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rn skills day study packet42450223824800 2018 REQUIRED READING 1. Policy #12048: Pressure Ulcer Risk Assessment, Prevention, Staging, and Treatment2. Policy # 14355: Restraint and Seclusion3. Policy # 12055: Tracheostomy Tubes-One-way Valve and Cap AssessmentAlso see attached Referenced Document: Performance Criteria Plugging4. Policy # 11945: Code Blue/White- Response & Interventions5. Policy # 23384: Musculoskeletal Injury Prevention Program 6. Policy # 23614: Review Safe Patient Handling GuidelinesThere are 6 classic locations, but can be located over any bony prominence or under any medical deviceSacral/coccygeal area (most common)Greater trochanter (most severe)35941002014855Ischial tuberosityHeelLateral malleolusElbows*Pressure injuries can develop within 2-6 hoursPRESSURE INJURY RISK ASSESSMENT TOOLHOW DO WE PREVENT PRESSURE INJURIES?38354004904740004239260533400000357505120015Pressure Redistributions surfacesSpecialty BedsMattresses and OverlaysCushions OffloadingHeel pressure relieving bootsRepositioning PillowsWedgesPrevention DressingKerrafoam00Pressure Redistributions surfacesSpecialty BedsMattresses and OverlaysCushions OffloadingHeel pressure relieving bootsRepositioning PillowsWedgesPrevention DressingKerrafoam47663103751580532701534480500-2804926278000A quick-release knot allows you to quickly release the knot using one hand if the patient is in distress or has an emergency. Follow the steps below to tie a quick-release knot.Wrap the attachment strap once around the bed frame (not the side rail) leaving at least an 8″ tail.Fold the loose end in half to create a loop (as shown).661035-28130500Cross the loop over the other end of the tie (as shown).7137403302000Insert the folded strap where the straps cross over each other. This step will feel like when you're tying your shoes.7759703937000Pull on the loop to tighten the strap7118352730500Please Review the following resources:1). Policy # 14355: Restraint and Seclusion2). Watch videos located on the Education and Staff Development websiteOR go to:3). CMC Forum→ Virtual Library→ Nursing Resource Center Plus→ Restraints, Physical: Applying in Older AdultsRestraint DocumentationEvery 12 hour shift:Restraint type Less restrictive alternativesRationale for useEducation to patient and family (i.e., D/C criteria)Document to the care plan and education in Education activity every shiftMinimum of every 2 hours(even hours and document all):Visual checkCirculationInjuryRange of MotionFluidsFood/MealEliminationONLY document “side rails” as a restraint if the MD orders them. Review the restraints flow sheet as part of your Hand-OffDC the order per protocol and resolve the care plan when restraints are discontinuedPlease Review the following resources:1). Education and Staff Development website- Chest Tubes2). CMC Forum→ Virtual Library→ Nursing Resource Center Plus→ Chest Tubes: Monitoring, Care, and Dressing Changes (pictures and videos included)Purpose of Chest Tubes: a tube inserted into the pleural space of the lungs to remove air or fluid and to help the lung re-expand OR it is a tube placed in the mediastinum space to help drain blood or fluid from around the heart after cardiac surgery.Mediastinal chest tubes are usually placed after cardiac surgery to help drain blood from the pericardial space (placed under the sternum) which?prevents fluid from compressing the heart which can lead to cardiac tamponade.Pleural space: a small space that surrounds the lungs that contains a small amount of serous fluid. This small space is surrounded by the parietal and visceral pleurae. These two layers glide over each other which creates a negative pressure. Therefore, if air or extra fluid enters into the pleural space the lungs are severely affected and can collapse.Reasons for a chest tube:Cardiovascular surgeryPneumothorax: air enters into the pleural space and causes the lung to collapse (trauma to the chest or spontaneous)Pleural Effusion: fluid in the pleural space Types of Pleural Effusions: Hemothorax: blood enters in the pleural space and causes lung to collapse (trauma to the chest, disease TB, blood clotting issue)Empyema (infection in the pleural space)Chylothorax (lymphatic fluid in pleural space),Type of Chest Tubes Drainage SystemsWet Suction (water seal suction) or Dry SuctionWet: suction regulated by the height of water in the suction control chamber when connected to wall suction…some have stop-cocks to help regulate to amount of bubbling (you will hear bubbling while it’s working….water evaporates overtime so you will have to re-add it)…physician determines the suction level (usually -20cmH2O).Dry Suction: This chest drainage system has no water column to control suction but uses a suction monitor bellow (looks like an orange accordion) that balances the wall suction and you can adjust water suction pressure using the rotary suction dial on the side of the system. It allows for higher suction pressure levels, has no bubbling sounds, and water does not evaporate from it as with other systems.Nursing Management of a Chest Tube:Drainage system itself: keep system below patient’s chestTubing: Keep it free from kinks and make sure it is draining freely (not clots or stagnate fluid) and that all connections are sealedDrainage Collection Chamber: Monitor drainage (color, amount…..should drain no more than 100 cc/hr and record routinely)Water Seal Chamber: ?performs an underwater seal on the tube to allow air to be removed from pleural space while preventing outside air from entering lungsWater in the water seal chamber?fluctuates as the patient breathes in and out. If the patient is breathing on their own the water will increase during inspiration and decrease during expiration (it will be the opposite if the patient is on positive pressure mechanical ventilation). There may be intermittent bubbling, which is expected as air is drained from the pleural space, especially for treatment of a pneumothorax. ?Remember that a pneumothorax is an AIR leak between the lung and chest wall….therefore air can escape into the water seal chamber causing intermittent bubbles. What if it doesn’t fluctuate at all? The lung could have re-expanded or there is a kink somewhere.Excessive bubbling? There is an air leak somewhere.Suction Control Chamber:Dry: suction controlled by a dial on the side and is regulated by suction monitor bellow (orange accordion). There is no water column.Wet: remember watch the amount of water because it evaporates over time and it should gently bubble due to the suction working.*Water in the water seal and suction control can evaporate over time so watch the water and add as needed.Patient Assessment: Note lung sounds, rate, any dyspnea? Worsening pneumothorax or hemothoraxNote skin around insertion site for any subcutaneous crepitus (crackling sensation felt on palpitation) that is due to carbon dioxide escaping into the tissues.Keep patient moving by turning frequently, coughing, and deep breathing…helps move fluid and improve lung functionMishaps with a Chest Tube and What to Do?What to do if chest tube becomes dislodged? Cover the site with a sterile dressing, and tape on three sides (this allows air to escape and prevent tension pneumothorax) and notify physician immediately.Milking or stripping tubing? Not recommended anymore because it creates too much negative pressure (always follow hospital policies)Clamping tubing? Increase risk of patient developing a tension pneumothorax. ?Never do it without an order and follow hospital policies.Chest tube NCLEX Review (2017). In . Retrieved from review Policy # 12055 Tracheostomy Tubes-One-way Valve and Cap Assessment and review the attached referenced document: Performance Criteria Plugging. Watch Videos regarding Trach Plugging and Trach Suctioning found on the Education and Staff Development website under Trach Care.Tracheostomy Plugging HighlightsHow does a one-way valve and a cap work?OWV – Pt. breathes in through the trach and out through the upper airway.Cap – Pt. breathes in and out through the upper airway.Evaluate secretion status (increased secretions may delay procedure)Discuss O2 status – what type will be on pt. when valve in placeDescribe type of trach in placeCuffed – will have pilot balloonCuffless – no balloon on trach flangeValidate equipment at bedside:Oxygen source, manual resuscitation Bag and Mask, inner-cannula (same size as tracheostomy tube), pulse oximeter, call light, suction equipment, suction device, extra trach same size as the one in place, obturatorOnce airway clear, if cuffed trach, deflate pilot balloon COMPLETELY and ensure there is no air left in the balloonPlacing the One-Way ValvePlace valve on trachObserve for S/S of obstruction or distressHave pt. say, “Ahhhhh”O2 as ordered and pulse ox in placePlacing a Cap on the TrachEnsure clear airway – suction if neededEnsure cleanliness of capRemove inner-cannula from trachEnsure 2nd inner-cannula at bedside for manual ventilation (can’t bag without it) Place cap on trachObserve for S/S of obstruction or distress – Have pt. say, “Ahhhh”O2 as ordered and pulse ox in placeALERT – A CAP may only be placed on a trach tube that does NOT have a cuff. A cuffed trach that has a CAP placed with the cuff inflated will completely occlude the pt’s