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Aacn procedure manual for critical care 6th edition free download |
Aacn procedure manual for critical care 6th edition free download
Procedures are described step by step, with identification and delineation of rationale, special considerations, expected and unexpected outcomes, patient monitoring, documentation, and references. Icons identify procedures that require, for example advanced skills, hand hygiene, or personal protective equipment. Charts, tables, diagrams,and illustrations are all designed to present information efficiently and well.
You may also like. Comment Cancel reply. Conditions the tissue is then converted to a digital value such as increased pH, decreased temperature, decreased representing the percentage of hemoglobin saturated PaCO2, and decreased 2,3-DPG will increase oxygen binding with oxygen Fig.
For example, in some patients, there is a patient's oxygenation status and are not a substitute for difference in SpO2 values at rest compared with those during measurement of arterial partial pressure of oxygen activity, such as ambulation or positioning. PaO2, or of ventilation. Reprinted by saturation. The affinity of hemoglobin to oxygen may permission of Mallinckrodt I nc.
Sensor types and sensor sites for pulse oximetry monitoring. Use "wrap" style sensors on the fingers including thumb , great toe, and nose. The windows for the light source and photodetector must be placed directly opposite each other on each side of the arteriolar bed to ensure accuracy of Sp02 measurements. Choosing the correct size of the sensor will help decrease the incidence of excess ambient light interferences and optical shunting. Ensuring that the arteriolar bed is well within the clip with the windows directly opposite each other will decrease the possibility of excess ambient light interference and optical shunting.
Reprinted by permission of Mallinckrodt Inc. Therefore, enhancing the patient's Sp02 may limit his or Rationale: Providing an understanding of the use of an alarm her ability to ventilate. The baseline Sp02 for a patient with system and its importance in the overall management of the known severe restrictive disease needs to be considered. Dark nail polish and bruising under the the bedside.
Readings in the presence Patient Assessment of carbon monoxide will be falsely elevated. Anticipation of conditions in which hypoxia could be present allows earlier intervention before unfavorable outcomes occur. Answer questions as they arise, and reinforce information as needed.
Wash hands, and use personal protective Reduces transmission of microorganisms and body equipment. Select the appropriate pulse oximeter The correct sensor optimizes signal capture and Several different types of sensors are sensor for the area with the best pulsatile minimizes artifact-related difficulties. These include disposable and vascular bed to be sampled Fig.
Use nondisposable sensors that may be applied of finger probes has been found to produce over a variety of vascular beds. Select desired sensor site. If using the Adequate arterial pulse strength is Avoid sites distal to indwelling arterial digits, assess for warmth and capillary necessary for obtaining accurate SpO2 catheters, blood pressure cuffs, military refill. Confirm the presence of an measurements.
Plug oximeter into grounded wall When using electrical outlets, grounded Portable systems have rechargeable outlet if the unit is not portable. If the outlets decrease the occurrence of batteries and are dependent on sufficient unit is portable, ensure sufficient electrical interference. Plug patient cable into monitor. When system is used in the portable mode, always check battery capacity. Apply the sensor in a manner that To properly determine a pulse oximetry allows the light source light-emitting value, the light sensors must be in diodes to be: opposing positions directly over the area of the sample.
Directly opposite the light detector photodetector Level IV: Limited clinical studies to support recommendations B. Shielded from excessive Light from sources such as examination If the oximeter sensor fails to detect a environmental light lights or overhead lights can cause pulse when perfusion seems adequate, Level V: Clinical studies in more elevated oximetry values.
Troubleshoot by reapplying the sensor or shielding the sensor with a towel or blanket. All sensor-emitted light comes in If the light is seen directly from the Known as optical shunting, the light contact with perfused tissue beds and sensor without coming in contact with bypasses the vascular bed.
Shielding the is not seen on the other side of the the vascular bed, too much light can be sensor will not eliminate this if the sensor sensor without coming in contact with seen by the sensor, resulting in either a is too large or not properly positioned. Restriction of arterial blood flow can D. The sensor does not cause restriction The pulse oximeter is unable to cause a falsely low value as well as lead to arterial flow or venous return.
