Tubes and DrainsPN 3

Respiratory TubesTracheostomy

Tracheostomy opening in trachea-surgically created Variety of tubes can be

inserted-temp/perm, length of use, speak

Variation of tubes-double or single lumen, cuffed or not

Tracheostomy

Comparison of features-Cannula Double lumen-

both inner and outer cannula

Easy cleaning Reusable or

disposable Shiley

Single lumen-no inner cannula

Short term use Not anticipated to

have copious secretions

Portex

Shiley

Portex

Cuff Cuff-allows to be

sealed off Prevent air loss or

prevent aspiration Inflate with air

using syringe to pilot ballon

No cuff-long term use

Don’t need mechanical ventilation

Low risk aspiration

Cuff Cuffed

Fenestration With-have holes in

tube to allow air to flow between larynx and trachea

During weaning so client can regain ability to breath

Allows for speech

Non-no holes Mechanical

ventilation or for people who don’t speak

Fenestration

Nursing Responsibilities HOB 30 degrees Ambu bag at

bedside Spare set, clamps at

bedside Humidified O2 TCDB Respiratory

Assessment q 4 hrs Suction-set up and

procedure

Inspect stoma Perform

tracheostomy care q 8 hrs

Change ties daily Monitor cuff

pressure q 8 hrs Alternate

communication devices

Complications Tube displacement-secure, keep spare at bedside,

don’t pull Tube obstruction-humidify O2, suction, TCDB, clean

inner cannula Tracheomalacia (dilation caused by high pressure

cuffs)-monitor pressure, bleeding, air volumes, aspiration, get to uncuffed asap

Tracheoesophageal fistula (abnormal connection between trachea and esophagus from high cuff pressure)-Same as above but may have Gtube inserted

Tracheal stenosis (narrowing from scar tissue)-surgical dilation

Tracheal-innominate artery fistula (erosion of trachea into artery cause by pressure-monitor pressure, bleeding, pulsation in trach tube, prepare for immediate life-saving surgical repair

Removal Accidental

Before 72 hrs-bag, call rapid response

After 72-insert new tube, ventilate with manual resuscitation bag, assess air exchange

Purposeful Suction Deflat cuff MD-cuts sutures and

withdraws tube during exhalation

Dry sterile dressing over stoma and tape gently

Close over next few days but leaves scar

Respiratory TubesEndotracheal tube

Ambu Bag

ET tube

Overview Short term use-10 to 14 days Keep patent airway Can use mechanical ventilation Long tube

One end-adapter for O2 Other end-cuff for inflation

Insertion Orotracheal

Larger tube Rapid restore of air Discomfort for pt, displacement with

tongue, occlusion from biting Nasotracheal

Smaller tube Increase respiratory effect

Orotracheal Tube

Nasotracheal Tube

Nasotracheal Tube

Nursing Management Check placement

every 8 hrs Confirm placement

with Chest X-Ray Mark lip line for cm

to insure placement Ambu bag at

bedside Suction as needs Check respiratory

every 4 hrs

Inflate cuff Insert oral airway

to prevent biting Position on one

side of the mouth Oral care every 2

hours Provide

alternative means of communication

Removal Suction Elevate HOB-semi fowlers to fowlers Deflate cuff Have client inhale and remove at

peak inspiration Encourage to cough O2 Monitor closely for 30 min Teach they will have a sore throat,

hoarse voice

Closed Chest Drainage SystemChest Tube

Chest tube insertion Why are chest tubes placed?

3 types of drainage systems single chamber-water seal and drainage

collection in same chamber. dual chamber-water seal and collection

chamber separately three chamber-water seal, collection

drainage and suction control in separate chambers.

Pneumothorax, hemothorax, pleural effusions, lung abscess, post-op chest drainage (thoracotomy or CABG)

Chest Tube-Nursing Care Document vitals, breath sounds, oxygen sat and resp

effort at least every 4 hours. Tape all connections, secure to chest wall. Keep chamber below chest level. Check frequently for kinks or loops/ s/s of infection

crepitus If water seal system used, The water level should

fluctuate with respiration. If it does not it may not be patent.

Keep device upright- monitor water level, add fluid as need to maintain 2cm water seal.

Measure drainage every 8 hrs marking the level Keep 2 covered hemostats, bottle of sterile water

and an occlusive dressing at bedside at all times.

Complications Air leaks

monitor water seal chamber for continuous bubbling Accidental disconnection

◦ check all connections◦ instruct to exhale as much as possible & cough,

cleanse tip and reconnect tubing If tube accidentally removed..place Vaseline gauze

immediately over site Tension Pneumothorax

What can cause a tension pneumothorax?

When are chest tubes removed?

Chest Tubes

Chest Tube

Renal and Urinary Tubes

Nephrostomy/Ureteral Tube Position tube so it maintain patency,

don’t clamp Monitor urine output Don’t irrigate unless ordered then use

surgical aseptic technique with a max of 5 mL

Report if patency is not restored

Nephrostomy

Indwelling Urinary Catheter Insert with sterile techique, record

amout of outflow Position below bladder and secure to

thigh Accurate I and O Routine cath care Removal-explain to pt, empty and

record, deflate balloon, withdraw while client exhales

Nasogastric Tubes

NG tubes Insertion

High fowlers Measure-nose to earlobe then to xiphoid

process-apply tape Lubricate Tilt head downward Insert naris and advance upward and

backward until resistance is met then rotate catheter

Ask to take sips of water or swallow-stop if they start to cough or reach tape

Tape in place Can start suction but no feedings unless

placement is confirmed by chest x-ray

NG Tube

NG-Nursing Management Check placement

Chest x-ray, check pH, insert air and listen for popping noise

Check every 4 hrs Monitor residual

Prior to and regularly during feedings-q4hrs Irrigate-check patency Mouth care q 2 hrs Monitor naris for ulceration Removal

Remove tape, hold breath, withdraw in 1 smooth motion

NG Tube

Nasoenteric Tube

Nasoenteric (Intestinal) Tubes

Nasoenteric Tubes Inserted in nare into stomach and passed

into intestines bc the are weighted Pt on rt side to facilitate passage

Placement checked by abdominal x-ray Wait to tape until verified

Suction allows for bowel decompression and intestinal secretions

Perform abdominal assessment and measure girth

Combined Esophageal and Gastric Tubes

Combined Pressure to bleeding esophageal varices Sengstaken-Blakemore tube-3 lumen-

low gastric suction, balloon applies pressure against bleeding blood vessels Traction is needed to maintain position of

inflated balloons NG tube inserted to suction secretions above

balloon Minnesota is similar but 4 lumens-drain

secretions

Combined

Combined Insertion

Upright position Check all balloons before insertion

Complication