are placed on the chest and the monitor will chart your hearts electric
activity on graph paper.
Ultrasound: uses sound waves to produce images inside the body of internal
organs. It helps diagnose the cause of pain, swelling, or infection inside
the body. Ultrasound is non-invasive.

Med terms overview


Prefixes
Angio- blood vessel Lapar- abdominal cavity

Arthr- joint Mammo- related to breast

Colono- colon/large intestine Myo-muscle

Cysto- bladder Nephro- kidney

Encephal- the brain Oophor- ovary

Gastr- stomach Orchid-testicle

Hepat- liver Rhino-nose

Hyster- uterus Thoraco-chest

Suffixes
Centesis-surgical puncture
Desis- fusion of two parts into one
Ectomy- surgical removal
Opsy- looking at
Oscopy- viewing of, usually with a scope

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Ostomy- surgically creating a hole
Otomy-surgical incision
Pexy-to fix or secure
Plasty- to modify or reshape

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References
Smith-Gabai, H., & American Occupational Therapy Association. (2011). Occupational therapy in
acute care. Rockville, MD: AOTA Press.

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