Edema from support recommendations accumulation. Elevating the site above the level of the heart will reduce the possibility of venous pulsations. Moving the sensor to another site on a routine schedule will also reduce tissue compromise. If the pulse rate detected This problem occurs particularly with of a monitored heart rate or an by oximeter does not correlate with the the use of the fingers and the toes in apical heart rate or both.
Set appropriate alarm limits. Heart rate alarms should be consistent with the cardiac monitoring limits if monitored. Reduces transmission of microorganisms to Wash hands. Patient Monitoring and Care Patient Monitoring and Care Rationale Reportable Conditions These conditions should be reported if they persist despite nursing interventions.
Data should be integrated into a complete assessment to determine the overall status of the patient. Monitor the site for excessive movement.
Excessive movement of the sampled site may result in unreliable saturation values. Moving the sensor to a less physically active site will reduce motion artifact. Using a lightweight sensor will also help. If the digits are used, ask the patient to rest the hand on a flat or secure surface. A difference in heart rate and pulse rate from oximeter oximeter to determine accuracy of values. Grap MJ. Pulse oximetry. Crit Care Nurse. Rutherford KA. Principles and application of pulse oximetry.
Crit Care Nurs Clin Am. Siegel MN, Garvenstein N. Preventing ambient light from affecting pulse oximetry. A simple method to prevent interference with pulse oximetry by infrared heating lamps. Anesth Analg. Ambient light affects pulse oximeters. Use of pulse oximetry in critically ill adults. Heart Lung. Additional Readings Carroll P. Using pulse oximetry in the home. Home Healthc Nurse.
Tittle M, Flynn MB. Correlation of pulse oximetry and co-oximetry. Dimens Crit Care Nurs. Respir Care Clin N Am. Archives of Disease in Childhood Pulse oximetry in sickle cell disease. Journal of Chiropractic Medicine The use of pulse oximetry in chiropractic practice: a rationale for its use: the authors' response. Journal of Clinical Monitoring and Computing Non-invasive cardiac output and oxygen delivery measurement in an infant with critical anemia.
Journal of Clinical Monitoring and Computing Pulse oximetry-derived respiratory rate in general care floor patients. American Journal of Critical Care New-generation pulse oximetry in the care of critically Ill patients. Seminars in Fetal and Neonatal Medicine Monitoring oxygen saturation and heart rate in the early neonatal period. Oxygen therapy and oximetry in the delivery room. Preliminary evaluation of a new fibre-optic cerebral oximetry system.
Pulse oximetry in the oesophagus.
❿Aacn procedure manual for critical care 6th edition free download - Document Information
You may also like. Comment Cancel reply. Rationale: Removal ensures that objects do not advance farther into the airway during insertion. Rationale: This positioning promotes patient and nurse comfort and provides easy access to the oral cavity. Maintain cervical stabilization in a trauma patient, using the jaw-thrust technique only. Rationale: Opening the airway can prevent obstructions that result from posterior displacement of the tongue and epiglottis.
A, Advance airw ay w ith curved end up. B, Rotate airw ay degrees. In ACLS: principles and practice,. Dulak, S. Placing an oropharyngeal airway. Pierce, L. Management of the mechanically ventilated -patient,.
Care of mec hanic ally ventilated patients. Jones and Bartlett, S udbury, MA, S ec kel. PURPOSE: Endotracheal or tracheostomy tube suctioning is performed to maintain the patency of the artificial airway and to improve gas exchange, decrease airway resistance, and reduce infection risk by removing secretions from the trachea and main-stem bronchi.
Suctioning also may be performed to obtain samples of tracheal secretions for laboratory analysis. The presence of these artificial airways, especially endotracheal tubes, prevents effective coughing and secretion removal, necessitating periodic removal of pulmonary secretions with suctioning.
In acute care situations, suctioning is always performed as a sterile procedure to prevent hospital-acquired pneumonia. In the open-suction technique, after disconnection of the endotracheal or tracheostomy tube from any ventilatory tubing or oxygen sources, a single-use suction catheter is inserted into the open end of the tube. In the closed-suction technique, also referred to as in-line suctioning, a multiple-use suction catheter inside a sterile plastic sleeve is inserted through a special diaphragm attached to the end of the endotracheal or tracheostomy tube Fig.
