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.

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Tubes and Drains

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Tubes and drains

Tubes and Drains

PN 3


Respiratory tubes

Respiratory Tubes

Tracheostomy


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


Tracheostomy1

Tracheostomy


Comparison of features cannula

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

Shiley


Portex

Portex


Tubes and drains

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


Tubes and drains

Cuffed

Cuff


Fenestration

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


Fenestration1

Fenestration


Nursing responsibilities

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

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

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 tubes1

Respiratory Tubes

Endotracheal tube


Ambu bag

Ambu Bag


Et tube

ET tube


Overview

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

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

Orotracheal Tube


Nasotracheal tube

Nasotracheal Tube


Nasotracheal tube1

Nasotracheal Tube


Nursing management

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


Removal1

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 system

Closed Chest Drainage System

Chest Tube


Chest tube insertion

Chest tube insertion

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

  • 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.


Chest tube nursing care

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.


Complications1

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 Tubes


Chest tube

Chest Tube


Renal and urinary tubes

Renal and Urinary Tubes


Nephrostomy ureteral tube

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

Nephrostomy


Indwelling urinary catheter

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

Nasogastric Tubes


Ng 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 Tube


Ng nursing management

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 tube1

NG Tube


Nasoenteric tube

Nasoenteric Tube


Nasoenteric intestinal tubes

Nasoenteric (Intestinal) Tubes


Nasoenteric 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 Esophageal and Gastric Tubes


Combined

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


Combined1

Combined


Combined2

Combined

  • Insertion

    • Upright position

    • Check all balloons before insertion

  • Complication


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