airwayLeaving the PatientOnce OWV or CAP are in place, reassess your patient for any S/S obstruction or distressEnsure monitoring/Equipment is at bedsideO2 devices you would use if you needed to administer supplemental O2 – NC or FMDocument your airway assessment Every 2 HoursQ 2 H – remove OWV or CAP – remember you can’t hear secretions with valve in place.Have pt. cough or suction if secretions presentAssess breath soundsKey Points to RememberRN to perform airway check Q2 hours and documentRCP to perform airway check Q4 hours and documentANYONE CAN REMOVE A VALVE OR CAP IF A PATIENT IS IN DISTRESS!!!Please review Policy # 11945 Code Blue/White-Response & InterventionsWatch Videos regarding Mock Code Blue Education and Staff Development website under Mock Code Blue. Review the positions in a code and be ready to demonstrate each positionSafe Patient Handling TrainingBasic Manual TransferMain Points of Emphasis:Remember to let the patient do itThey will need encouragement to do it themselvesThey will need time to do it themselvesNot for patients who cannot bear weightDo not lift patient Only patients who can partially or fully bear weight. (BMAT - Level 3 and above)Transferring a patient to a chairPatient must first scoot forwardMust lean forward (reach near arm across to chair)Caregiver is next to patient (not in front)Cue patient to lean forward and lift up own body, then pivot to chairDo not assist (guide)Do not lift (cue to lean forward)Give patient timeLearner is to demonstrate the above. Learner must cue appropriately and must not lift.Skills Station - Mechanical LiftMain Points of Emphasis:Use a lift for any patient who cannot bear their own weightFull body sling lifts are for patients with no ability to bear weight, or who are unpredictable or uncooperative. BMAT Level 1, 2Use stand assist aid for patients with partial ability to bear weight, BMAT levels 2,3Use full body sling lift for any patient who is on the floor and cannot get up themselves (with guidance)Refer to manufactures guidelines for techniques on specific equipmentFull Body Sling Lift:Sling placementRoll patient onto their sideRoll patient onto their sidePlace sling under the patient’s back and buttocks - fully cover the shoulders and headRoll patient to opposite side to ensure full coverage of sling and proper positioningSlide your hands under the patient, smoothing out all wrinklesRoll patient onto their backIf patient already seated, use behind the back method for placementPosition liftPosition the legs of the lift perpendicular to the patientSet the lift’s adjustable base to its widest position to ensure optimal stabilityMove the lift so that its arm is directly over the patientConnect the straps to the side arms of the liftTransfer PatientInstruct the patient to place their arms across their chestPress the “up” button to unweight patient from the bed/surfaceMomentarily suspend the patient above the surface to ensure sling supportTilt the patient into a comfortable positionMove the patient steadily until they are positioned above the transfer surfacePress the “down” button to lower the patient onto the transfer surfaceUnhook the straps of the sling but leave sling in placeMove the lift away from the patientMonitor patient to ensure tolerance to new positionSkills Station - Patient Repositioning and Lateral Transfers with HoverMattMain Points of Emphasis:Remember to let the patient do itThey will need encouragement to do it themselvesThey will need time to do it themselvesUse sufficient CaregiversUse equipment when necessaryHoverMattUse at least 2 caregivers (one on each side)Patient in horizontal positionUse proper roll technique to place HoverMatt under patient.Attach safety strapsAttach hose and snap in placePosition transfer surfaces close as possible and lock brakes.Turn on pumpGrasp handles and pull patient on an angle (feet or head first) until in desired positionTurn off pump, remove HoverMatt using roll techniqueTransfers to/from Chair1057275352425Can patient bear weight?Is patient able to stand/walk without assistance? If no, how much assistance is needed?as00Can patient bear weight?Is patient able to stand/walk without assistance? If no, how much assistance is needed?asBed to Chair, Chair to Toilet, Chair to Chair, Chair to Exam Table1358902592705Use mechanical lift appropriate for patient’s weight per manufactures guidelines00Use mechanical lift appropriate for patient’s weight per manufactures guidelines102044521113750025869902708910Stand-and-pivot technique with or without gait/transfer belt or stand assist lift00Stand-and-pivot technique with or without gait/transfer belt or stand assist