The closed-suction technique allows for the maintenance of oxygenation and ventilation support, which may be beneficial in patients with moderate to severe pulmonary insufficiency. In addition, the closed-suction technique decreases the risk for aerosolization of tracheal secretions during suction-induced coughing.
When clinical indicators of the need for suctioning exist, there is no absolute contraindication to suctioning. In situations in which the development of a suctioning complication would be poorly tolerated by the patient, strong evidence of a clinical need for suctioning should exist. These areas of damage increase the risk of infection and bleeding. Use of special-tipped catheters, low levels of suction pressure, or intermittent suction pressure has not been shown to decrease tracheal mucosal damage with suctioning.
Instillation of a bolus of normal saline solution does not thin secretions, may cause decreases in arterial and mixed venous oxygenation, and may contribute to lower airway contamination from the mechanical dislodgment of bacteria within the artificial airway or from contamination of saline solution during instillation.
Rationale: The explanation reduces anxiety. Rationale: This information reduces anxiety and elicits patient cooperation. Rationale: This information encourages cooperation and facilitates removal of secretions.
Rationale: These pressures indicate potential secretions in the airway, increasing resistance to gas flow. Rationale: These values indicate potential secretions in the airway, decreasing gas exchange. Rationale: This communication evaluates and reinforces understanding of previously taught information. Rationale: This positioning promotes comfort, oxygenation, and ventilation and reduces strain. Endotracheal suctioning of mechanically ventilated adults and children with artificial airways.
Oral care in the critically ill. Akgul, S, Akyolcu, N. Effects of normal saline on endotracheal suctioning. Arroyo-Novoa, CM, et al, Pain related to tracheal suctioning in awake acutely and critically ill adults.
Intensive Crit Care Nurs ; — Bourgault, AM, et al. Effects of endotracheal tube suctioning on arterial oxygen tension and heart rate variability. Biol Res Nurs. Dimens Crit Care Nurs ; — Centers for Disease Control and Prevention, Guidelines for prevention of health-care-associated pneumonia, RR-3 :1— Czarnik, R, et al. Differential effects of continuous versus intermittent suction on tracheal tissue.
Ellstrom, K. The pulmonary system. In: Alspach J, ed. Core curriculum for critical care nursing. St Louis: Elsevier; — Glass, C, et al. Nurse performance of hyperoxygenation. Grap, MJ, et al, Endotracheal suctioning.
Hess, D, Goff, G, The effects of two-hand versus one-hand ventilation on volumes delivered during bag-valve ventilation at various resistances and compliances. Tracheal suctioning of adults with an artificial airway. Best Practice. Jongerden, IP, et al, Open and closed endotracheal suction systems in mechanically ventilated intensive care patients.
Crit Care Med ; — Evaluation of tracheal bronchial suction techniques. J Cardiovasc Surg. Acute histologic changes in the tracheobronchial tree associated with different suction catheter insertion techniques. Klockare, M, et al, Comparison between direct humidification and nebulization of the respiratory track at mechanical ventilation.
J Clin Nurs ; — Kubota, Y, et al. Is a straight catheter necessary for selective bronchial suctioning in the adult. Kuzenski, B. Effect of negative pressure on tracheobronchial trauma. Lasocki, S, et al, Open and closed-circuit endotracheal suctioning in acute lung injury.
McCauley, C, Boller, L. Bradycardiac responses to endotracheal suctioning. Ogburn-Russell, L. The effect of continuous and intermittent suctioning on the tracheal mucosa of dogs. Oh, H, Seo, W. A meta-analysis of the effects of various interventions in preventing endotracheal suctioning induced hypoxemia.
Rauen, CA, et al, Seven evidence-based practice habits. Endotracheal suctioning with and without instillation of isotonic sodium chloride solutions in critically ill children. A potential infection hazard associated with the use of disposable saline vials.
Infect Control. St John, RE. Airway and ventilator management. In: Chulay M, Burns S, eds. AACN essentials of critical care nursing. In: Burns SM, ed. AACN protocol for practice: care of mechanically ventilated patients. Subirana, M, et al. Closed tracheal suction systems versus open tracheal systems for mechanically ventilated adult patients. Cochrane Database Syst Rev. Preoxygenation for tracheal suctioning in ventilated adults protocol.
