Potential Complications Although thoracentesis is generally considered safe, procedural complications are associated with increased morbidity, mortality, and healthcare costs. Thoracentesis is a generally safe procedure. Performing ultrasound guided procedures such as liver biopsies, abdominal wall drains, thoracentesis, paracentesis, FNA of superficial structures, wireloc and breast biopsies, and assists in OR on needed cases vascular and Obstetrics. Using an inhaler? B: The periosteum is injected with the local anesthetic. Ascitic fluid may be used to helpdetermine the etiology of ascites, as well as to evaluate for infection or presence of cancer. They might wait a few minutes after this step to make sure the area is numb. breath at certain times during the procedure. Techniques. Explore lung, breathing and allergy disorders, treatments, tests and prevention services provided by the Cleveland Clinic Respiratory Institute. serum liver enzyme levels a nurse manager is preparing to teach a group of newly licensed nurses about effective time management. Is chest radiography routinely needed after thoracentesis? This article reviews the relevant anatomy followed by diagnosis and management of complications including pneumothorax, bleeding, re-expansion pulmonary edema, pain, and infection. It also allows time for questions to clarify information and Color flow doppler can help differentiate free-flowing effusion versus a hypoechoic mass. These results may help your healthcare provider diagnose your specific medical condition. 10 tips for encouraging sharing (and discouraging self-interest) this Christmas. Infection of the chest wall or pleural space (. Thoracentesis or pleural tap, is a procedure in which a needle is inserted into the pleural space between the lungs and the chest wall to remove excess fluid, known as a pleural effusion, from the pleural space to help you breathe easier. The needle or tube is removed when the procedure is completed. This is normal and helps your lungs expand again. Open pneumothorax. These are done to find the If you are having thoracentesis as an outpatient, make sure to bring your insurance card and any necessary paperwork with you. Your healthcare provider doesnt have to make large cuts or damage tissue (minimally invasive), so theres low risk of complications. The fluid appearance provides some key clues about the general cause of fluid accumulation. chest wall, respiratory distress, sudden I do not give the patient any medication before to the Thoracentesis. Pulmonary angiography. INTRODUCTION. If so, you will be given a pleural fluid. 4=m5(Sz0VBUk2 ^qSJp? This can help reduce the risk of a potential complication, like pneumothorax. 3). 5. If diagnostic purpose remove less than 100 ml of fluid from the pleural cavity. Thoracentesis can be fraught with patient anxiety, and pain is the most common complication. Post-Apply dressing over puncture site, check the dressing If youve been newly diagnosed with a medical condition, your medical team will help plan the best treatment for you. People need to be monitored after getting thoracentesis, even if they are having the procedure as an outpatient. Ultrasound-guided thoracentesis performed by radiologists has been shown to have fewer complications than blind thoracentesis. Thoracentesis is a common procedure, with nearly 180,000 done each year in the U.S. alone. The basic thoracentesis apparatus in this kit is an 8-F gauge catheter over an 18-gauge needle with a three-way stopcock and self-sealing valve. Diagnostic Criteria: Anorexia Nervosa. This is called the pleural space. Are you having the procedure for diagnosis, for therapy, or for both? bleeding (hypotension, reduced Hgb level) form.Gather all needed supplies.Obtain preprocedure x-ray site. It also helps ease any shortness of breath or pain by removing the fluid and . It's used to test the fluid for infection or other illnesses and to relieve chest pressure that makes it tough to breathe. With proper training in both thoracentesis itself and the use of bedside ultrasonography, providers can perform this procedure safely and successfully. RN VATI Adult Medical Surgical 2019 CLOSE Question 72 loaded rationals provided. J Hosp Med. Diagnostic procedures. Connect you to machines to watch your heart rate and other vital signs. Clean part of your back with antiseptic and cover the area with a drape. The fluid prevents the pleura This study source was downloaded by 100000768633663 from CourseHero on 01-20-2022 12:31:49 GMT -06: Powered by TCPDF (tcpdf) coursehero/file/76702771/Thoracentesis-Therapeutic-Procedure-form-2pdf/, Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, This study source was downloaded by 100000768633663 from CourseHero.com on 01-20-2022 12:31:49 GMT -06:00, https://www.coursehero.com/file/76702771/Thoracentesis-Therapeutic-Procedure-form-2pdf/, Civilization and its Discontents (Sigmund Freud), Give Me Liberty! Appendicectomy & Appendectomy = same procedure, different terminology. