tubes and drains
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DESCRIPTIONTubes and Drains. PN 3. Respiratory Tubes. Tracheostomy. 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. - PowerPoint PPT Presentation
Tubes and DrainsPN 3
Tracheostomyopening in trachea-surgically createdVariety of tubes can be inserted-temp/perm, length of use, speakVariation of tubes-double or single lumen, cuffed or not
Comparison of features-CannulaDouble lumen-both inner and outer cannulaEasy cleaningReusable or disposableShiley
Single lumen-no inner cannulaShort term useNot anticipated to have copious secretionsPortex
CuffCuff-allows to be sealed offPrevent air loss or prevent aspirationInflate with air using syringe to pilot ballonNo cuff-long term useDont need mechanical ventilationLow risk aspiration
FenestrationWith-have holes in tube to allow air to flow between larynx and tracheaDuring weaning so client can regain ability to breathAllows for speech Non-no holesMechanical ventilation or for people who dont speak
Nursing ResponsibilitiesHOB 30 degreesAmbu bag at bedsideSpare set, clamps at bedsideHumidified O2TCDBRespiratory Assessment q 4 hrsSuction-set up and procedureInspect stomaPerform tracheostomy care q 8 hrsChange ties dailyMonitor cuff pressure q 8 hrsAlternate communication devices
ComplicationsTube displacement-secure, keep spare at bedside, dont pullTube obstruction-humidify O2, suction, TCDB, clean inner cannulaTracheomalacia (dilation caused by high pressure cuffs)-monitor pressure, bleeding, air volumes, aspiration, get to uncuffed asapTracheoesophageal fistula (abnormal connection between trachea and esophagus from high cuff pressure)-Same as above but may have Gtube insertedTracheal stenosis (narrowing from scar tissue)-surgical dilationTracheal-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
RemovalAccidentalBefore 72 hrs-bag, call rapid responseAfter 72-insert new tube, ventilate with manual resuscitation bag, assess air exchangePurposefulSuctionDeflat cuffMD-cuts sutures and withdraws tube during exhalationDry sterile dressing over stoma and tape gentlyClose over next few days but leaves scar
Respiratory TubesEndotracheal tube
OverviewShort term use-10 to 14 daysKeep patent airwayCan use mechanical ventilationLong tubeOne end-adapter for O2Other end-cuff for inflation
InsertionOrotrachealLarger tubeRapid restore of airDiscomfort for pt, displacement with tongue, occlusion from bitingNasotrachealSmaller tubeIncrease respiratory effect
Nursing ManagementCheck placement every 8 hrsConfirm placement with Chest X-RayMark lip line for cm to insure placementAmbu bag at bedsideSuction as needsCheck respiratory every 4 hrsInflate cuffInsert oral airway to prevent bitingPosition on one side of the mouthOral care every 2 hoursProvide alternative means of communication
RemovalSuctionElevate HOB-semi fowlers to fowlersDeflate cuffHave client inhale and remove at peak inspirationEncourage to coughO2Monitor closely for 30 minTeach they will have a sore throat, hoarse voice
Closed Chest Drainage SystemChest Tube
Chest tube insertionWhy are chest tubes placed?
3 types of drainage systemssingle chamber-water seal and drainage collection in same chamber.dual chamber-water seal and collection chamber separatelythree 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 crepitusIf 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.
ComplicationsAir leaksmonitor water seal chamber for continuous bubblingAccidental disconnectioncheck all connectionsinstruct to exhale as much as possible & cough, cleanse tip and reconnect tubingIf tube accidentally removed..place Vaseline gauze immediately over siteTension PneumothoraxWhat can cause a tension pneumothorax?
When are chest tubes removed?
Renal and Urinary Tubes
Nephrostomy/Ureteral TubePosition tube so it maintain patency, dont clampMonitor urine outputDont irrigate unless ordered then use surgical aseptic technique with a max of 5 mLReport if patency is not restored
Indwelling Urinary CatheterInsert with sterile techique, record amout of outflowPosition below bladder and secure to thighAccurate I and ORoutine cath careRemoval-explain to pt, empty and record, deflate balloon, withdraw while client exhales
NG tubesInsertionHigh fowlersMeasure-nose to earlobe then to xiphoid process-apply tapeLubricateTilt head downwardInsert naris and advance upward and backward until resistance is met then rotate catheterAsk to take sips of water or swallow-stop if they start to cough or reach tapeTape in placeCan start suction but no feedings unless placement is confirmed by chest x-ray
NG-Nursing ManagementCheck placementChest x-ray, check pH, insert air and listen for popping noiseCheck every 4 hrsMonitor residualPrior to and regularly during feedings-q4hrsIrrigate-check patencyMouth care q 2 hrsMonitor naris for ulcerationRemovalRemove tape, hold breath, withdraw in 1 smooth motion
Nasoenteric (Intestinal) Tubes
Nasoenteric TubesInserted in nare into stomach and passed into intestines bc the are weightedPt on rt side to facilitate passagePlacement checked by abdominal x-rayWait to tape until verifiedSuction allows for bowel decompression and intestinal secretionsPerform abdominal assessment and measure girth
Combined Esophageal and Gastric Tubes
CombinedPressure to bleeding esophageal varicesSengstaken-Blakemore tube-3 lumen-low gastric suction, balloon applies pressure against bleeding blood vesselsTraction is needed to maintain position of inflated balloonsNG tube inserted to suction secretions above balloonMinnesota is similar but 4 lumens-drain secretions
CombinedInsertionUpright positionCheck all balloons before insertionComplication
*Suction-hyperoxygenate before and after, dont suction no more than 10 secs at one timeInspect stoma for infection and crepitusTracheostomy care-half strength peroxide, suction before cleaning, keep sterile*Placement-both side rise and fall, auscultate for bilateral breath sounds and over epigastric area to make sure it is not in the stomach**(suckling chest wounds, prolonged clamping of tubing, kinks or obstruction.
Removed when the lungs have re-expanded and or there is no more fluid draining