Additional Readings Kerr, M, et al. Effec t of endotrac heal suc tioning on c erebral oxygenation in traumatic brain-injured patients. Crit Ca re Med. Labarc a, J, et al. A multistate outbreak of Ralstonia pic kettii c olonization assoc iated with an intrinsic ally c ontaminated respiratory c are solution. Clin Infect Dis. Paul-Allen, J, Ostrow, C. S urvey of nursing prac tic es with c losed-system suc tioning.
Am J Crit Ca re. Pierc e, LN. Management of the mec hanic ally ventilated -patient, ed 2. S t Louis: Elsevier, A multisite survey of -suc tioning tec hniques and airway management prac tic es. PURPOSE: The tracheal tube cuff helps stabilize the endotracheal or tracheal tube and maintains an adequate airway seal so that air moves through the tube into the lungs. The cuff also may decrease the risk of aspiration of large food particles, but it does not protect against aspiration of liquid. When inflated, the cuff presses against the tracheal wall to prevent air leakage and pressure loss from the lungs.
Effects of soft and hard cuff inflation on the tracheal w all. The older cuff design low-volume high-pressure may require 40 mm Hg Ideally, the cuff pressures should be between 20 and 25 mm Hg and still meet the goals of cuff use. Tracheal capillary perfusion pressure is 25 to 35 mm Hg for patients with normotensive conditions. Lower cuff pressures are associated with less mucosal damage but also are associated with silent aspiration, which has been shown to be more prevalent at cuff pressures less than 20 mm Hg.
The MLT involves air inflation of the tube cuff until any leak stops; then, a small amount of air is removed slowly until a small leak is heard on inspiration. Problems with this technique include difficulty maintaining positive end expiratory pressure PEEP , aspiration around the cuff, and increased movement of the tube in the trachea during cuff deflation.
The MOV consists of injection of air into the cuff until no leak is heard, then withdrawal of the air until a small leak is heard on inspiration, and then addition of more air until no leak is heard on inspiration.
MLT decreases tracheal mucosal injury and assists in mobilizing secretions forward into the pharynx. MOV is used if the patient needs a seal to provide adequate ventilation or is at risk for aspiration. These complications may be more likely to occur in conditions that adversely affect tissue response to mucosal injury, such as hypotension.
Two major mechanisms are mainly responsible for airway damage: tube movement and pressure. Duration of intubation also plays a significant role. Rationale: This information elicits patient cooperation. Rationale: This explanation elicits patient cooperation. Rationale: This assessment assists in verification of tube placement. Rationale: The amount of air previously used to inflate the cuff can be used as a guideline to determine changes in volume or pressure or both.
Rationale: Volume and pressure of air needed to seal the airway depend on the relationship of tube and trachea diameters. Rationale: This positioning promotes general relaxation, oxygenation, and ventilation. It also reduces stimulation of the gag reflex and risk of aspiration. Hess, D. Tracheostomy tubes and related appliances. MacIntyre, N, Branson, R. Mechanical ventilation,, ed 2. Philadelphia: Saunders; Ann Otol Rhinol Laryngol. Management of the mechanically ventilated patient.
Plambeck, A, Adult ventilation management. Roman, M. Tracheostomy tubes. Medsurg Nurs. St John R, Protocols for practice. Crit Care Nurse. Austr Nurs J. PURPOSE: Tracheostomy tube care is performed to maintain airway patency and decrease infection risk by removing secretions that accumulate within the inner cannula.
Tracheostomy refers to the opening, or stoma, made by the incision. The tracheostomy tube is the artificial airway inserted into the trachea during tracheotomy Fig. FIGURE A tracheostomy sometimes called a tracheotomy is created surgically by making an opening through the skin of the neck into the trachea.
Serra A: Tracheostomy care, Nurs Stand ,, The tubes can be metal or plastic, with standard or extra length. Clinicians who care for patients with tracheostomy tubes must understand the differences and select a tube that appropriately fits the patient and clinical condition. A tracheostomy tube is shorter than but similar in diameter to an endotracheal tube and has a squared-off distal tip for maximization of airflow. The outer cannula forms the body of a tracheostomy tube with a cuff.
