중환자간호 매뉴얼 Volume 4

1권

UNIT 1 Pulmonary System _ 1
SECTION 1
Airway Management_1
1 Combitube Insertion and Removal _ 1
2 Endotracheal Intubation(perform) _ 9
3 Endotracheal Intubation(Assist) _ 23
4 Endotracheal Tube and Oral care _ 32
5 Extubation/Decannulation(Perform) _ 39
6 Extubation/Decannulation(Assist) _ 44
7 Laryngeal Mask Airway _ 49
8 Nasopharyngeal Airway Insertion _ 62
9 Oropharyngeal Airway Insertion _ 67
10 Suctioning：Endotracheal or Tracheostomy Tube _ 73
11 Tracheal Tube Cuff Care _ 83
12 Tracheostomy Tube Care_ 93
SECTION 2
Special Pulmonary Procedures _ 103
13 Continuous End-Tidal Carbon Dioxide Monitoring _ 103
14 Continuous Mixed Venous Oxygen Saturation Monitoring _ 111
15 Oxygen Saturation Monitoring by Pulse Oximetry _ 119
16 Pronation Therapy _ 127
SECTION 3
Thoracic Cavity Management _ 142
17 Autotransfusion _ 142
18 Chest Tube Placement(Perform) _ 147
19 Chest Tube Placement(Assist) _ 157
20 Chest Tube Removal(Perform) _ 164
21 Chest Tube Removal(Assist) _ 172
22 Closed Chest Drainage System _ 179
23 Needle Thoracostomy(Perform) _ 201
24 Thoracentesis(Perform) _ 206
25 Thoracentesis(Assist) _ 214
SECTION 4
Ventilatory Management _ 220
26 Arterial-Venous Oxygen Difference Calculation _ 220
27 Auto-PEEP Calculation _ 224
28 Compliance and Resistance Measurement _ 229
29 Manual Self-Inflating Resuscitation Bag _ 233
30 Indices of Oxygenation _ 242
31 Shunt Calculation _ 246
32 Ventilatory Management-Volume and Pressure Modes _ 251
33 Weaning Criteria-Negative Inspiratory Pressure, Positive End-Expiratory Pressure,
Spontaneous Tidal Volume, and Vital Capacity Measurement _ 269
34 Weaning Procedure_ 275

UNIT 2 Cardiovascular System _ 290
SECTION 5
Cardiac Emergencies _ 290
35 Automated External Defibrillation _ 290
36 Cardioversion _ 298
37 Defibrillation(External) _ 310
38 Defibrillation(Internal) _ 319
39 Emergent Open Sternotomy(Perform) _ 325
40 Emergent Open Sternotomy(Assist) _ 331
41 Pericardiocentesis(Perform) _ 336
42 Pericardiocentesis(Assist) _ 344
SECTION 6
Cardiac Pacemakers _ 351
43 Atrial Electrogram _ 351
44 Atrial Overdrive Pacing (perform) _ 361
45 Epicardial Pacing Wire Removal _ 369
46 Implantable Cardioverter-Defibrillator _ 373
47 Permanent Pacemaker (Assessing Function) _ 385
48 Temporary Transcutaneous(External) Pacing _ 396
49 Temporary Transvenous Pacemaker Insertion(Perform) _ 404
50 Temporary Transvenous and Epicardial Pacing _ 413
SECTION 7
Circulatory Assist Devices _ 428
51 Intraaortic Balloon Pump Management _ 428
52 External Counterpressure with Pneumatic Antishock Garments _ 450
53 Ventricular Assist Devices _ 457
SECTION 8
Electrocardiographic Leads and Cardiac Monitoring _ 487
54 Electrophysiologic Monitoring：Hardwire and Telemetry _ 487
55 Extra Electrocardiographic Leads：Right Precordial and Left Posterior
Leads _ 499
56 Continuous ST-Segment Monitoring _ 510
57 Twelve-Lead Electrocardiogram _ 520
SECTION 9
Hemodynamic Monitoring _ 529
58 Arterial Catheter Insertion (Perform) _ 529
59 Arterial Catheter Insertion(Assist), Care and Removal _ 536
60 Blood Sampling from an Arterial Catheter _ 552
61 Blood Sampling From Central Venous Catheters _ 560
62 Blood Sampling From a Pulmonary Artery Catheter _ 565
63 Cardiac Output Measurement Techniques(Invasive) _ 572
64 Central Venous Catheter Removal _ 590
65 Central Venous Catheter Site Care _ 595
66 Central Venous/Right Atrial Pressure Monitoring _ 599
67 Esophageal Doppler Monitoring of Aortic Blood Flow：Probe Insertion _ 608
68 Esophageal Doppler Monitoring of Aortic Blood Flow：Care and Removal _ 615
69 Left Atrial Catheter：Care and Assisting With Removal _ 621
70 Noninvasive Hemodynamic Monitoring： Impedance Cardiography _ 629
71 Pulmonary Artery Catheter Insertion(Perform) _ 641
72 Pulmonary Artery Catheter Insertion(Assist) and Pressure Monitoring _ 650
73 Pulmonary Artery Cathter Removal _ 673
74 Pulmonary Artery Catheter and Pressure Lines, Troubleshooting _ 680
75 Single-and Multiple-Pressure Transducer Systems _ 697
SECTION 10
Special Cardiac Procedures _ 710
76 Arterial and Venous Sheath Removal _ 710
77 Pericardial Catheter Management _ 718
78 Transesophageal Echocardiography(Assist) _ 731
SECTION 11
Vascular Access _ 740
79 Arterial Puncture _ 740
80 Central Venous Catheter Insertion(perform) _ 749
81 Central Venous Catheter Insertion(Assist) _ 764
82 Implantable Venous Access Device：Access, Deaccess, and Care _ 775
83 Peripheral Intravenous Catheter Insertion _ 786
84 Peripherally Inserted Central Catheter _ 798
85 Venipuncture _ 811

