Medical equipment use and safety

Introduction

Medical equipment is essential to modern client care, but it also introduces risk when misused, malfunctions, or is poorly monitored. On the Next generation NCLEX (NGN), questions in this domain focus on client safety, early complication detection, infection prevention, and prioritization.

This section emphasizes commonly tested hospital equipment, especially that used in older adults, post-operative clients, and high-acuity settings.

Learning objectives

By the end of this section, the learner should be able to:

• Identify common medical devices and their associated risks
• Recognize early signs of device-related complications
• Apply safety checks and nursing responsibilities
• Prioritize interventions when equipment failure is suspected

Core concept: Equipment supports physiology, not replaces assessment

Medical equipment provides data and support, but the nurse must always assess the client first.

When alarms sound, the first step is to check the client, not the machine.

Nursing accountability & legal responsibility

Medical equipment safety is not just technical; it is a professional responsibility.

The nurse is accountable for:

• Verifying correct settings at the start of shift
• Ensuring equipment is functioning properly
• Reporting malfunction immediately
• Documenting:
  • Settings
  • Client response
  • Interventions performed
  • Provider notification (if applicable)

If equipment malfunctions:

1. Remove from the client if unsafe
2. Tag per facility policy
3. Notify biomedical engineering
4. Document objectively

Oxygen delivery devices

Nasal cannula

Typically used for oxygen flow rates of 1-6 L/min. Higher flow rates may cause nasal dryness and discomfort.

Non-rebreather mask

Used to deliver high concentrations of oxygen to clients with significant hypoxemia. One-way valves keep the client from rebreathing exhaled air, so the reservoir bag holds oxygen only. Ensure the reservoir bag remains partially inflated during use.

• Hypoxia from dislodgement
• Dry mucous membranes
• Skin breakdown
• Oxygen toxicity (high concentrations)

Oxygen safety

Oxygen supports combustion.

Safety measures

• Post “No Smoking” signage
• Keep oxygen 5-10 feet away from heat sources
• Avoid petroleum-based products (e.g., Vaseline)
• Ensure humidification if >4 L/min
• Secure oxygen tanks upright

Oxygen toxicity

Risk increases with:

• High FiO₂ concentrations
• Prolonged exposure (>24-48 hours)
• Mechanically ventilated clients

NGN tip: If hypoxia is suspected, apply oxygen first. Then investigate the cause.

Signs may include:

• Restlessness
• Non-productive cough
• Chest pain

Definitions

Hypoxia

Inadequate oxygen delivery to tissues.

Ventilation

The movement of air into and out of the lungs.

Oxygenation

The process by which oxygen moves from the lungs into the bloodstream.

NGN tip: Always verify oxygen flow rate and device placement when SpO₂ declines.

Pulse oximetry

Limitations

• Poor perfusion
• Cold extremities
• Nail polish or artificial nails
• Motion artifact

Capnography

Capnography measures end-tidal CO₂ (ETCO₂) and reflects ventilation. Capnography is often used with oxygen delivery devices (e.g., specialized nasal cannulas) to monitor ventilation and help detect airway or device-related problems.

This is especially relevant in:

• Post-operative clients
• Clients receiving opioids
• Procedural sedation

Normal ETCO₂: 35-45 mmHg

Early respiratory depression sign: ⬆ Rising ETCO₂ before oxygen saturation drops.

NGN insight: Pulse oximetry measures oxygenation (oxygen saturation), not ventilation. Capnography measures ventilation.

Intravenous (IV) therapy equipment

Potential complications

• Infiltration - leakage of non-vesicant fluid into the surrounding tissue
• Extravasation
• Phlebitis
• Infection
• Air embolism (rare but serious)

NGN tip: Any liquid categorized as a vesicant requires frequent site assessment to detect extravasation early.

IV pump safety & high-alert medications

Infusion pumps are frequently tested due to medication error risk.

High-alert medications:

• Insulin
• Heparin
• Chemotherapy
• Vasopressors

Safety checks

• Trace tubing from bag to insertion site
• Verify rate with order
• Double-check pump programming
• Label all tubing clearly.

If an occlusion alarm sounds:

• Check for kinks
• Assess insertion site
• Ensure clamps are open

Air embolism recognition

Although rare, signs include:

• Sudden dyspnea
• Chest pain
• Hypotension

Immediate action: If suspected, clamp tubing immediately and position the client in left lateral Trendelenburg position (left side-lying, head down) to trap air in the right atrium.

Enteral feeding equipment

Key safety considerations

• Verify tube placement before feeding
• Elevate head of bed ≥30°
• Monitor for aspiration
• Check residuals per protocol

NGN tip: Aspiration risk increases when the client is in the supine position.

Urinary catheters

Major risks

• Catheter-associated urinary tract infection (CAUTI) - an infection related to indwelling urinary catheter use
• Obstruction
• Trauma during insertion

NGN tip: Use indwelling urinary catheters only when clinically necessary and remove them as soon as they are no longer needed.

Chest tubes and wound drainage devices

Chest tubes remove air, blood, or fluid from the pleural or mediastinal space and restore negative pressure so the lung can re-expand. Wound drainage devices (e.g., Jackson-Pratt, Hemovac) use gentle suction to remove fluid from a surgical site and promote healing.

Key safety considerations

• Keep the drainage system below the chest or wound level, with tubing free of dependent loops and kinks
• Monitor drainage color, consistency, and amount; report a sudden increase, an abrupt decrease, or continuous bubbling in the water-seal chamber (a sign of an air leak)
• Never clamp a chest tube unless directed by the provider or facility policy
• Keep two enclosed hemostats and an occlusive dressing at the bedside in case the tube becomes dislodged

NGN tip: If a chest tube is accidentally dislodged, cover the insertion site with an occlusive dressing taped on three sides and notify the provider immediately.

Suction equipment

Safety risks

• Hypoxia
• Mucosal trauma
• Dysrhythmias from vagal stimulation

NGN tip: Suctioning should be brief (typically ≤10-15 seconds per pass) and only as needed.

Bed safety and mobility equipment

Safety principles

• Lowest bed position
• Wheels locked
• Call light within reach
• Proper use of alarms

NGN insight: Bed rails are not restraints unless they restrict voluntary movement.

Alarm management

Key concepts

• Do not silence alarms without assessment
• Address cause, not just sound
• Prevent alarm fatigue through proper settings

NGN tip: Ignoring alarms is a client safety violation.

Common pitfalls on the NCLEX:

• Leaving urinary drainage bags above bladder level (causes backflow and raises CAUTI risk)
• Using “patient” instead of the exam’s preferred “client” terminology