lift344891520789280050044352555875Caregiver stand by for safety or assistance as needed00Caregiver stand by for safety or assistance as needed59321702076450001058545132080001327151078230NoPatient is unable to bear weight or patient is unpredictable or uncooperative00NoPatient is unable to bear weight or patient is unpredictable or uncooperative24765001039495Partially AblePatient can bear some weight and cooperate or assist00Partially AblePatient can bear some weight and cooperate or assist32181801308100049485551047115Yes, Fully AblePatient performs task safely, without assistance. Patient requires no more help than standby, cueing, or coaching00Yes, Fully AblePatient performs task safely, without assistance. Patient requires no more help than standby, cueing, or coaching3994154293870When equipment is used to assist with patient transfers, follow manufacturer’s guidelines for the number of caregivers required to operate equipment safely. When no assistive devices are used, as a guideline, divide the patient’s weight in pounds by 50 or weight or in kilograms by 23 to determine the number of caregivers needed to move the patient. If the patient is unpredictable or uncooperative add a caregiver. If the patient is cooperative and can bear greater than 50% of his weight subtract a caregiver for every 50 pounds or 23 kilograms that represents. 020000When equipment is used to assist with patient transfers, follow manufacturer’s guidelines for the number of caregivers required to operate equipment safely. When no assistive devices are used, as a guideline, divide the patient’s weight in pounds by 50 or weight or in kilograms by 23 to determine the number of caregivers needed to move the patient. If the patient is unpredictable or uncooperative add a caregiver. If the patient is cooperative and can bear greater than 50% of his weight subtract a caregiver for every 50 pounds or 23 kilograms that represents. 413385014224000Patient RepositioningSide-to-Side, Up in Bed2437629342476Can patient assist?00Can patient assist?16224254140200036004504267200046348654267200096393064770No00No311213559055Partially able00Partially able518033059055Yes, fully able00Yes, fully able7448551508125001974002025015Less than 90 kg (200 lbs)= minimum 2 caregivers00Less than 90 kg (200 lbs)= minimum 2 caregivers25469851520825001896110201549090 kg – 160 kg (200-350 lbs)= 2 - 3 caregivers0090 kg – 160 kg (200-350 lbs)= 2 - 3 caregivers370586015208250037807902011680Greater than 160 kg (350 lbs)Minimum 3 caregivers and/or use full-body sling, with mechanical lift for patient repositioning tasks00Greater than 160 kg (350 lbs)Minimum 3 caregivers and/or use full-body sling, with mechanical lift for patient repositioning tasks152844524257000970280666750Use Draw sheet or Trendelenburg position (if tolerated) Number of staff needed to assist depends on how much weight is born by the patient and the assistive device. 00Use Draw sheet or Trendelenburg position (if tolerated) Number of staff needed to assist depends on how much weight is born by the patient and the assistive device. 3403600242570005019040651510Assistance not needed. 00Assistance not needed. 5447665241300004000503789680REMEMBER: Maintain patient body alignment and secure all lines drains and artificial airways before during and after transfer. 020000REMEMBER: Maintain patient body alignment and secure all lines drains and artificial airways before during and after transfer. Lateral TransferTo and From: Bed to Stretcher2343150300355Can patient assist with transfer?00Can patient assist with transfer?center5913120REMEMBER: Maintain patient body alignment and secure all lines drains and artificial airways before during and after transfer. 020000REMEMBER: Maintain patient body alignment and secure all lines drains and artificial airways before during and after transfer. 1080135504825No 00No 210820025400002952115486410 Partially able00 Partially able372940615559004753610467995Yes, fully able to assist00Yes, fully able to assist49917351397000107188049847500181419548069500274383544132500363855041402000553021544640500263525106680Patient weight greater than 90 kg (200lbs)00Patient weight greater than 90 kg (200lbs)1870075107315Patient weight less than 90 kg (200lbs)00Patient weight less than 90 kg (200lbs)340296595885Patient weight greater than 90 kg (200lbs)00Patient weight greater than 90 kg (200lbs)497268592075Stand by for safety minimum of 2 caregivers00Stand by for safety minimum of 2 caregivers441706088265002865120111125009613901104900038836603810Slider board or draw sheet with minimum of 2 caregivers or mechanical lift or air assisted lift with a minimum of 200Slider board or draw sheet with minimum of 