UNIT 3 Neurologic System _ 821
SECTION 12
Neurologic Monitoring _ 821
86 Bispectral Index Monitoring _ 821
87 Brain Tissue Oxygen Monitoring : Insertion(Assist), Care, and Troubleshooting
_ 836
88 Intracranial Bolt insertion(Assist), Monitoring, Care,
Troubleshooting, and Removal _ 846
89 Intraventricular Catheter Insertion(Assist), Monitoring, Care, Troubleshooting and
Removal _ 858

90 Jugular Venous Oxygen Saturation Monitoring：Insertion(Assist),
Care, Troubleshooting, and Removal _ 868
91 Lumbar Subarachnoid Catheter Insertion(Assist)
for Cerebral Spinal Fluid Pressure Monitoring and Drainage _ 879
92 Neurologic Drainage and Pressure Monitoring System _ 888
93 Transcranial Doppler Monitoring _ 903

SECTION 13
Special Neurologic Procedures _ 916
94 Cerebrospinal Fluid Drainage Assessment _ 916
95 External Warming/Cooling Devices _ 920
96 Ice-water Caloric Testing for Vestibular Function(assist) _ 929
97 Lumbar Puncture (perform) _ 934
98 Lumbar and Cisternal Punctures (Assist) _ 942
SECTION 14
Traction Management _ 949
99 External Fixation Device Insertion(Assist) _ 949
100 Halo Traction Care _ 955
101 Tong and Halo Pin Site care _ 963
102 Traction Maintenance _ 967
SECTION 15
Pain Management _ 974
103 Epidural Catheters ：Assisting With Insertion and Pain Management _ 974
104 Peripheral Nerve Stimulators _ 986
105 Patient-Controlled Analgesia _ 996
106 Peripheral Nerve Blocks (Assist) _ 1004

UNIT 4 Gastrointestinal System _ 1015
SECTION 16
Special Gastrointestinal Procedures _ 1015
107 Esophagogastric Tamponade Tube _ 1015
108 Gastric Lavage in Hemorrhage and Overdose _ 1025
109 Monitoring Gastrointestinal Perfusion With a Gastric Tonometer _ 1034
110 Intraabdominal Pressure Monitoring _ 1049
111 Nasogastric Tube Insertion, Care, and Removal _ 1057
112 Paracentesis (Perform) _ 1067
113 Paracentesis (Assist) _ 1075
114 Peritoneal Lavage (Perform) _ 1081
115 Peritoneal Lavage (Assist) _ 1090
116 Scleral Endoscopic Therapy _ 1098

