NUR 431L (LINES, TUBES, DRAINS)
FINAL EXAM QUESTIONS WITH
CORRECT ANSWERS
(1) pressure bag is inflated to 300 mm Hg,
(2) flush bag contains fluid
(3) system is delivering a continuous slow (approximately 3 mL/hr) flush; because of the
risk of heparin-induced thrombocytopenia (HIT) (use normal saline for the flush solution)
- Answer-To maintain arterial line patency and limit thrombus formation, assess the
flush system every 1 to 4 hours to determine that the:
•Flush tubing & make sure all stopcocks in right place & your clamp is open
•Blow up pressure bag (about 250-300- green line will tell you when)
•Hang transducer tubing, make sure tubing going towards pt. is facing upward and cable
is facing downwards
•Push it, allow air to get out (Flush A line)
•Connect transducer cable to transducer - Answer-Arterial line setup:
-acute hypertension and hypotension
-respiratory failure, shock, neurologic injury
-coronary interventional procedures, continuous infusion of vasoactive drugs (e.g.,
sodium nitroprusside)
-frequent arterial blood gas (ABG) sampling. - Answer-Arterial BP Monitoring:
Continuous arterial BP monitoring is indicated for patients in many situations
-immobilize the insertion site to prevent dislodging or kinking the catheter line. - Answer-
After arterial line insertion, the catheter is usually sutured in place
-In heart failure, the systolic upstroke may be slower.
-In volume depletion, systolic pressure varies greatly with mechanical ventilation,
decreasing during inspiration. - Answer-The high- and low-pressure alarms are set
based on the patient's current status and then activated.
-If enough fluid or air accumulates in pleural space --> neg pressure becomes positive --
> lungs collapse
-Chest tube are then inserted to drain pleural space, restablish neg pressure, and allow
for proper lung expansion
-Tubes may be inserted into mediastinal space to drain air and fluid postop
-Tubes are appromiately 20 in long & vary in size (varies based off pt condition) -
Answer-Chest Tube:
-Can take place in ER, OR, or bedside
-Elevated HOB 30-60 degrees
, -X-ray confirms affected side
-Wound is covered w/ occlusive dressing
-Proper tube placement = confirmed by x-ray - Answer-chest tube insertion
-Insertion is VERY painful; monitor pain level and comfort level
-Appropriate pain relieving interventions
-DO NOT CLAMP TUBES, MILK TUBES, OR STRIP TUBES
-If tidaling (rising with inspiration and falling with expiration in the spontaneously
breathing patient) is not observed, the drainage system is blocked, the lungs are
reexpanded, or the system is attached to suction.
-If bubbling increases, there may be an air leak in the drainage system or a leak from
the patient (bronchopleural leak). - Answer-NI for chest tubes
-Gives you multiple lumens
-Good for high concentrated things/toxic drugs
-Great, reliable assess site to keep pt alive
-Will give us central venous pressure - Answer-We use a central line instead of a
peripheral IV in some situations d/t:
-once medication reaches blood stream, VERY diluted
-Tunnel caths are used for long-term access
-Heparin is only really used in dialysis and those nurses do it
-Our job is to get everything ready; we don't put them in
-Can't use the line until placement has been verified via CXR - Answer-central lines
*Remember it is a DIRECT line to the heart so always clamp and cover (sterile)
*When drawing blood, waste the first 3 cc d/t the long line and the residual that's left
-scrub hub for 15-30 seconds
-release the clamp, with the blue cap on (it's a one-way valve so prevents air from
getting in)
-flush with NS, medication, end with NS - Answer-When collecting a blood draw and
giving meds with a cental line
-check VS, for consent, and if on blood thinners; check colag factors and electrolytes -
Answer-central lines and arterial lines
A chest tube - Answer--is a clear flexible plastic tube that is inserted through the chest
wall into the pleural space or the mediastinum to drain fluid or air from the pleural space
-Doesn't sit in the actual lungs! The whole purpose of a chest tube is to drain something
-Pneumothorax
-hemothorax
-hemo-pneumothorax
-empyema
-pleural effusion - Answer-indications for chest tube
