Tubes and DrainsPN 3
Respiratory TubesTracheostomy
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 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
Portex
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
Cuff Cuffed
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
Fenestration
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 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 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 TubesEndotracheal tube
Ambu Bag
ET tube
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 Orotracheal
Larger tube Rapid restore of air Discomfort for pt, displacement with
tongue, occlusion from biting Nasotracheal
Smaller tube Increase respiratory effect
Orotracheal Tube
Nasotracheal Tube
Nasotracheal Tube
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
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 SystemChest Tube
Chest tube insertion 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.
Pneumothorax, hemothorax, pleural effusions, lung abscess, post-op chest drainage (thoracotomy or CABG)
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.
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 Tube
Renal and Urinary Tubes
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
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
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-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 Tube
Nasoenteric Tube
Nasoenteric (Intestinal) 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 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
Combined
Combined Insertion
Upright position Check all balloons before insertion
Complication