Therapeutic Procedures

Therapeutic procedures are essential components of nursing practice that involve providing direct care to patients. These procedures range from catheterization and wound care to various interventions that require precise technique and vigilant monitoring. This chapter will delve into common therapeutic procedures, focusing on catheterization and wound care, while emphasizing the importance of monitoring patients during and after these procedures.

Common Therapeutic Procedures

Catheterization

Catheterization involves the insertion of a catheter into a body cavity, duct, or vessel for diagnostic or therapeutic purposes. Understanding the types of catheters, their indications for use, and proper aseptic technique is crucial for ensuring patient safety and comfort.

Types of Catheters

1. Urinary Catheters
   • Indications for Use: Urinary catheters are employed for various reasons, including:
     • Urinary Retention: To relieve bladder distension when patients cannot void independently.
     • Surgical Procedures: To monitor urine output during and after surgery.
     • Incontinence Management: To manage urinary incontinence in patients who cannot perform self-care.
   • Types of Urinary Catheters:
     • Intermittent Catheters: Used for temporary drainage and inserted multiple times a day (e.g., straight catheters).
     • Indwelling Catheters (Foley Catheters): Remain in place for continuous drainage and are commonly used in hospitalized patients.
     • Suprapubic Catheters: Inserted directly into the bladder through the abdominal wall for long-term use when urethral catheterization is not feasible.
2. Central Venous Catheters (CVCs)
   • Indications for Use: CVCs are used for:
     • Administration of Medications: Especially when frequent access to the venous system is required (e.g., chemotherapy, total parenteral nutrition).
     • Hemodynamic Monitoring: To assess central venous pressure (CVP) for fluid status and cardiac function.
     • Long-term Access: For patients requiring extended treatment or frequent blood draws.
   • Types of Central Venous Catheters:
     • Tunneled Catheters: Inserted under the skin and threaded into the central vein, providing long-term access.
     • Non-tunneled Catheters: Inserted directly into a central vein, often used for short-term access.
     • Peripherally Inserted Central Catheters (PICCs): Inserted into a peripheral vein and advanced into the central circulation, suitable for extended use.

Aseptic Technique and Care of Catheters

Aseptic technique is vital in preventing infections associated with catheterization. Proper education and adherence to aseptic practices ensure patient safety.

1. Preparation:
   • Hand Hygiene: Perform thorough handwashing with soap and water or use alcohol-based hand sanitizer before and after patient contact.
   • Personal Protective Equipment (PPE): Wear sterile gloves, gowns, and masks when inserting or caring for catheters.
2. Insertion:
   • Sterile Field: Create and maintain a sterile field during catheter insertion. Use sterile drapes and ensure all equipment is sterile.
   • Catheter Insertion Technique:
     • For urinary catheters, use a sterile lubricated catheter, and follow the anatomical guidelines for insertion.
     • For CVCs, follow the specific protocols based on the site of insertion (subclavian, internal jugular, or femoral).
3. Care and Maintenance:
   • Regular Cleaning: Clean the catheter insertion site daily with antiseptic solutions and change dressings as needed.
   • Catheter Patency: Ensure patency by flushing with sterile saline as per facility protocol.
   • Monitoring for Infection: Assess for signs of infection at the insertion site, such as redness, swelling, and discharge.

Wound Care

Wound care is an essential nursing skill that involves managing and treating wounds to promote healing and prevent infection. A thorough understanding of different types of dressings, the healing process, and signs of infection is crucial.