UNIT 5 Renal System _ 1105
SECTION 17
Renal Replacement _ 1105
117 Continuous Renal Replacement Therapies _ 1105
118 Hemodialysis _ 1133
119 Peritoneal Dialysis _ 1151
SECTION 18
Special Renal Procedures _ 1162
120 Apheresis, Plasmapheresis , and Plasma Exchange (Assist) _ 1162

UNIT 6 Hematologic System _ 1171
SECTION 19
Fluid Management _ 1171
121 Blood and Blood Component Administration _ 1171
122 Blood Pump Use _ 1183
123 Continuous Arteriovenous Rewarming _ 1187
124 Massive infusion devices _ 1199
125 Transfusion Reaction Management _ 1211
SECTION 20
Special Hematologic Procedures _ 1218
126 Bone Marrow Biopsy and Aspiration(Perform) _ 1218
127 Bone Marrow Biopsy and Aspiration(Assist) _ 1225
128 Determination of Microhematocrit via Centrifuge _ 1231

UNIT 7 Integumentary System _ 1237
SECTION 21
Burn Wound Management _ 1237
129 Donor Site Care _ 1237
130 Burn Wound Care _ 1245
131 Skin Graft Care _ 1260
SECTION 22
Special Integumentary Procedures _ 1270
132 Intracompartmental Pressure Monitoring _ 1270
133 Pressure-Reducing Devices：Lateral Rotation Therapy _ 1281
134 wound closure _ 1289
135 Suture Removal _ 1302
SECTION 23
Wound Management _ 1308
136 Cleaning , Irrigating , Culturing , and Dressing an Open Wound _ 1308
137 Debridement ：Pressure Ulcers, Burns, and Wounds _ 1319
138 Dressing Wounds With Drains _ 1327
139 Drain Removal _ 1333
140 Pouching a Wound _ 1337

141 Vacuum-Assisted ClosureTM (V.A.C.)￡o System for Wounds _ 1342

UNIT 8 Nutrition _ 1358
142 Enteral Nutrition _ 1358
143 Parenteral Nutrition _ 1368
144 Percutaneous Endoscopic Gastrostomy( PEG ), Gastrostomy,
or jejunostomy Tube Care _ 1377
145 Small-Bore Feeding Tube Insertion and Care _ 1382

UNIT 9 End of Life _ 1387
146 Advance Directives _ 1387
147 Determination of Death _ 1394
148 Care of the Organ Donor _ 1404
149 Identification of Potential Organ Donors _ 1409
150 Request for Organ Donation _ 1414
151 Non-Heart-Beating Organ Donation (Donation After Cardiac Death) _ 1419
152 Withholding and Withdrawing Life-Sustaining Therapy _ 1426

UNIT 10 Calculating Medication Doses _ 1433
153 Calculating Doses, Flow Rates, and Administration Of
Continuous Intravenous Infusions _ 1433

2권

Unit 1 Pulmonary System
Unit 2 Cardiovascular System
Unit 3 Neurologic System
Unit 4 Gastrointestinal System
Unit 5 Renal System
Unit 6 Hematologic System
Unit 7 Integumentary System
Unit 8 Nutrition
Unit 9 End of Life
Unit 10 Calculating Medication Doses

