tubes and drains

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Tubes 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

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  • Tubes and DrainsPN 3

  • Respiratory TubesTracheostomy

  • 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

  • Tracheostomy

  • 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

  • Shiley

  • Portex

  • 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

  • CuffCuffed

  • 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

  • Fenestration

  • 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

  • Ambu Bag

  • ET 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

  • Orotracheal Tube

  • Nasotracheal Tube

  • Nasotracheal Tube

  • 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?

  • Chest Tubes

  • Chest Tube

  • 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

  • Nephrostomy

  • 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

  • Nasogastric Tubes

  • 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 Tube

  • 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

  • NG Tube

  • Nasoenteric Tube

  • 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

  • Combined

  • 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

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