Surgical Tubes and Drain Flashcards
Procedure for tube insertion (14 steps)
- Consent
- Prepare instruments
- Tube, Sterile glove, Antiseptic solutions, Sterile drapes, Blade and artery forceps
- Check the tube
- Type, size, expiry date
- Check balloon patency if the tube/catheter has balloon.
- Cleaning
- Clean the area using antiseptic solution (povidone iodine , cetrimide or chlorhexidine for
perineum)
- Draping
- “Square” draping or “hole” draping
- Using linen or paper
7)Local anaesthetic
With 1% lignocaine, if skin incision is needed
- Lubricant
(lignocaine gel, KY gel) if to insert catheter through natural orifice.( eg: Continuous Bladder
Drainage )
- Insert the tube
- Check proper placing of tube.
- Connect tube/catheter to reservoir
- Anchor tube to skin
- Dressing as necessary
- Monitoring
Chest tube
-indication
-contraindication
-complication
-insertion technique
- Indications
Pleural effusion, Pneumo/haemo/chylothorax, empyema
- Contraindications
Pleural space adhesion, refractory coagulopathy
- Complications
-Injury to the lung/heart/aorta/liver/spleen/diaphragm, reexpansion pulmonary
edema, infection
- Insertion technique
Supine position
Sterile technique
Site: 5th ICS, just anterior to midaxillary line or “safety Triangle”
LA 1% lignocaine
Skin incision
Nasogastric Tube
-indication
-contraindication
-complications
-insertion technique
- Indications
Gastric decompression, enteral feeding, administration of medications, gastric lavage
- Contraindications
Base of skull fracture, severe facial injury, esophageal obstruction, gastric bypass.
- Complications
Nasal bleeding, esophageal perforation, nasal and esophageal erosion, aspiration
pneumonia, intracranial penetration
- Insertion technique
Upright position
Sterile technique
Lubricant gel
Insert through nostril
Tests for tube placement: Aspiration stomach content,
guggling sound upon injecting air, litmus paper, x-ray.
T tube
-indication
-contraindication
-complications
-insertion technique
Indication
-following exploration of CBD
-splint for CBD
-choledocholithiasis
Contraindication
-charcot’s triad (pain ,fever ,jaundice)
-pain or leakage after clamping
Complication
-occlusion
-dislodgment biliary peritonitis
-pancreatitis ,cholangitis
Insertion
-during open CBD exploration
Percutaneous Transhepatic Biliary Drainage (PTBD tube)
-indication
-insertion technique
- Indication: To decompress biliary system
- Inserted by radiologist under ultrasound guided
- May be replaced by biliary stenting later, for long
term management of biliary obstruction
Sengstaken-Blackmore Tube
-indication
-insertion technique
- Indications
Bleeding esophageal varices - Insertion technique
Aseptic technique
Foley’s catheters
-indications
-contraindications
-complications
-insertion technique
- Indications
Comatose/paralysed, urine output monitoring, urinary retention etc
- Contraindications
Urethral injury / stricture
- Complications
- UTI, urethral injury, retained tube, false passage, bleeding
- Insertion technique
Supine position
Sterile technique
Lubricant gel
Insert while penis in vertical position
How many kinds of drains we have ? and what it is ?
2 ; rubber and silicon
We have 2 types of drain . Name it .
Passive and Active drain
Name the passive drains
Rubber drain (most common)
Penrose drain
Sump drain
Name the active drain.
Jackson Pratt drain
-a suction drainage device used to pull excess fluid from the body by constant suction
Redivac drain
-high negative
pressure drain used for larger draining amounts.
Gastrostomy tube
- Tube inserted through a small incision in the abdomen or endoscopically (PEG tube) in to the
stomach. - Tube used:
– Malecot’s catheter
– Foley’s catheter
– PEG tube(Percutaneous
Endoscopic Gastrostomy) - Indications
– Enteral feeding: for long term feeding in patient who cant tolerate oral feeding , but has normal
gut function.