3권

UNIT 1 Pulmonary System 1
SECTION 1
Airway Management1
1 Combitube Insertion and Removal 1
2 Endotracheal Intubation(perform) 9
3 Endotracheal Intubation(Assist) 23
4 Endotracheal Tube and Oral care 32
5 Extubation/Decannulation(Perform) 39
6 Extubation/Decannulation(Assist) 44
7 Laryngeal Mask Airway 49
8 Nasopharyngeal Airway Insertion 62
9 Oropharyngeal Airway Insertion 67
10 Suctioning：Endotracheal or Tracheostomy Tube 73
11 Tracheal Tube Cuff Care 83
12 Tracheostomy Tube Care 93
SECTION 2
Special Pulmonary Procedures 103
13 Continuous End-Tidal Carbon Dioxide Monitoring 103
14 Continuous Mixed Venous Oxygen Saturation Monitoring 111
15 Oxygen Saturation Monitoring by Pulse Oximetry 119
16 Pronation Therapy 127
SECTION 3
Thoracic Cavity Management 142
17 Autotransfusion 142
18 Chest Tube Placement(Perform) 147
19 Chest Tube Placement(Assist) 157
20 Chest Tube Removal(Perform) 164
21 Chest Tube Removal(Assist) 172
22 Closed Chest Drainage System 179
23 Needle Thoracostomy(Perform) 201
24 Thoracentesis(Perform) 206
25 Thoracentesis(Assist) 214
SECTION 4
Ventilatory Management 220
26 Arterial-Venous Oxygen Difference Calculation 220
27 Auto-PEEP Calculation 224
28 Compliance and Resistance Measurement 229
29 Manual Self-Inflating Resuscitation Bag 233
30 Indices of Oxygenation 242
31 Shunt Calculation 246
32 Ventilatory Management-Volume and Pressure Modes 251
33 Weaning Criteria-Negative Inspiratory Pressure, Positive End-Expiratory Pressure,
Spontaneous Tidal Volume, and Vital Capacity Measurement 269
34 Weaning Procedure 275

UNIT 2 Cardiovascular System 290
SECTION 5
Cardiac Emergencies 290
35 Automated External Defibrillation 290
36 Cardioversion 298
37 Defibrillation(External) 310
38 Defibrillation(Internal) 319
39 Emergent Open Sternotomy(Perform) 325
40 Emergent Open Sternotomy(Assist) 331
41 Pericardiocentesis(Perform) 336
42 Pericardiocentesis(Assist) 344
SECTION 6
Cardiac Pacemakers 351
43 Atrial Electrogram 351
44 Atrial Overdrive Pacing (perform) 361
45 Epicardial Pacing Wire Removal 369
46 Implantable Cardioverter-Defibrillator 373
47 Permanent Pacemaker (Assessing Function) 385
48 Temporary Transcutaneous(External) Pacing 396
49 Temporary Transvenous Pacemaker Insertion(Perform) 404
50 Temporary Transvenous and Epicardial Pacing 413
SECTION 7
Circulatory Assist Devices 428
51 Intraaortic Balloon Pump Management 428
52 External Counterpressure with Pneumatic Antishock Garments 450
53 Ventricular Assist Devices 457
SECTION 8
Electrocardiographic Leads and Cardiac Monitoring 487
54 Electrophysiologic Monitoring：Hardwire and Telemetry 487
55 Extra Electrocardiographic Leads：Right Precordial and Left Posterior
Leads 499
56 Continuous ST-Segment Monitoring 510
57 Twelve-Lead Electrocardiogram 520
SECTION 9
Hemodynamic Monitoring 529
58 Arterial Catheter Insertion (Perform) 529
59 Arterial Catheter Insertion(Assist), Care and Removal 536
60 Blood Sampling from an Arterial Catheter 552
61 Blood Sampling From Central Venous Catheters 560
62 Blood Sampling From a Pulmonary Artery Catheter 565
63 Cardiac Output Measurement Techniques(Invasive) 572
64 Central Venous Catheter Removal 590
65 Central Venous Catheter Site Care 595
66 Central Venous/Right Atrial Pressure Monitoring 599
67 Esophageal Doppler Monitoring of Aortic Blood Flow：Probe Insertion 608
68 Esophageal Doppler Monitoring of Aortic Blood Flow：Care and Removal 615
69 Left Atrial Catheter：Care and Assisting With Removal 621
70 Noninvasive Hemodynamic Monitoring： Impedance Cardiography 629
71 Pulmonary Artery Catheter Insertion(Perform) 641
72 Pulmonary Artery Catheter Insertion(Assist) and Pressure Monitoring 650
73 Pulmonary Artery Cathter Removal 673
74 Pulmonary Artery Catheter and Pressure Lines, Troubleshooting 680
75 Single-and Multiple-Pressure Transducer Systems 697
SECTION 10
Special Cardiac Procedures 710
76 Arterial and Venous Sheath Removal 710
77 Pericardial Catheter Management 718
78 Transesophageal Echocardiography(Assist) 731
SECTION 11
Vascular Access 740
79 Arterial Puncture 740
80 Central Venous Catheter Insertion(perform) 749
81 Central Venous Catheter Insertion(Assist) 764
82 Implantable Venous Access Device：Access, Deaccess, and Care 775
83 Peripheral Intravenous Catheter Insertion 786
84 Peripherally Inserted Central Catheter 798
85 Venipuncture 811

