Drains and Tubes Flashcards
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JP drain
What are three S’s of JP drain removal?
- Stitch removal
- Suction discontinuation
- Slow, steady pull
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Penrose drain
Define G-tube
Gastrostomy tube; used for drainage or feeding
Definte J-tube
Jejunostomy tube: used for feeding; may be a small-needle cathetar or large red rubber cathetar
Define Cholecystostomy tube
Tube placed percutaneously or with US guidance into gallbladder
Define T tube
Tube placed in common bile duct w/ ascending and desccending limb
Drains percutaneously; placed after common bile duct exploration
Chest Tube insertion process
- Admin local anesthetic
- Incise skin in 4 or 5 ICS etween mid- and ant-axillary lines
- blunt kelly clamp dissection OVER rib (avoid nerve damage) into pleural space
- Finger exploration
- place tube posterior superior
Is chest tube placed over or under rib?
over - avoid VAN damage
What are the three chambers on the pleuravac?
- Colleciton
- Water seal
- Suction control
Describe how each chamber of pleuravac box works as the old three-bottle system:
Collection Chamber
Collects fluid, pus, blood, chyle and measures amaount: connects to water seal and chest tube
Describe how each chamber of pleuravac box works as the old three-bottle system:
Water Seal
One-way valve- allows air to be removed
does not allow air back into pleural cavity
connects to suction control bottle and to collection chamber
Describe how each chamber of pleuravac box works as the old three-bottle system:
Suction-control Chamber
Controls amount of suction by height of water column
Sucking in room air releases excessive suction
connects to wall suction and water seal bottle
Intermittent bubbling in the pleurevac
Normal w/ pleural drainage, especially w/ a cough
Continuous bulbbling w/ pleur evac
Leak is present –> check all connections
Tidaling with pleur evac
Normal operation for spontaneously breathing pts the fluid should move towards the pleural space w/ inspiration and back towards the device w/ expiration. The opposite will be observed in pt’s with ppv
NO tidaling w/ pleur evac
- The lung has re-expanded and tube can be removed
OR
- There is a kink in the chest tube straighten out the tube
OR
- The chest tube has been clamped (unclamped unless doc has ordered a clamp)
Excessive bubbling in suction chamber of pleur evac
suction is too high
Recommendatiosn for removal of chest tube placed for PTX
(NOT HOW TO REMOVE)
- Suction until PTX resolves and air leak is gone
- Water seal for 24h
- Remove chest tube if no PTX or air leak is present p 24 h of water seal
How fast is a small, stable PTX absorbed?
approx 1%/day there fore a 10% PTx will take about 10 days
How shoudl a chest tube be removed?
- Cut stitch
- Ask pt to exhale or inhale maximally
- Rapidly remove tube (split second) and at same time place petro jelly guaze covered by 4X4’s and then tape
- Obtain CXR