Types of Dressings and Their Appropriate Use

1. Primary Dressings
   • Hydrocolloid Dressings:
     • Composition: These dressings consist of gel-forming agents that provide a moist environment.
     • Uses: Suitable for partial-thickness wounds and those with minimal exudate. They help in autolytic debridement and can remain in place for several days.
   • Alginate Dressings:
     • Composition: Made from seaweed, alginates are absorbent and conformable.
     • Uses: Ideal for wounds with moderate to heavy exudate, alginates promote a moist healing environment and can be used on infected wounds.
2. Secondary Dressings
   • Foam Dressings:
     • Uses: Provide cushioning and absorb excess exudate. Suitable for a variety of wound types, including pressure ulcers.
   • Transparent Film Dressings:
     • Uses: Provide a protective barrier while allowing for moisture vapor exchange. Ideal for superficial wounds and as a secondary dressing.

Understanding the Healing Process and Signs of Infection

1. Phases of Wound Healing
   • Hemostasis: The initial phase where the body works to stop bleeding through clot formation.
   • Inflammation: Characterized by redness, swelling, heat, and pain, this phase occurs as the body clears debris and pathogens.
   • Proliferation: Involves tissue formation, including collagen deposition and new blood vessel formation.
   • Maturation: The final phase, where the wound continues to strengthen and remodel over time.
2. Signs of Infection
   • Local Signs: Redness, increased warmth, swelling, pain, and purulent discharge at the wound site.
   • Systemic Signs: Fever, chills, increased heart rate, and elevated white blood cell count. Early recognition and prompt intervention are essential to prevent further complications.

Monitoring Patients During and After Procedures

Monitoring patients effectively during and after therapeutic procedures is critical in identifying complications and ensuring positive outcomes.

Recognizing Signs of Complications During Therapeutic Procedures

1. Bleeding:
   • Indicators: Uncontrolled bleeding may present as increased drainage from a wound or catheter site, changes in vital signs (e.g., tachycardia, hypotension), or visible blood.
   • Response: Immediate assessment of the site and vital signs, applying pressure if necessary, and notifying the healthcare provider.
2. Allergic Reactions:
   • Indicators: Patients may experience itching, hives, swelling, or respiratory distress following medication administration or contact with allergens.
   • Response: Stop the procedure, monitor vital signs, and administer antihistamines or other prescribed medications as directed.
3. Infection:
   • Indicators: Look for signs such as increased pain, swelling, erythema, and purulent discharge.
   • Response: Notify the healthcare provider and prepare for potential cultures or antibiotics.

Post-procedure Assessments

Post-procedure assessments are vital in ensuring patient safety and identifying any complications that may arise after a therapeutic procedure.

1. Vital Signs Monitoring:
   • Frequency: Check vital signs at designated intervals, typically immediately after the procedure, and then according to facility protocols (e.g., every 15 minutes for the first hour).
   • Parameters: Monitor for changes in heart rate, blood pressure, respiratory rate, and temperature that could indicate complications.
2. Site Integrity:
   • Assessment: Inspect the catheter insertion site or wound for signs of infection or complications, including swelling, redness, and drainage.
   • Documentation: Record findings in the patient’s medical record to track changes and facilitate communication among the healthcare team.

Documentation of Procedures and Patient Responses

Accurate and thorough documentation is essential for providing quality patient care and maintaining continuity among healthcare providers.

1. Procedure Documentation:
   • Content: Include the type of procedure performed, the date and time, the personnel involved, the patient’s response, and any complications encountered.
   • Use of Templates: Utilize standardized templates or electronic health record (EHR) systems to streamline documentation and ensure consistency.
2. Patient Response:
   • Observations: Document the patient’s vital signs, pain level, and any reported symptoms or complaints during and after the procedure.
   • Patient Education: Record any education provided to the patient regarding post-procedure care and signs to report.

Conclusion

Understanding and assisting with therapeutic procedures is a fundamental aspect of nursing practice. Through comprehensive knowledge of catheterization, wound care, and effective monitoring, nurses can significantly reduce the risk of complications and enhance patient outcomes. This chapter emphasizes the importance of recognizing signs of complications during and after procedures, performing thorough assessments, and maintaining meticulous documentation. By adhering to established protocols and fostering collaboration within the healthcare team, nurses can ensure safe and effective care for their patients.