UNIT 3 Neurologic System 821
SECTION 12
Neurologic Monitoring 821
86 Bispectral Index Monitoring 821
87 Brain Tissue Oxygen Monitoring : Insertion(Assist), Care, and Troubleshooting
836
88 Intracranial Bolt insertion(Assist), Monitoring, Care,
Troubleshooting, and Removal 846
89 Intraventricular Catheter Insertion(Assist), Monitoring, Care, Troubleshooting and
Removal 858
90 Jugular Venous Oxygen Saturation Monitoring：Insertion(Assist),
Care, Troubleshooting, and Removal 868
91 Lumbar Subarachnoid Catheter Insertion(Assist)
for Cerebral Spinal Fluid Pressure Monitoring and Drainage 879
92 Neurologic Drainage and Pressure Monitoring System 888
93 Transcranial Doppler Monitoring 903

SECTION 13
Special Neurologic Procedures 916
94 Cerebrospinal Fluid Drainage Assessment 916
95 External Warming/Cooling Devices 920
96 Ice-water Caloric Testing for Vestibular Function(assist) 929
97 Lumbar Puncture (perform) 934
98 Lumbar and Cisternal Punctures (Assist) 942
SECTION 14
Traction Management 949
99 External Fixation Device Insertion(Assist) 949
100 Halo Traction Care 955
101 Tong and Halo Pin Site care 963
102 Traction Maintenance 967
SECTION 15
Pain Management 974
103 Epidural Catheters ：Assisting With Insertion and Pain Management 974
104 Peripheral Nerve Stimulators 986
105 Patient-Controlled Analgesia 996
106 Peripheral Nerve Blocks (Assist) 1004

UNIT 4 Gastrointestinal System 1015
SECTION 16
Special Gastrointestinal Procedures 1015
107 Esophagogastric Tamponade Tube 1015
108 Gastric Lavage in Hemorrhage and Overdose 1025
109 Monitoring Gastrointestinal Perfusion With a Gastric Tonometer 1034
110 Intraabdominal Pressure Monitoring 1049
111 Nasogastric Tube Insertion, Care, and Removal 1057
112 Paracentesis (Perform) 1067
113 Paracentesis (Assist) 1075
114 Peritoneal Lavage (Perform) 1081
115 Peritoneal Lavage (Assist) 1090
116 Scleral Endoscopic Therapy 1098

UNIT 5 Renal System 1105
SECTION 17
Renal Replacement 1105
117 Continuous Renal Replacement Therapies 1105
118 Hemodialysis 1133
119 Peritoneal Dialysis 1151
SECTION 18
Special Renal Procedures 1162
120 Apheresis, Plasmapheresis , and Plasma Exchange (Assist) 1162

UNIT 6 Hematologic System 1171
SECTION 19
Fluid Management 1171
121 Blood and Blood Component Administration 1171
122 Blood Pump Use 1183
123 Continuous Arteriovenous Rewarming 1187
124 Massive infusion devices 1199
125 Transfusion Reaction Management 1211
SECTION 20
Special Hematologic Procedures 1218
126 Bone Marrow Biopsy and Aspiration(Perform) 1218
127 Bone Marrow Biopsy and Aspiration(Assist) 1225
128 Determination of Microhematocrit via Centrifuge 1231

UNIT 7 Integumentary System 1237
SECTION 21
Burn Wound Management 1237
129 Donor Site Care 1237
130 Burn Wound Care 1245
131 Skin Graft Care 1260
SECTION 22
Special Integumentary Procedures 1270
132 Intracompartmental Pressure Monitoring 1270
133 Pressure-Reducing Devices：Lateral Rotation Therapy 1281
134 wound closure 1289
135 Suture Removal 1302
SECTION 23
Wound Management 1308
136 Cleaning , Irrigating , Culturing , and Dressing an Open Wound 1308
137 Debridement ：Pressure Ulcers, Burns, and Wounds 1319
138 Dressing Wounds With Drains 1327
139 Drain Removal 1333
140 Pouching a Wound 1337
141 Vacuum-Assisted ClosureTM (V.A.C.)￡o System for Wounds 1342

