Drains and Tubes

Question 1

Answer 1

JP drain

Question 2

What are three S’s of JP drain removal?

Answer 2

1. Stitch removal
2. Suction discontinuation
3. Slow, steady pull

Question 3

Answer 3

Penrose drain

Question 4

Define G-tube

Answer 4

Gastrostomy tube; used for drainage or feeding

Question 5

Definte J-tube

Answer 5

Jejunostomy tube: used for feeding; may be a small-needle cathetar or large red rubber cathetar

Question 6

Define Cholecystostomy tube

Answer 6

Tube placed percutaneously or with US guidance into gallbladder

Question 7

Define T tube

Answer 7

Tube placed in common bile duct w/ ascending and desccending limb

Drains percutaneously; placed after common bile duct exploration

Question 8

Chest Tube insertion process

Answer 8

1. Admin local anesthetic
2. Incise skin in 4 or 5 ICS etween mid- and ant-axillary lines
3. blunt kelly clamp dissection OVER rib (avoid nerve damage) into pleural space
4. Finger exploration
5. place tube posterior superior

Question 9

Is chest tube placed over or under rib?

Answer 9

over - avoid VAN damage

Question 10

What are the three chambers on the pleuravac?

Answer 10

1. Colleciton
2. Water seal
3. Suction control

Question 11

Describe how each chamber of pleuravac box works as the old three-bottle system:

Collection Chamber

Answer 11

Collects fluid, pus, blood, chyle and measures amaount: connects to water seal and chest tube

Question 12

Describe how each chamber of pleuravac box works as the old three-bottle system:

Water Seal

Answer 12

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

Question 13

Describe how each chamber of pleuravac box works as the old three-bottle system:

Suction-control Chamber

Answer 13

Controls amount of suction by height of water column

Sucking in room air releases excessive suction

connects to wall suction and water seal bottle

Question 14

Intermittent bubbling in the pleurevac

Answer 14

Normal w/ pleural drainage, especially w/ a cough

Question 15

Continuous bulbbling w/ pleur evac

Answer 15

Leak is present –> check all connections

Question 16

Tidaling with pleur evac

Answer 16

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

Question 17

NO tidaling w/ pleur evac

Answer 17

1. The lung has re-expanded and tube can be removed

OR

2. There is a kink in the chest tube straighten out the tube

OR

3. The chest tube has been clamped (unclamped unless doc has ordered a clamp)

Question 18

Excessive bubbling in suction chamber of pleur evac

Answer 18

suction is too high

Question 19

Recommendatiosn for removal of chest tube placed for PTX

(NOT HOW TO REMOVE)

Answer 19

1. Suction until PTX resolves and air leak is gone
2. Water seal for 24h
3. Remove chest tube if no PTX or air leak is present p 24 h of water seal

Question 20

How fast is a small, stable PTX absorbed?

Answer 20

approx 1%/day there fore a 10% PTx will take about 10 days

Question 21

How shoudl a chest tube be removed?

Answer 21

1. Cut stitch
2. Ask pt to exhale or inhale maximally
3. Rapidly remove tube (split second) and at same time place petro jelly guaze covered by 4X4’s and then tape
4. Obtain CXR