Hospital Lines

(If you’re using EPIC for documentation, the kardex will give you an idea of what lines patients have before you walk into their room.)

In line management, a few principles apply: Most critical lines on top, lines oriented towards the side you’re moving to. It also helps if nursing can disconnect any lines before your therapy session.

Common lines for medication administration

• IV line
• PICC line
• Central line
• AV fistula (for dialysis)

Note about lines on the patient’s arms: There are some considerations you should take before taking BP readings:

• Pink wrist band - protected limb, don’t take BP readings here!
• Don’t take BP readings on the arm with a PICC line. It could create issues that will require nursing to redo the line.
• Some patients have an AV fistula for dialysis which will look like an abnormal bump that has a slight vibration when you touch it. Do not take the BP on this arm.
• Try to avoid the side with a running IV if you can. If you must run the BP on that arm, check with nursing about pausing the IV before running a BP reading. Some IV medications require continuous transfusion while others can be paused.

Urine lines

• Foley catheter
  • Keep below the level of the groin or urine can flow backwards.
• Condom catheter
  • Comes off easily but is easy to place as well.

Drainage Lines

• JP drains
  • Clip onto the patient gown to keep it from tugging.
• Chest tubes
  • Don’t tip over because medical personnel are reading the fluid level in the box. Keep below the level of the patient’s chest. Check in the orders and with nursing if you can disconnect the suction line (medical jargon: “Can chest tube go to water seal?”).
• Wound vac
• Nephrostomy tubes
  • Notify the nurse if the liquid level in the bag is not changed from the start and end of your session.
• Pleural catheters
• Suprapubic catheters

Respiratory lines

Check with nursing or the respiratory therapist before increasing or decreasing supplemental O2.

• Nasal cannula
• High flow nasal cannula
• Non-rebreather mask
• BiPAP
• Ventilator

Nutrition Lines

• Nasogastric tube
  • Make sure the head of bed is elevated at least 30 deg to prevent aspiration. (It’s a good idea to pause the feed during bed mobility)
    • Oral hygiene for this population is very important.

Some patients have special diet orders. Check with nursing before offering water or food.

For example, giving water to a patient with aspiration precautions may cause them to aspirate and choke. Many cardiac patients have water restriction orders because they are retaining fluids. Giving food to a patient about to go to the OR may stall the procedure an additional day.

Possible precautions: NPO (nothing by mouth), soft diet, liquid diet.

Good resources about hospital lines.