UNIT 8 Nutrition 1358
142 Enteral Nutrition 1358
143 Parenteral Nutrition 1368
144 Percutaneous Endoscopic Gastrostomy( PEG ), Gastrostomy,
or jejunostomy Tube Care 1377
145 Small-Bore Feeding Tube Insertion and Care 1382

UNIT 9 End of Life 1387
146 Advance Directives 1387
147 Determination of Death 1394
148 Care of the Organ Donor 1404
149 Identification of Potential Organ Donors 1409
150 Request for Organ Donation 1414
151 Non-Heart-Beating Organ Donation (Donation After Cardiac Death) 1419
152 Withholding and Withdrawing Life-Sustaining Therapy 1426

UNIT 10 Calculating Medication Doses 1433
153 Calculating Doses, Flow Rates, and Administration Of
Continuous Intravenous Infusions 1433

4권

UNIT 1 Pulmonary System _ 1
SECTION 1
Airway Management_1
1 Combitube Insertion and Removal _ 1
2 Endotracheal Intubation(perform) _ 9
3 Endotracheal Intubation(Assist) _ 23
4 Endotracheal Tube and Oral care _ 32
5 Extubation/Decannulation(Perform) _ 39
6 Extubation/Decannulation(Assist) _ 44
7 Laryngeal Mask Airway _ 49
8 Nasopharyngeal Airway Insertion _ 62
9 Oropharyngeal Airway Insertion _ 67
10 Suctioning：Endotracheal or Tracheostomy Tube _ 73
11 Tracheal Tube Cuff Care _ 83
12 Tracheostomy Tube Care_ 93
SECTION 2
Special Pulmonary Procedures _ 103
13 Continuous End-Tidal Carbon Dioxide Monitoring _ 103
14 Continuous Mixed Venous Oxygen Saturation Monitoring _ 111
15 Oxygen Saturation Monitoring by Pulse Oximetry _ 119
16 Pronation Therapy _ 127
SECTION 3
Thoracic Cavity Management _ 142
17 Autotransfusion _ 142
18 Chest Tube Placement(Perform) _ 147
19 Chest Tube Placement(Assist) _ 157
20 Chest Tube Removal(Perform) _ 164
21 Chest Tube Removal(Assist) _ 172
22 Closed Chest Drainage System _ 179
23 Needle Thoracostomy(Perform) _ 201
24 Thoracentesis(Perform) _ 206
25 Thoracentesis(Assist) _ 214
SECTION 4
Ventilatory Management _ 220
26 Arterial-Venous Oxygen Difference Calculation _ 220
27 Auto-PEEP Calculation _ 224
28 Compliance and Resistance Measurement _ 229
29 Manual Self-Inflating Resuscitation Bag _ 233
30 Indices of Oxygenation _ 242
31 Shunt Calculation _ 246
32 Ventilatory Management-Volume and Pressure Modes _ 251
33 Weaning Criteria-Negative Inspiratory Pressure, Positive End-Expiratory Pressure,
Spontaneous Tidal Volume, and Vital Capacity Measurement _ 269
34 Weaning Procedure_ 275