The neck flange, attached to the outer cannula, assists in stabilizing the tube in the trachea and provides the small holes necessary for proper securing of the tube. Some tracheostomy setups have an inner cannula inserted into the outer cannula. The inner cannula is removable for easy cleaning without airway compromise. The cuff is a balloon inflated with air to maintain a seal around the tube.
As the air flows through the one-way inflation valve, the pilot balloon inflates, which indicates the volume of air present in the cuff. The cuff limits aspiration of oral and gastric secretions. Uncuffed tubes are commonly used in children, in adults with laryngectomies, and during decannulation of the tracheostomy. A fenestrated tracheostomy tube has an opening in the curvature of the posterior wall of the outer cannula.
Fenestrated tracheostomy tubes are useful for patients with smaller tracheas and during weaning. Foam cuff tracheostomy tubes consist of a high-volume cuff and are composed of polyurethane foam covered with a silicone sheath. Despite the long availability of this type of tracheostomy tube, it is not commonly used and is usually reserved for patients who already have tracheal injury related to the cuff.
Most often, the procedure is elective and performed in the operating room with sterile conditions. An emergency tracheotomy is performed at the bedside with aseptic technique or before arrival in the critical care unit when swelling, injury, or other upper airway obstruction prevents intubation with an endotracheal tube. Percutaneous tracheotomies also are performed at the bedside. Minimally invasive percutaneous tracheotomy was introduced recently as an alternative to the traditional surgical technique.
It has gained widespread acceptance in the past decade. The percutaneous procedure has achieved outcomes comparable with outcomes with the surgical technique. Table Indications for Tracheostomy Bypass acute upper airway obstruction Prolonged need for artificial airway Prophylaxis for anticipated airway problems Reduction of anatomic dead space Prevention of pulmonary aspiration Retained tracheobronchial secretions Chronic upper airway obstruction.
Often, nurses at the bedside take an active role in assisting with tracheotomy and insertion of a tracheostomy tube; however, some institutions have surgical personnel at the bedside to assist with the procedure. Its smooth surface protrudes from the outer cannula and minimizes tracheal trauma.
When the tracheostomy tube is inserted, the obturator is removed and replaced with the inner cannula, which locks in place. The same size sterile tracheostomy tube should be available at the bedside for easy access in case of accidental decannulation. A tracheostomy tube is the preferred method of airway maintenance in a patient who needs intubation for more than 14 to 21 days.
Each case must be reviewed individually. The body responds by increasing mucus production. Also, ciliary movement is impaired, which limits the forward movement of the mucociliary escalator.
Because the tracheostomy bypasses the upper airway and its protective and hydrating mechanisms, patients are at increased risk of infection. Lack of hydration by the upper airway can lead to thick mucus, which increases the risk of airway obstruction.
Tracheostomy patients should receive continuous humidified air or oxygen for this reason. Also, care of the patient, such as suctioning, oral care, and ability to meet nutritional needs, is simplified.
Bright frank bleeding or constant oozing is not expected and should be brought to the attention of the physician or advanced practice nurse. An extra pair of hands can minimize the risk for accidental dislodgment. Involve patient and family members in ongoing education, particularly if a home discharge with the tracheostomy is anticipated.
Rationale: Education to the patient and family encourages cooperation and compliance and reduces anxiety. Rationale: Tube irritation to mucosa results in increased production of secretions.
Prior to performing a procedure, the nurse should ensure the correct identification of the patient for the intended intervention. A, Face plate w ith threading of tw ill tape for prevention of decannulation, an additional person needs to stabilize face plate. B, Advancing of the tw ill tape around the back of the neck and looping through the other side of face plate.
C, Doubling of the tw ill tape and securing in a knot. Billau, C. In: Russell C, Matta B, eds. Tracheostomy a multiprofessional handbook.