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.thoracic.org/patients/patient-resources/resources/thoracentesis.pdf). therapeutic relief of pleural pressure. b) Cleanse the procedure area with an antiseptic solution. Many people have fluid on their lungs that keeps coming back because of an underlying medical condition. J Thorac Dis. Thoracentesis The thoracentesis was performed in an identical manner b y the same individual (C.J.G.) Stone CK, Humphries RL. Discuss a theoretical model of cultural competency that is complementary to your nursing philosophy of patient care. Bulimia Nervosa. Ruth Jessen Hickman, MD, is a freelance medical and health writer and published book author. Relief of abd ascites pressure bandage, Check vital signs, record weight, and measure abdominal girth, Administer IV fluids or albumin as prescribed, Assist patient into a comfortable position with HOB elevated to Afterward, you could get a Alternative Names Pleural fluid aspiration; Pleural tap How the Test is Performed The test is done in the following way: You sit on a bed or on the edge of a chair or bed. The most common causes of pleural effusions are the following: However, other medical causes are also possible, including certain autoimmune diseases and other problems affecting the cardiovascular, gastrointestinal, or pulmonary systems. Will you receive a sedative before the procedure? This is a condition in which the space between the lungs and the inside of the chest wall contains excess fluid. complications of thoracentesis ati. In contrast, infection or cancer would be more likely to cause exudates. These terms are just general categories that can help your clinician discover what is going on with your health. mortality compared with those undergoing Thoracentesis is a short, low-risk procedure done while youre awake. Other times, thoracentesis is used in diagnosis. : an American History, CWV-101 T3 Consequences of the Fall Contemporary Response Worksheet 100%, Leadership class , week 3 executive summary, I am doing my essay on the Ted Talk titaled How One Photo Captured a Humanitie Crisis https, School-Plan - School Plan of San Juan Integrated School, SEC-502-RS-Dispositions Self-Assessment Survey T3 (1), Techniques DE Separation ET Analyse EN Biochimi 1. Winner of the Standing Ovation Award for "Best PowerPoint Templates" from Presentations Magazine. Procedure steps for diagnostic thoracentesis (1) Sterilize a wide area surrounding the puncture site with chlorhexidine 0.05% (applied with vigorous scrubbing) or povidone-iodine 10% in circular fashion with adequate drying time. -monitor for manifestations of pneumothorax What is thoracentesis. It helps relieve symptoms and figure out what might be causing the fluid, so that your provider can treat it appropriately. monitor vital signs, measure and record amount of fluid removed from 3. Some causes of pleural effusion are serious and require prompt treatment. is removed. Thoracentesis is a common procedure performed by a wide range of healthcare providers in both the inpatient and outpatient settings [].Although generally considered a low-risk intervention, complications of thoracentesis, including pneumothorax, bleeding (puncture site bleeding, chest wall hematoma, and hemothorax), and re-expansion pulmonary edema (REPE), Preparation of the patient. The ideal position for the patient is to sit upright leaning forward. A needle is put through the chest wall into the pleural space. 2lCZe[u)S?X1%D+Jk -hEn( URq%6|1p?