UNIT 2 Cardiovascular System _ 290
SECTION 5
Cardiac Emergencies _ 290
35 Automated External Defibrillation _ 290
36 Cardioversion _ 298
37 Defibrillation(External) _ 310
38 Defibrillation(Internal) _ 319
39 Emergent Open Sternotomy(Perform) _ 325
40 Emergent Open Sternotomy(Assist) _ 331
41 Pericardiocentesis(Perform) _ 336
42 Pericardiocentesis(Assist) _ 344
SECTION 6
Cardiac Pacemakers _ 351
43 Atrial Electrogram _ 351
44 Atrial Overdrive Pacing (perform) _ 361
45 Epicardial Pacing Wire Removal _ 369
46 Implantable Cardioverter-Defibrillator _ 373
47 Permanent Pacemaker (Assessing Function) _ 385
48 Temporary Transcutaneous(External) Pacing _ 396
49 Temporary Transvenous Pacemaker Insertion(Perform) _ 404
50 Temporary Transvenous and Epicardial Pacing _ 413
SECTION 7
Circulatory Assist Devices _ 428
51 Intraaortic Balloon Pump Management _ 428
52 External Counterpressure with Pneumatic Antishock Garments _ 450
53 Ventricular Assist Devices _ 457
SECTION 8
Electrocardiographic Leads and Cardiac Monitoring _ 487
54 Electrophysiologic Monitoring：Hardwire and Telemetry _ 487
55 Extra Electrocardiographic Leads：Right Precordial and Left Posterior
Leads _ 499
56 Continuous ST-Segment Monitoring _ 510
57 Twelve-Lead Electrocardiogram _ 520
SECTION 9
Hemodynamic Monitoring _ 529
58 Arterial Catheter Insertion (Perform) _ 529
59 Arterial Catheter Insertion(Assist), Care and Removal _ 536
60 Blood Sampling from an Arterial Catheter _ 552
61 Blood Sampling From Central Venous Catheters _ 560
62 Blood Sampling From a Pulmonary Artery Catheter _ 565
63 Cardiac Output Measurement Techniques(Invasive) _ 572
64 Central Venous Catheter Removal _ 590
65 Central Venous Catheter Site Care _ 595
66 Central Venous/Right Atrial Pressure Monitoring _ 599
67 Esophageal Doppler Monitoring of Aortic Blood Flow：Probe Insertion _ 608
68 Esophageal Doppler Monitoring of Aortic Blood Flow：Care and Removal _ 615
69 Left Atrial Catheter：Care and Assisting With Removal _ 621
70 Noninvasive Hemodynamic Monitoring： Impedance Cardiography _ 629
71 Pulmonary Artery Catheter Insertion(Perform) _ 641
72 Pulmonary Artery Catheter Insertion(Assist) and Pressure Monitoring _ 650
73 Pulmonary Artery Cathter Removal _ 673
74 Pulmonary Artery Catheter and Pressure Lines, Troubleshooting _ 680
75 Single-and Multiple-Pressure Transducer Systems _ 697
SECTION 10
Special Cardiac Procedures _ 710
76 Arterial and Venous Sheath Removal _ 710
77 Pericardial Catheter Management _ 718
78 Transesophageal Echocardiography(Assist) _ 731
SECTION 11
Vascular Access _ 740
79 Arterial Puncture _ 740
80 Central Venous Catheter Insertion(perform) _ 749
81 Central Venous Catheter Insertion(Assist) _ 764
82 Implantable Venous Access Device：Access, Deaccess, and Care _ 775
83 Peripheral Intravenous Catheter Insertion _ 786
84 Peripherally Inserted Central Catheter _ 798
85 Venipuncture _ 811

UNIT 3 Neurologic System _ 821
SECTION 12
Neurologic Monitoring _ 821
86 Bispectral Index Monitoring _ 821
87 Brain Tissue Oxygen Monitoring : Insertion(Assist), Care, and Troubleshooting
_ 836
88 Intracranial Bolt insertion(Assist), Monitoring, Care,
Troubleshooting, and Removal _ 846
89 Intraventricular Catheter Insertion(Assist), Monitoring, Care, Troubleshooting and
Removal _ 858

90 Jugular Venous Oxygen Saturation Monitoring：Insertion(Assist),
Care, Troubleshooting, and Removal _ 868
91 Lumbar Subarachnoid Catheter Insertion(Assist)
for Cerebral Spinal Fluid Pressure Monitoring and Drainage _ 879
92 Neurologic Drainage and Pressure Monitoring System _ 888
93 Transcranial Doppler Monitoring _ 903