2 caregivers or mechanical lift or air assisted lift with a minimum of 222891756350Use slide board or draw sheet and minimum 2 caregivers00Use slide board or draw sheet and minimum 2 caregivers8856836133Slider board or draw sheet with minimum of 3 caregivers or mechanical lift or air assisted lift with a minimum of 200Slider board or draw sheet with minimum of 3 caregivers or mechanical lift or air assisted lift with a minimum of 2B.M.A.T. – BEDSIDE MOBILITY ASSESSMENT TOOL FOR NURSESPRE-MOBILITY SCREENMOBILITY LEVEL 0Identify patients that are not stable enough for mobility outside of the bed. If patient has any of these conditions, they are not stable for mobility outside of the bed & DO NOT proceed with mobility assessment. ? Unstable spinal cord injury? FIO2 > 60 or PEEP > 10? Unstable fractures? Open chest or abdomen? Elevated ICP? Sever agitation uncontrolled by meds? Active Bleeding? Comfort care or impending withdrawal of care? SBP < 90 and/or MAP < 55? Dysrhythmia requiring new anti-dysrhythmia meds in last 6 hrs? Vasoactive meds titrated up within the last 2-4 hrs in a non-ICU setting? MEWS 4 or greater in a non-ICU settingPASS: Patient does not have any identified conditions preventing mobility. Passed Pre-Mobility Screen = Proceed with BMAT assessment.FAIL: Patient has an unstable condition. Patient is MOBILITY LEVEL 0Suggested Activities for Level 0 ? Repositioning every 2 hrs at a minimum ? Consider CLRT ? Active/Passive ROM twice a shift Tools/Equipment ? Use total lift with sling and/or repositioning sheet and/or straps ? Use lateral transfer devices such as roll board, friction reducing (slide sheets/tube), or air assisted device ? Wedge or pillows to hold patient positionConsult with Physical Therapist when needed & appropriate.Assessment Level 1: Cognition / Trunk Strength / Seated BalanceMOBILITY LEVEL 1Sit & Shake: From a semi-reclined position, ask patient to sit upright & rotate* to a seated position at the side of the bed; may use bedrail. Note patient’s ability to maintain bedside position. Ask patient to reach out & grab your hand & shake making sure patient reaches across his/her midline. *If needed, use slider sheet/tube sheet to make it easier for patient to rotate to side of bed; then complete assessment.Note: If patient has ‘strict bed rest’ or bilateral ‘non-weight bearing’ restrictions, DO NOT proceed with the assessment.PASS: Patient able to complete task. Passed Assessment Level 1 = Proceed with Assessment Level 2.FAIL: Patient unable to complete task. Patient is MOBILITY LEVEL 1Suggested Activities for Level 1 ? Sitting position in bed – 20 min 3x day ? Out of bed in Stretcher Chair – 1 hr 2x day ? Repositioning every 2 hrs when in bed Progress activity daily in time/frequency as tolerated.Tools/Equipment ? Use total lift with sling and/or repositioning sheet and/or straps ? Stretcher Chair ? Use lateral transfer devices such as roll board, friction reducing (slide sheets/tube), or air assisted deviceConsult with Physical Therapist when needed & appropriate.Assessment Level 2: Lower Extremity Strength / StabilityMOBILITY LEVEL 2Stretch & Point: With patient in seated position at the side of the bed, have patient place both feet on the floor (or stool) with knees no higher than hips. DO NOT attempt to raise the knee if s/p hip replacement; follow hip precautions. Ask patient to stretch one leg & straighten the knee, then bend the ankle/flex & point the toes. If appropriate, repeat with the other leg. May test only one leg & proceed accordingly (e.g., stroke patient, patient with ankle in a cast).PASS: Patient able to complete task. Passed Assessment Level 2 = Proceed with Assessment Level 3.FAIL: Patient unable to complete task. Patient is MOBILITY LEVEL 2Suggested Activities for Level 2 ? Sit at side of bed for meals ? Sit in chair at bedside using a lift device or Stretcher Chair – 1-2 hrs 3x day Progress activity daily in time/frequency as tolerated.Tools/Equipment ? Use total lift for patient unable to weight-bear o at least one leg ? Stretcher Chair ? Use sit-to-stand lift for patient who can weight-bear on at least one leg Consult with Physical Therapist when needed & appropriate.Assessment Level 3: Lower Extremity Strength for StandingMOBILITY LEVEL 3Stand: Ask patient to elevate off the bed or chair (seated or standing) using an assistive device (cane, bedrail). Patient should be able to raise buttocks off bed & hold for a count of five. May repeat once. May test with weight-bearing on only one leg & proceed accordingly (e.g., stroke patient, patient with ankle in cast). If any assistive device (cane, walker, crutches) is needed, patient is MOBILITY