FINAL EXAM QUESTIONS WITH
CORRECT ANSWERS
(1) pressure bag is inflated to 300 mm Hg,
(2) flush bag contains fluid
(3) system is delivering a continuous slow (approximately 3 mL/hr) flush; because of the
risk of heparin-induced thrombocytopenia (HIT) (use normal saline for the flush solution)
- Answer-To maintain arterial line patency and limit thrombus formation, assess the
flush system every 1 to 4 hours to determine that the:
•Flush tubing & make sure all stopcocks in right place & your clamp is open
•Blow up pressure bag (about 250-300- green line will tell you when)
•Hang transducer tubing, make sure tubing going towards pt. is facing upward and cable
is facing downwards
•Push it, allow air to get out (Flush A line)
•Connect transducer cable to transducer - Answer-Arterial line setup:
-acute hypertension and hypotension
-respiratory failure, shock, neurologic injury
-coronary interventional procedures, continuous infusion of vasoactive drugs (e.g.,
sodium nitroprusside)
-frequent arterial blood gas (ABG) sampling. - Answer-Arterial BP Monitoring:
Continuous arterial BP monitoring is indicated for patients in many situations
-immobilize the insertion site to prevent dislodging or kinking the catheter line. - Answer-
After arterial line insertion, the catheter is usually sutured in place
-In heart failure, the systolic upstroke may be slower.
-In volume depletion, systolic pressure varies greatly with mechanical ventilation,
decreasing during inspiration. - Answer-The high- and low-pressure alarms are set
based on the patient's current status and then activated.
-If enough fluid or air accumulates in pleural space --> neg pressure becomes positive --
> lungs collapse
-Chest tube are then inserted to drain pleural space, restablish neg pressure, and allow
for proper lung expansion
-Tubes may be inserted into mediastinal space to drain air and fluid postop
-Tubes are appromiately 20 in long & vary in size (varies based off pt condition) -
Answer-Chest Tube:
-Can take place in ER, OR, or bedside
-Elevated HOB 30-60 degrees
, -X-ray confirms affected side
-Wound is covered w/ occlusive dressing
-Proper tube placement = confirmed by x-ray - Answer-chest tube insertion
-Insertion is VERY painful; monitor pain level and comfort level
-Appropriate pain relieving interventions
-DO NOT CLAMP TUBES, MILK TUBES, OR STRIP TUBES
-If tidaling (rising with inspiration and falling with expiration in the spontaneously
breathing patient) is not observed, the drainage system is blocked, the lungs are
reexpanded, or the system is attached to suction.
-If bubbling increases, there may be an air leak in the drainage system or a leak from
the patient (bronchopleural leak). - Answer-NI for chest tubes
-Gives you multiple lumens
-Good for high concentrated things/toxic drugs
-Great, reliable assess site to keep pt alive
-Will give us central venous pressure - Answer-We use a central line instead of a
peripheral IV in some situations d/t:
-once medication reaches blood stream, VERY diluted
-Tunnel caths are used for long-term access
-Heparin is only really used in dialysis and those nurses do it
-Our job is to get everything ready; we don't put them in
-Can't use the line until placement has been verified via CXR - Answer-central lines
*Remember it is a DIRECT line to the heart so always clamp and cover (sterile)
*When drawing blood, waste the first 3 cc d/t the long line and the residual that's left
-scrub hub for 15-30 seconds
-release the clamp, with the blue cap on (it's a one-way valve so prevents air from
getting in)
-flush with NS, medication, end with NS - Answer-When collecting a blood draw and
giving meds with a cental line
-check VS, for consent, and if on blood thinners; check colag factors and electrolytes -
Answer-central lines and arterial lines
A chest tube - Answer--is a clear flexible plastic tube that is inserted through the chest
wall into the pleural space or the mediastinum to drain fluid or air from the pleural space
-Doesn't sit in the actual lungs! The whole purpose of a chest tube is to drain something
-Pneumothorax
-hemothorax
-hemo-pneumothorax
-empyema
-pleural effusion - Answer-indications for chest tube
