what is this sh!t??...continuous wall suction flush ports (every time) suction: water/saline sump:...
TRANSCRIPT
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WHAT IS THIS SH!T?? LINES, TUBES AND DRAINS 101
Jamii St. Julien
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First thing’s first
Jamii Jah - MEE
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Goals
Identify Understand Troubleshoot
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Arterial Lines
Function: Continuous blood pressure Arterial blood gas measurements
Sites: Radial, femoral Axillary, brachial
Troubleshooting bad wave forms Reposition, splint Replace vs guidewire exchange
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Central Venous Catheters
Intravenous access Fluid/medication administration Phlebotomy
Invasive monitoring CVP Allows placement of PA artery catheter
Dialysis access Sites:
Internal jugular, subclavian, femoral
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Temporary central venous lines
Triple lumen catheter Cordis introducer MAC
SLIC
PICC Vascath (dialysis)
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Vascath
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Always check your position
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Swan-Ganz (Pulmonary Artery) Catheter
Hemodynamic monitoring Access via MAC, Cordis
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Tunneled catheters
Hickman Broviac Permacath (Dialysis) Portacath (chemotherapy)
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Nasogastric tubes
Gastric decompression: Small bowel obstruction, Ileus Postoperative foregut surgery Upper GI bleed Toxic ingestion
Aspiration prevention Feeding/medication
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Salem sump
• 1st lumen – suction port • 2nd lumen – sump port • 16Fr or 18Fr
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What to do on rounds
Continuous wall suction Flush ports (every time)
Suction: Water/Saline Sump: Air (permitted to throw away filter)
Quantity/character of drainage If persistently high bilious output check KUB (post-
pyloric)
Do not replace NGT after foregut operation (notify upper level)
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Dobhoff tube
Feeding Blind, image-, fluoroscopically-, and endoscopically-
guided placement Need KUB to confirm before feeding! Weighted/Non-weighted Stylet needs to be removed prior to use
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Gastrostomy tube
Long term enteral access Open, laparoscopic, fluoroscopic, endoscopic (PEG) Continuous & bolus feeds, meds Drain x24hrs, then feed Abdominal binder Nausea/vomiting = place to gravity
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PEG done fell out
< 7 days Stomach not adequately
secured to abdominal wall=leak
OR
> 30 days Immediately replace KUB with gastrograffin 7-30 days = contrast
study
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Jejunostomy
Open, laparoscopic, endoscopic (PEG-J, PEJ) Continuous feeds only (can cycle) NO CRUSHED MEDS!
Carbonated beverage, enzymes to unclog
GI Lap (endoscopy) or IR (fluoroscopy) to replace PEG-J
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Drains
Evacuate fluid collections Intraop, postop
Open Closed suction
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Open drains
Penrose Malecot Pezzer
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Closed suction
Jackson Pratt Round Perforated or fluted
Blake Flat Perforated or fluted
Davol Sump and irrigation ports
Pigtail catheter
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On rounds
Strip drains Ensure suction Know character/quantity Know location
Op note, resident, attending
Remember to take off suction when removing drain Don’t forget to cut suture in pigtail prior to removal
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Chest Tubes
Drain air Drain fluid 28-32Fr, pigtail
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Position
Sentinel eye
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Things to do on rounds
Suction or waterseal? Presence/absence of air leak? Quantity/character of output
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Vacuum Assisted Closure (VAC)
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