/ Cb ok+]'aIjLnu'$ftn Prior to the procedure, which of the following actions should the nurse take? In this case, your healthcare team will work hard to manage your overall clinical picture. Deliver up-to-date nursing information to every student and faculty member. to obtain speciments for diagnostic evaluation, instill medication, and remove fluid, -transudates (heart failure, cirrhosis, nephritic syndrome) However, some people need to have thoracentesis repeated if a pleural effusion comes back due to their underlying medical condition. Interpretation of Findings What to expect when undergoing this test or treatment. What happens during the procedure? Removing the fluid might cause you some discomfort, but it shouldnt be painful. D. Benzocaine spray is administered for a bronchoscopy, not a thoracentesis. Or it may be done as part of a longer stay in the hospital. Someone may ask you to sign a consent form. Which of the following findings should the nurse expect - Joint pain 18) A nurse is reinforcing dietary teaching with a client who has a new diagnosis of GERD about foods to avoid because they worsen the manifestations of GERD. Cavanna L, Mordenti P, Bert R, et al. Thoracentesis, commonly known as a pleural tap or chest tap, is a procedure where excess pleural fluid is drained from the pleural space for diagnostic and/or therapeutic reasons. This type of thoracentesis usually removes a smaller amount of fluid compared to a therapeutic thoracentesis. After the procedure, another chest x-ray may be needed to check for the presence of a pneumothorax (see complications below). Before you agree to the test or the procedure make sure you know: The reason you are having the test or procedure, What results to expect and what they mean, The risks and benefits of the test or procedure, What the possible side effects or complications are, When and where you are to have the test or procedure, Who will do the test or procedure and what that persons is called pleural effusion. What is the considerations of diversity and cultural awareness in the topic of Human trafficking? D3VD@d\s&Ekddrx However, some people opt to take a sedative before the procedure, so they will be awake but sleepy. A thoracentesis is a minimally invasive procedure that involves a doctor removing fluid or air from the pleural space around your lungs with a A thoracentesis. Wiederhold BD, Amr O, O'Rourke MC. Failure to identify the deepest pocket of fluid, Failure to identify the diaphragm, avoiding intra-abdominal injury, Failure to use this diagnostic tool for all thoracentesis procedures. What Is Thoracentesis?Purpose of Thoracentesis. In some cases, if it is expected that the fluid will reaccumulate quickly (such as in chest trauma) a drain might be connected before the needle is removed. A diagnostic test includes all diagnostic x-ray tests, all diagnostic laboratory tests, and other diagnostic tests furnished to a beneficiary. How to prepare for a thoracentesis: There are many indications for thoracentesis that can generally be categorized under one of two headings: Diagnostic: Evaluation of pleural fluid to diagnose primary disease process. Purpose The lungs are lined on the outside with two thin layers of tissue called pleura. in a procedure room, or in a provider's office. Patients who have a bleeding disorder, or who are taking anticoagulant medications such as warfarin, may be at increased risk of bleeding during the procedure. Thoracentesis is performed under local anesthesia by a provider at the clients bedside, and pain. Ascitic fluid may be used to help Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. considerations. The lung is seen as an echogenic structure moving with respiration. determine etiology, differentiate transudate Diagnostic thoracentesis is a simple procedure which can be done at a patients bedside. Access puncture site dressing for drainageWeight the pt. Removal of this fluid by needle aspiration is called a thoracentesis. In patients with adverse prognostic factors (pH < 7.20, glucose < 60 mg/dL (< 3.33 mmol/L), positive Gram stain or culture, loculations), the effusion should be completely drained via thoracentesis How To Do Thoracentesis Thoracentesis is needle aspiration of fluid from a pleural effusion. smoking: 6-8 h inhaler: 4-6 h 2. Therapeutic intervention in a symptomatic patient. $18.49. Report at a scam and speak to a recovery consultant for free. You also might need imaging under other circumstances that increase your risk of complications, such as having multiple needle insertions, having advanced lung disease, if you are on mechanical ventilation, or if a large volume of fluid was removed. Sometimes people also receiving medical imaging after thoracentesis to assess any remaining fluid. The tests done here may take a day or more to come back. INDICATION: _ PROCEDURE OPERATOR: _ ATTENDING PHYSICIAN: _ In Attendance (Y/N): _ CONSENT: [_] During the informed consent discussion regarding the procedure, or treatment, I explained the following to the patient/designee: a. Hawatmeh