CARE OF DRAINS

NASOGASTRIC TUBE FOLYS CATHETER SUPRA PUBIC CATHETER WOUND DRAINAGE

NG Tube Indications

• Aspirate stomach contents• Diagnostic or

therapeutic

• Assessment of GI bleeding

• Determine gastric acid content

NG Tube Indications

• Treat paralytic ileus • Treat intestinal obstruction• Recurrent vomiting likely• Trauma• Overdose

Determine length of tube to be inserted

Tube placement must be confirmed before use. Following initial x-ray film confirmation; verify tube

position every 4 to 6 hours and as needed.◦Observe characteristics of fluid aspirated from

tube.◦Test the pH of aspirated fluid.

Tube irrigation maintains tube patency:◦Before, between, and after medications and

feedings.◦30 mL of plain water is the preferred irrigation

solution.

Allow gravity infusion of irrigating solution.

Verifying Feeding Tube Placement and Irrigation

Confirm NG Tube Placement

• X-ray• Most reliable if tube is radiopaque• Requires order from physician

• Injecting air• 60 cc catheter syringe• Place stethoscope over LUQ of abdomen• Inject air into lumen of tube• Listen for “swoosh” sound

Confirm NG Tube Placement

•Test pH of gastric aspirate• pH < 4 = 95% chance that tip is in stomach

• pH > 6 = may be in lung or pleural space

Nasogastric Tube Position

NG Tube Contraindications

• Esophageal strictures• Alkali ingestion, caustic ingestions, esophageal burns

NG Tube Contraindications

• Trauma patients with:• Cervical or intracranial bleeding• Increased intracranial pressure

• Recent surgery of the following types:• Oropharyngeal• Nasal• Gastric

Complications

Excessive coughing, motion, gagging may aggravate the following:

• Neck injuries• Increased risk for C-spine injuries

• Penetrating neck wounds• May increase hemorrhage

• Tube misplacement• Pulmonary• Intracranial

Evaluation

• Note location of external site marking on the tube• Documentation

• Size of tube, which nostril and client’s response.• Record length of tube from the nostril to end of tube• Record aspirate pH and characteristics

X-ray of misplaced NG tube

CARE OF PATIENT

FOLYS CATHETER

URINARY CATHETERS• CATHETER - A TUBE USED

TO DRAIN OR INJECT FLUID THROUGH A BODY OPENING

• INSERTED THROUGH THE URETHRA, INTO THE BLADDER TO DRAIN THE URINE.

• CAN BE TEMPORARY OR LEFT IN PLACE

• A BALLON IS INFLATED TO HOLD THE CATHETER IN PLACE

WHICH PATIENT NEEDS A URINARY CATHETER

• TOO WEAK

• DISABLED

• POST SURGICAL

• PROTECT WOUNDS OR PRESSURE ULCERS

• FREQUENT URINARY MEASUREMENTS

DRAINAGE BAG• THE END OF THE CATHETER IS ATTACHED TO A DRAINAGE BAG

NURSING CARE FOR PATIENT WITH AN INDWELLING CATHETER

• LEAVE THE SYSTEM CLOSED AS MUCH AS POSSIBLE

• DO NOT ALLOW THE BAG OR TUBING TO TOUCH THE FLOOR

• ALWAYS KEEP THE DRAINAGE BAG BELOW THE LEVEL OF THE BLADDER

• KEEP THE CATHETER AND DRAINAGE TUBING FREE OF KINKS

• ATTACH THE DRAINAGE BAG TO THE BEDFRAME – NEVER THE SIDERAIL

• THE DRAINAGE TUBING IS COILED ON THE BED AND CLAMPED TO THE BOTTOM LINEN TO PREVENT KINKING OF THE TUBING.

• SLACK IS LEFT ON THE CATHETER TO PREVENT PULLING.

•

• NOTICE THE

• CATHETER TAPED TO

• THE INNER THIGH.

• NOTICE THE DRAINAGE

• BAG HOOKED ON THE

• BEDFRAME.

USE OF LEG BAG• USE A LEG BAG ONLY WHEN THE PERSON IS AMBULATORY OR SITTING IN A CHAIR—NEVER WHEN IN BED

• A LEG BAG HOLDS ABOUT 1000 CC OF URINE, A DRAINAGE BAG HOLDS 2000 CC.

IF A DRAINAGE SYSTEM IS ACCIDENTALLY DISCONNECTED:

• Tell the nurse at once.• Do not touch the ends of the catheter or tubing.• Practice hand hygiene and put on gloves.• Wipe the end of the tube with an antiseptic wipe. • Wipe the end of the catheter with another antiseptic wipe. • Do not put the ends down.• Do not touch the ends after you clean them.• Connect the tubing to the catheter.• Discard the wipes into a biohazard bag.• Remove the gloves and practice hand hygiene.

