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Tubes and Drains

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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  1. Tubes and Drains PN 3

  2. Respiratory Tubes Tracheostomy

  3. 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

  4. Tracheostomy

  5. 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

  6. Shiley

  7. Portex

  8. 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

  9. Cuffed Cuff

  10. 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

  11. Fenestration

  12. 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

  13. 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

  14. 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

  15. Respiratory Tubes Endotracheal tube

  16. Ambu Bag

  17. ET tube

  18. 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

  19. Insertion • Orotracheal • Larger tube • Rapid restore of air • Discomfort for pt, displacement with tongue, occlusion from biting • Nasotracheal • Smaller tube • Increase respiratory effect

  20. Orotracheal Tube

  21. Nasotracheal Tube

  22. Nasotracheal Tube

  23. 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

  24. 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

  25. Closed Chest Drainage System Chest Tube

  26. 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.

  27. 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.

  28. 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?

  29. Chest Tubes

  30. Chest Tube

  31. Renal and Urinary Tubes

  32. 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

  33. Nephrostomy

  34. 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

  35. Nasogastric Tubes

  36. 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

  37. NG Tube

  38. 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

  39. NG Tube

  40. Nasoenteric Tube

  41. Nasoenteric (Intestinal) Tubes

  42. 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

  43. Combined Esophageal and Gastric Tubes

  44. 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

  45. Combined

  46. Combined • Insertion • Upright position • Check all balloons before insertion • Complication

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