A, Thawabi M, Jmeian A, et al. You will stay in the hospital until the catheter Czd' Ask any Chest X ray should be taken before thoracentesis is done , to diagnose the location of the fluid in the pleural cavity 3. This space is between the outside surface of the lungs (pleura) and the chest wall. Used to evaluate the clients respiratory status by checking indicators such as. Thoracentesis and paracentesis both remove extra fluid from your body. Also known as pleural fluid analysis, thoracentesis is a procedure that removes fluid or air from the chest through a needle or tube. 1. for bleeding or drainage.Monitor vitals and respiratory A needle is inserted through the back of the chest wall and into the pleural space to extract pleural effusion for diagnostic (where pleural fluid is examined a.k.a. linfonodi ascellari covid. 2017;8(1):130133. Obtain vital signs, weightAssist patient to void, to reduce risk of injury to bladder It is the responsibility of the provider, not the nurse, to explain the procedure to the client. Read the form carefully. *Blunt, crushing, or penetrating chest The -assess site for bleeding Removal of this fluid by needle aspiration is called a thoracentesis. *Monitor for coughing and hemoptysis. Sims position with the head of the bed flat. It may be done for diagnosis and/or therapy. Thoracentesis is a procedure to remove fluid or air from around the lungs. 2015;7(Suppl 1):S1S4. When the area is numb, the healthcare provider will put a needle Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. 2005. It is important to remain still so that the needle is inserted into the correct place. Pleural tap / Thoracentesis Consent Explain the procedure including relevant risks (pneumothorax, bleeding, infection) Obtain and document written consent where possible Online patient information leaflet on pleural effusion may be of use Indications Diagnostic tap: unilateral pleural effusion Ask your healthcare provider to explain the risks in your specific case. activity for a few days. Learn faster with spaced repetition. Bear in mind that the lung is a moving structure and that the depth of fluid may vary with respiration. Fluid will slowly be withdrawn into the needle. *Exuadates (inflammatory, infectious, Dont hesitate to ask if you have any questions about how the procedure works or how to best interpret the results from your procedure. Healthcare providers are also very cautious in giving thoracentesis in people with certain lung diseases such as emphysema or in people receiving ventilator support. View All Products Page Link ATI Nursing Blog. effusion, Systemic lupus erythematosus (SLE) and other autoimmune disease, Inflammation of the pancreas (pancreatitis), A blood clot in the lung (pulmonary embolism), An area of pus in the pleural space (empyema). Inside the space is a small amount of fluid. Fluid in the pleural space appears anechoic and is readily detected above the brightly echogenic diaphragm when the patient is in a supine position. A numbing medicine (local anesthetic) will be injected in the area. Siva Nanda Reddy. Position pt supine with head of bed elevatedAssist pt with relaxation technique Arteries are blood vessels that carry blood away from the heart. Read our, Pleural Cavity: Anatomy, Effusion Causes, Treatment, Tests of Fluid Gathered From Thoracentesis, Chest Pain When Breathing: Causes and When to See a Doctor, The Functions and Disorders of the Pleural Fluid. Is chest radiography routinely needed after thoracentesis? stream During the thoracentesis, your doctor removes fluid from the pleural space. (Select all that apply.) It causes symptoms like: Chest pain. For example, thoracentesis is not usually recommended for people with severe respiratory failure or people who dont have adequate blood pressure. File Upload, PN pharmacology 2020 ATI proctored assessment exam, 1.Review the questions taken this week and identify 2 that you found interesting, challenging, and/or confusing. bacterial peritonitis. Thoracentesis to remove the excess air or fluid to Ease breathing, Thoracentesis Procedure Nursing Responsibilities Indications:- To relieve pain, dyspnoea, and symptoms of pressure, Emphysema, Malignant pleural effusion, For diagnosis e.g. hypovolemia, or changes in mental status, Monitor puncture site for bleeding or Your provider can get to your back in this position and its easier to hold yourself still. If you -bleeding Thoracentesis is a percutaneous procedure where pleural fluid is removed either through a needle (typically for small volumes eg, <30 mL), needle over catheter system, or a small bore catheter. It is most often used to diagnose the cause of pleural effusion, the abnormal accumulation of fluid in the pleural space. Dont hesitate to ask your healthcare provider about any concerns you have. Diagnostic thoracentesis, or sampling of a pleural effusion using a needle through the chest wall, is a simple procedure done to look for the cause of a pleural effusion. Site marked and prepared with swabs of betadine. Some other possible problems include: In some cases, these complications might mean that you will need to stay longer at the hospital. It can also be performed to drain large effusions that lead to respiratory compromise. Dont hesitate to ask your clinician any questions you have about the procedure. location of insertion site, evidence of leakage, manifestation of (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3020354/), (https://www.merckmanuals.com/professional/pulmonary-disorders/how-to-do-pulmonary-procedures/how-to-do-thoracentesis). fluid is then examined in a lab. Pleural effusion can be dangerous if left untreated. Someone may also mark the appropriate side for the needle insertion. This is A. Transcript. Copyright 2023 StudeerSnel B.V., Keizersgracht 424, 1016 GC Amsterdam, KVK: 56829787, BTW: NL852321363B01, Paracentesis is a procedure in which a needle or catheter is inserted into the peritoneal cavity, to obtain ascitic fluid for diagnostic or therapeutic purposes. Ensure consent form is signed, gather supplies, position client ocate Thoracentesis is a procedure to remove fluid from the space between the lungs and the chest wall called the pleural space. Verywell Health's content is for informational and educational purposes only. The Safe-t-Centesis needle was then introduced through the skin incision into the pleural space using negative aspiration pressure and the red colormetric indicator to confirm appropriate positioning of the needle. Thoracentesis kit 2. Mahesh Chand. Will you receive a chest X-ray afterward? Ultrasound use for guidance decreases the risk of complications. Detailed analysis of the fluid in a lab can help identify the source of your problem. The lab will look for signs of infectious diseases or other causes of pleural effusion. Watch movement of diaphragm for a few respiratory cycles to determine how cephalad the diaphragm moves and mark a location for needle insertion above the that point to insure avoiding the diaphragm during the procedure. Your provider uses a local anesthetic to numb the surrounding area. Thoracentesis (thor-a-sen-tee-sis) is a procedure that is done to remove a sample of fluid from around the lung. Thoracentesis can be done as frequently as every few days for certain conditions. If thoracentesis is being performed for symptom relief, as well as for use as a diagnostic test, it is important to be aware that there is a risk the effusion will reaccumulate. Your a) Wear goggles and a mask during the procedure. Tell your provider if you have chest pains or feel short of breath or faint. FIGURE 28.2 Diagnostic thoracentesis. Pleural fluid testing involves removing a sample of this fluid so that it can be analyzed using one or more laboratory methods. Using either a rigid bronchoscope or flexible fiber optic bronchoscope -visualization of abnormalities -biopsy of suspicious tissue ( ex lung cancer) -aspiration of deep sputum or lung abcesses for C & S test, Doorbell Chime Humming After Nest Install. -auscultate lungs qualifications are, What would happen if you did not have the test or procedure, Any alternative tests or procedures to think about, Who to call after the test or procedure if you have questions or It is found in the right iliac region of the abdomen, beneath the ileocecal valve (McBurneys point). Ask For example, it is likely you will need thoracentesis if you have a new pleural effusion and if the medical reason for it is not clear. Stop taking medications after a certain time. Cross), The Methodology of the Social Sciences (Max Weber), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Student-ETOH-Withdrawal-Pneumonia-Unfolding Reasoning, Introduction to Biology w/Laboratory: Organismal & Evolutionary Biology (BIOL 2200), Organic Chemistry Laboratory I (CHM2210L), Biology: Basic Concepts And Biodiversity (BIOL 110), Curriculum Instruction and Assessment (D171), Introduction to Christian Thought (D) (THEO 104), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), 3.4.1.7 Lab - Research a Hardware Upgrade, General Chemistry I - Chapter 1 and 2 Notes, TB-Chapter 16 Ears - These are test bank questions that I paid for. Thoracentesis pre-procedure The patient is repositioned as appropriate for his or her comfort and respiratory status. Look for the deepest pocket of fluid superficial to the lung. Repeat Thoracentesis in Hepatic Hydrothorax and Non-Hepatic Hydrothorax Effusions: A Case-Control Study. This parameter does not address the use of ultrasound for preoperative image-guided localizationFor further . Thoracentesis involves the removal of pleural fluid for diagnostic or therapeutic purposes. Typically, a healthcare provider will perform the thoracentesis, with nurses assisting before and after the procedure. The pleura is a double layer of membranes that surrounds the lungs. versus exudate, detect the presence of x\YoZ!YNLSM+f@Q KS}J A C~KpR\\|g!lZEokqwxl}{2lx:m4g4woovVwm\nm\3'rc3ns+~?X>:u_?Zv(A~{V
!vOVKyZ?7h5o_7?z*[jR)- Thoracentesis, commonly known as a pleural tap or chest tap, is a procedure where excess pleural fluid is drained from the pleural space for diagnostic and/or therapeutic reasons. Performed for Therapeutic reasons such as. The risks of this procedure may include: Air in the space between the lung covering (pleural space) that Thoracentesis. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. McGraw-Hill, 2006. *Pneumothorax Yes, youre awake during a thoracentesis procedure. is a procedure to remove extra fluid or air from between your lungs and your inner chest wall. Not appreciating that the lung is a moving structure. The major difference is the amount of fluid removed. Just like a hinge needs oil to help the door move smoothly, your lungs need pleural fluid to help you breathe. complications of thoracentesis ati. It can be done as an outpatient procedure, which means youre able to go home afterward. Common causes of transudates are liver cirrhosis or heart failure. needle. Both the diagnostic and therapeutic thoracenteses are performed using a similar technique. this process: You may be asked to remove your clothes. During the procedure, most people sit while their heads and arms resting on a table. S[N)?lM\i(VJ0u89KI(;(^ug]<2'P4lY.oG7P`WGS'@'!9_]`E
endstream
endobj
5 0 obj
<< /Font
<< /F1 33 0 R /F2 61 0 R /F3 90 0 R /F4 17 0 R /F5 45 0 R /F6 68 0 R /TT1 55 0 R /F7 92 0 R /F8 9 0 R /F9 29 0 R /F10 27 0 R
>> /ProcSet
[ /PDF /Text
] /ExtGState
<< /GS1 78 0 R /GS2 62 0 R
>> /ColorSpace
<< /Cs8 47 0 R
>>
>>
endobj
6 0 obj
<< /S /D /St 222
>>
endobj
7 0 obj
<< /Subtype /Type1C /Filter /FlateDecode /Length 723
>>
stream Thoracentesis is a safe procedure with low risk for complications. antiseptic solution. Your pleura is a large, thin sheet of tissue that wraps around the outside of your lungs and lines the inside of your chest cavity. Patients undergoing early paracentesis Patients are usually asked to sit upright during the procedure. (See this article for more information about causes of pleural effusions.) Before thoracentesis is performed, a chest x-ray will usually be ordered to confirm the presence of a pleural effusion and to establish the precise location. Your healthcare provider may have other reasons to advise thoracentesis. Some common tests that might be run on the fluid include the following: Other tests may be necessary under specific circumstances, like tests for tumor markers or tests for markers of congestive heart failure.. lactate dehydrogenase (LDH) and amylase, Thoracocentesis: From bench to bed. It can Thoracentesis, also known as pleural fluid analysis, is a procedure in which a needle is inserted through the back of the chest wall into the pleural space (a space that exists between the two lungs and the anterior chest wall) to remove fluid or air. Refractory ascites. A diagnostic thoracentesis may be repeated if initial results fail to yield a diagnosis. Common reasons to have thoracentesis done include: Thoracentesis treats pleural effusion, or excess fluid in the space between your lungs and your chest wall. Diagnostic thoracentesis is indicated for differential diag-nosis for patients with pleural effusion of unknown etiol-ogy. Shojaee S, Khalid M, Kallingal G, Kang L, Rahman N. THORACENTESIS ACTIVE LEARNING TEMPLATE-THERAPEUTIC PROCEDURE.pdf 1 Cardiovascular Diagnostic and Therapeutic Procedures_Managing an Arterial Line.pdf 1 Chest Tube.pdf 1 ALT infection control.docx 2 chest tubes.pdf 1 COPD.pdf 1 homework View More Related Q&A PN pharmacology 2020 ATI proctored assessment exam Q&A