LEVEL 3.PASS: Patient able to complete task. Passed Assessment Level 3 = Proceed with Assessment Level 4.FAIL: Patient unable to complete task. Patient is MOBILITY LEVEL 3Note: Patient passes Assessment Level 3 but requires assistive device to ambulate; standby & set-up assistance required for ambulation; patient is MOBILITY LEVEL 3.Suggested Activities for Level 3 ? Stand at bedside with assistive device ? Walk in place at bedside ? Ambulate with assistive devices ? Up to bedside chair minimum 3x day Progress activity daily in time/frequency as tolerated.Tools/Equipment? Use non-powered raising/stand aid; default to powered sit-to-stand lift if no stand aid available? Use total lift with ambulation accessories ? Use assistive device (cane, walker, crutches) May use gait belt to help steady & guide movement NOT to lift patient.Consult with Physical Therapist when needed & appropriate.Assessment Level 4: Standing Balance / GaitMOBILITY LEVEL 3Walk: Ask patient to march in place at bedside. Then ask patient to advance step & return each foot. Note: There are ortho & neuro conditions that may render a patient unable to step backward; use your best clinical judgement.FAIL: Patient unable to complete task or shows signs of unsteady gait. Patient is refereed back to MOBILITY LEVEL 3. Patient is MOBILITY LEVEL 3.PASS: Patient able to complete task. Patient exhibits steady gait & good balance while marching & when stepping forwards & backwards. Patient can maneuver necessary turns for in-room mobility.MOBILITY LEVEL 4Passed – No assistance needed to ambulate; use your best clinical judgment to determine need for supervision during ambulation.-4953020256500EQUIPMENT & ASSISTIVE DEVICE OPTIONS FOR MOBILITY INTERVENTIONS & FALL PREVENTION79527402609850019558023749000MOBILITY LEVEL 119697701084580Arjo LiftArjo Lift18726154572000340233034290004921568523870063865138858200 44452219325ARJO LIFT - 500 LBS.00ARJO LIFT - 500 LBS. 7926596106348Stretcher Chair 0Stretcher Chair 6524625117569Liko Viking Lift 0Liko Viking Lift 5020945117569EZ Lift 0EZ Lift 3492024117569Liko Golvo Lift0Liko Golvo Lift19060596839HoverMatt - 1000 Pounds 0HoverMatt - 1000 Pounds 3625850526415 MOBILITY LEVEL 20 MOBILITY LEVEL 226670002215515 MOBILITY LEVEL 30 MOBILITY LEVEL 3-495302207260 00 61906153556635Stretcher Chair orBedside ChairStretcher Chair orBedside Chair50723803556635Liko Viking Lift Liko Viking Lift 39465253556635EZ Lift EZ Lift 15513053556635Arjo Lift Arjo Lift 1955803556635HoverMatt - 1000 Pounds HoverMatt - 1000 Pounds 61906152444750001955801913255HoverMatt - 1000 Pounds HoverMatt - 1000 Pounds 17265651913255Arjo Lift Arjo Lift 29972001913255Liko Golvo LiftLiko Golvo Lift42906951913255EZ Lift EZ Lift 55499001913255Liko Viking Lift Liko Viking Lift 67367151913255Stretcher Chair Stretcher Chair 79254351913255EZ Stand EZ Stand 1969770222250Arjo LiftArjo Lift-49530521335 00 780065890963700673671578803500541369392424200493617325822270038477832544762004191953888047002915920870585002697480252666500145415025419050016294108820150019558024447500019558078740000726503579375MOBILITY LEVEL 4No equipment required.Staff may use any level 3 equipment for safety as needed. 00MOBILITY LEVEL 4No equipment required.Staff may use any level 3 equipment for safety as needed. MOBILITY LEVEL 14712952105796EZ Stand 00EZ Stand 14365761892546ArjoHuntleigh Standing & Raising Aid0ArjoHuntleigh Standing & Raising Aid144081511080750030378592144609Walker 00Walker 41429612122209Canes 00Canes 51781292144733Crutches 00Crutches 63278922155844Rollator 00Rollator 6197600116014500502602510668000023931011929260027876501093470002776855904875Liko Golvo Lift0Liko Golvo Lift3930015110934500 411480234950CENTRAL LINE MAINTENANCE BUNDLE00CENTRAL LINE MAINTENANCE BUNDLEHAND HYGIENE!! Prior to accessing or manipulating the central lineProper access techniquesIf Curos (port protectors) are not in use, scrub the hub for 10-15 seconds prior to accessing a line594487020320000Remove lines in a timely mannerIndications for continued use:Hemodynamic monitoring and/or pacer insertionLong term antibiotic or antiviral useVasopressor or other caustic drugRapid or emergent fluid resuscitationLack of venous accessHemodialysisParenteral nutritionCatheter careAssess for signs and symptoms of infection every shift Secured properly Biopatch present and positioned correctlyDressing labeled and current Change dressing every 7 days and as neededFlushed and blood return noted every shiftIf no blood return, contact physician for order of AlteplaseIV tubing maintenance and care599249547625Labeled and current Curos on every port ................
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