SECTION 13
Special Neurologic Procedures _ 916
94 Cerebrospinal Fluid Drainage Assessment _ 916
95 External Warming/Cooling Devices _ 920
96 Ice-water Caloric Testing for Vestibular Function(assist) _ 929
97 Lumbar Puncture (perform) _ 934
98 Lumbar and Cisternal Punctures (Assist) _ 942
SECTION 14
Traction Management _ 949
99 External Fixation Device Insertion(Assist) _ 949
100 Halo Traction Care _ 955
101 Tong and Halo Pin Site care _ 963
102 Traction Maintenance _ 967
SECTION 15
Pain Management _ 974
103 Epidural Catheters ：Assisting With Insertion and Pain Management _ 974
104 Peripheral Nerve Stimulators _ 986
105 Patient-Controlled Analgesia _ 996
106 Peripheral Nerve Blocks (Assist) _ 1004

UNIT 4 Gastrointestinal System _ 1015
SECTION 16
Special Gastrointestinal Procedures _ 1015
107 Esophagogastric Tamponade Tube _ 1015
108 Gastric Lavage in Hemorrhage and Overdose _ 1025
109 Monitoring Gastrointestinal Perfusion With a Gastric Tonometer _ 1034
110 Intraabdominal Pressure Monitoring _ 1049
111 Nasogastric Tube Insertion, Care, and Removal _ 1057
112 Paracentesis (Perform) _ 1067
113 Paracentesis (Assist) _ 1075
114 Peritoneal Lavage (Perform) _ 1081
115 Peritoneal Lavage (Assist) _ 1090
116 Scleral Endoscopic Therapy _ 1098

UNIT 5 Renal System _ 1105
SECTION 17
Renal Replacement _ 1105
117 Continuous Renal Replacement Therapies _ 1105
118 Hemodialysis _ 1133
119 Peritoneal Dialysis _ 1151
SECTION 18
Special Renal Procedures _ 1162
120 Apheresis, Plasmapheresis , and Plasma Exchange (Assist) _ 1162

UNIT 6 Hematologic System _ 1171
SECTION 19
Fluid Management _ 1171
121 Blood and Blood Component Administration _ 1171
122 Blood Pump Use _ 1183
123 Continuous Arteriovenous Rewarming _ 1187
124 Massive infusion devices _ 1199
125 Transfusion Reaction Management _ 1211
SECTION 20
Special Hematologic Procedures _ 1218
126 Bone Marrow Biopsy and Aspiration(Perform) _ 1218
127 Bone Marrow Biopsy and Aspiration(Assist) _ 1225
128 Determination of Microhematocrit via Centrifuge _ 1231

UNIT 7 Integumentary System _ 1237
SECTION 21
Burn Wound Management _ 1237
129 Donor Site Care _ 1237
130 Burn Wound Care _ 1245
131 Skin Graft Care _ 1260
SECTION 22
Special Integumentary Procedures _ 1270
132 Intracompartmental Pressure Monitoring _ 1270
133 Pressure-Reducing Devices：Lateral Rotation Therapy _ 1281
134 wound closure _ 1289
135 Suture Removal _ 1302
SECTION 23
Wound Management _ 1308
136 Cleaning , Irrigating , Culturing , and Dressing an Open Wound _ 1308
137 Debridement ：Pressure Ulcers, Burns, and Wounds _ 1319
138 Dressing Wounds With Drains _ 1327
139 Drain Removal _ 1333
140 Pouching a Wound _ 1337
141 Vacuum-Assisted ClosureTM (V.A.C.)￡o System for Wounds _ 1342

UNIT 8 Nutrition _ 1358
142 Enteral Nutrition _ 1358
143 Parenteral Nutrition _ 1368
144 Percutaneous Endoscopic Gastrostomy( PEG ), Gastrostomy,
or jejunostomy Tube Care _ 1377
145 Small-Bore Feeding Tube Insertion and Care _ 1382

UNIT 9 End of Life _ 1387
146 Advance Directives _ 1387
147 Determination of Death _ 1394
148 Care of the Organ Donor _ 1404
149 Identification of Potential Organ Donors _ 1409
150 Request for Organ Donation _ 1414
151 Non-Heart-Beating Organ Donation (Donation After Cardiac Death) _ 1419
152 Withholding and Withdrawing Life-Sustaining Therapy _ 1426

UNIT 10 Calculating Medication Doses _ 1433
153 Calculating Doses, Flow Rates, and Administration Of
Continuous Intravenous Infusions _ 1433