Lines, drains, and airways

  • 3 minutes

Describe one device at a time. After you complete an action, state it in the present or past tense rather than the future tense. You can use familiar product names and abbreviations that map to clinical terms, including Foley catheter, JP drain, Hemovac, PureWick (specify male or female), PIV, PICC, Hep lock, and NG tube. For each device, state the action or timing, device type, location and side, status, and any measurement.

  • Peripheral IV: "Left forearm PIV. Site clean, dry, intact. Transparent dressing clean, dry, intact. Line flushed and saline locked."

  • PICC: "Left upper arm PICC. Site clean, dry, intact. Blood return noted. Line flushed. Cap changed."

  • Foley catheter and output: "Foley catheter. Urine output 350 milliliters. Urine yellow and cloudy."

  • JP drain: "JP drain at the abdominal surgical site emptied, 60-milliliters serosanguinous. Site warm and red."

  • Wound or incision: "Abdominal incision. Site clean and dry. Edges approximated. ABD dressing clean, dry, intact. Scant serosanguinous drainage." Speak about each wound separately.

  • Removal: "Left forearm 20-gauge PIV removed at 2 p.m."

  • Addition: "New peripheral IV, 22-gauge, placed in right forearm."

Choose words carefully. Use 'in place' only to describe a device’s presence. Use 'inserted,' 'placed,' or 'applied' to document an event. Describe a complication with the same five elements you use for a routine check: "Left forearm PIV. Site infiltrated. Leaking noted. Unable to flush. Removed."