CATHETER CARE

• THE CATHETER SITE WILL NEED • REGULAR CLEANING TO HELP PREVENT• INFECTION• WEAR GLOVES AND FOLLOW• STANDARD PRECAUTIONS• WASH AWAY FROM THE • URINARY MEATUS• CLEAN FOUR INCHES DOWN THE CATHETER• USE A DIFFERENT PART OF THE• WASHCLOTH OR A CLEAN ANTISEPTIC WIPE• FOR EACH STROKE

EMPTYING THE URINARY DRAINAGE BAG

EMPTY THE BAG AT THE END OF

EACH SHIFT

MEASURE AND RECORD THE

AMOUNT OF URINE PRESENT

RECORD THE AMOUNT ON THE

INTAKE AND OUTPUT SHEET

USE A GRADUATE TO MEASURE

THE AMOUNT OF URINE

CHECK THE AMOUNT OF URINE IN THE

BAG AT FREQUENT INTERVALS

FOLLOW STANDARD PRECAUTIONS AND

WEAR GLOVES

UNCLAMP THE SPOUT AND EMPTY THE DRAINAGE BAG.

CARE OF PATIENT WITH SUPRA PUBIC CATHETER

Why suprapubic catheterization ? (indications)

• May be used temporarily or long-term to drain the bladder.• When urethral diversion is needed• Urethral stricture or trauma.• Gynecologic or urethral surgery.• Urinary incontinence.

SUPRAPUBIC Vs URETHRAL

• Preventing urethral complications• Increased comfort• Separating urinary and genital functions

WHAT TO DO• Provide privacy and explain the procedure to patient• Perform hand hygiene and put on sterile gloves• Tell the patient to lie down position.• Remove the dressing and assess the catheter insertion site

for signs and symptoms of infection such as redness and skin excoriation.

• Make sure the catheter is looped and taped securely to the patient abdomen to prevent kinking or dislodgment inspect the catheter for patency. Catheter may become occluded with clots.

• If the catheter becomes dislodged. Cover the site with a sterile dressing and notify the health care provider immediately.

Continuous……. • Keep the drainage collection container below the level of

the patient’s bladder.• Assess the urine’s characteristics such as clarity,color and

odor if look for cloudy urine or other signs of urinary tract infection.

• Measure urine output at least every 8 hours.• Notify the health care provider immediately if the patient

develops abdominal pain,hematuria,fever,puslike drainage if urine leaked on the dressing or if the catheter stops draining.

• Document your nursing care the appearance of catheter site, skin integrity, urine amount and characteristics.

What’s happening in there?

A SPC is a urinary drainage catheter inserted into the bladder via an incision through the anterior abdominal wall, approx. 2cm above the pubic bone.

COMPLICATIONS• Bowel injury.• Bleeding.• displacement.• Infection.

INFECTION – catheter insertion site

CARE OF WOUND DRAIN

INDICATIONS

• To prevent accumulation of fluids.• To prevent accumulation of air.• To find characteristic of fluids.

SPECIFIC EXAMPLES OF DRAINS AND OPERATIONS• Breast surgery• Orthopedic procedures• Chest surgery • Infected cysts• Pancreatic surgery• Thyroid surgery• Neuro surgery

Surgical Drains• Prophylactic

• Remove pus, blood, serous exudates, chyle or bile.• Form a controlled fistula (e.g. t-tube after bile duct exploration)

Surgical Drains• Therapeutic

• Drain pus, blood, serous exudates, chyle or bile.• Drain air from pleural cavity.• Drain Ascitis.

Advantages of Surgical Drains• Advantages for their use include:

• Drainage of fluid removes potential sources of infection • Drains guard against further fluid collections • May allow the early detection of anastomotic leaks or haemorrhage • Leave a tract for potential collections to drain following removal

Surgical Drains• Disadvantages their use include:

• Presence of a drain increases the risk of infection • Damage may be caused by mechanical pressure or suction • Drains may induce an anastomotic leak

Classification• Open System

• Closed System

Penrose Drain

Pezzer Catheter

Pig-tail catheter

Pig Tail Catheter

T-tube

Chest tube

jackson pratt (JP) drain

NURSES RESPONSIBILITIES

• If active drain it can be attached to a suction source.• Ensure the drain is secured.• Accurately measure and record drainage output.• Monitor changes in character or volume of fluid.• Identify any complication resulting in leaking fluids.• Use measurements of fluid loss to assist intravenous

replacement of fluids.