Cambridge: Cambridge University Press; — Springhouse Corp, Springhouse, PA, — Burns, SM, et al. Are frequent inner cannula changes necessary? A pilot study. McCloskey, J, Bulechek, G. Nursing interventions classification, ed 3. Mittendorf, EA, et al. The information before the procedure is as follows: prerequisite nursing knowledge, that is, what the nurse needs to know before Sign In or Create an Account. Search Dropdown Menu. Advanced Search. User Tools Dropdown. Sign In. Skip Nav Destination Article Navigation.
Femoral Arterial and Venous Sheath Removal Radial Arterial Sheath Removal Pericardial Catheter Management Thenar Tissue Oxygen Saturation Monitoring Transesophageal Echocardiography Assist. Section Eleven: Vascular Access Arterial Puncture AP Central Venous Catheter Insertion Assist Intraosseus Devices Mid Line Catheters AP Section Twelve: Neurologic Monitoring Bispectral Index Monitoring Cerebral Blood Flow Monitoring Cerebral Micodialysis Section Thirteen: Special Neurologic Procedures Lumbar Puncture Perform AP Lumbar Puncture Assist Pupillometer Section Fourteen: Traction Management Cervical Traction Maintenance Halo Ring and Vest Care Section Fifteen: Pain Management Patient-Controlled Analgesia Section Sixteen: Special Gastrointestinal Procedures Esophagogastric Tamponade Tube Gastric Lavage in Hemorrhage and Overdose Endoscopic Therapy Intraabdominal Pressure Monitoring Early detection of critical congenital heart disease in new borns using pulse oximetry screening.
Textile integrated sensors and actuators for near-infrared spectroscopy. Journal of Biomedical Optics Trans-abdominal monitoring of fetal arterial blood oxygenation using pulse oximetry. By Permission of W. Lynn-McHale Karen K. Sandra L. The reading, obtained through pulse is increased, and 2,3-DPG levels a byproduct of glucose oximetry, uses a light sensor containing two sources of metabolism also found in stored blood products are light red and infrared that are absorbed by increased.
The amount of light transmitted through affinity for oxygen, less is available to the tissues. Conditions the tissue is then converted to a digital value such as increased pH, decreased temperature, decreased representing the percentage of hemoglobin saturated PaCO2, and decreased 2,3-DPG will increase oxygen binding with oxygen Fig.
For example, in some patients, there is a patient's oxygenation status and are not a substitute for difference in SpO2 values at rest compared with those during measurement of arterial partial pressure of oxygen activity, such as ambulation or positioning.
PaO2, or of ventilation. Reprinted by saturation. The affinity of hemoglobin to oxygen may permission of Mallinckrodt I nc. Sensor types and sensor sites for pulse oximetry monitoring. Use "wrap" style sensors on the fingers including thumb , great toe, and nose. The windows for the light source and photodetector must be placed directly opposite each other on each side of the arteriolar bed to ensure accuracy of Sp02 measurements.
Choosing the correct size of the sensor will help decrease the incidence of excess ambient light interferences and optical shunting. Ensuring that the arteriolar bed is well within the clip with the windows directly opposite each other will decrease the possibility of excess ambient light interference and optical shunting.
Reprinted by permission of Mallinckrodt Inc. Therefore, enhancing the patient's Sp02 may limit his or Rationale: Providing an understanding of the use of an alarm her ability to ventilate. The baseline Sp02 for a patient with system and its importance in the overall management of the known severe restrictive disease needs to be considered.
Dark nail polish and bruising under the the bedside. Readings in the presence Patient Assessment of carbon monoxide will be falsely elevated.
Anticipation of conditions in which hypoxia could be present allows earlier intervention before unfavorable outcomes occur. Answer questions as they arise, and reinforce information as needed.
Wash hands, and use personal protective Reduces transmission of microorganisms and body equipment. Select the appropriate pulse oximeter The correct sensor optimizes signal capture and Several different types of sensors are sensor for the area with the best pulsatile minimizes artifact-related difficulties.
These include disposable and vascular bed to be sampled Fig. Use nondisposable sensors that may be applied of finger probes has been found to produce over a variety of vascular beds.
Select desired sensor site. If using the Adequate arterial pulse strength is Avoid sites distal to indwelling arterial digits, assess for warmth and capillary necessary for obtaining accurate SpO2 catheters, blood pressure cuffs, military refill. Confirm the presence of an measurements.
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