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Active/Passive Drains for Post-Op Surgical Wounds
Percutaneous Drainage Catheters-General
Bilary Tubes
General Post-op drain considerations
Other tubes/drains
100
The most common passive (no suction) drain used post-op that allows fluids, pus, blood or necrotic debris to escape a wound by gravity
What is a Penrose Drain?
100
Interventional Radiologist
What is the profession that usually places these types of drains?
100
Liver bile ducts or gallbladder
What is the end point of these tubes?
100
Early mobilisation, bowels are working, lungs are clear, no pain and check for signs and symptoms of infection. Check incisions and drains.
What are post-op nursing assessments concerned with?
100
With specific orders for a nephrostomy tube and no more than 10mls of normal saline and never for tubes ending in a solid organ
Can we irrigage a nephrostomy tube?
200
Dry Gauze or Drain Gauzes, Tape + Safety Pin
What is used to collect the drainage of a penrose drain and what prevents it from migrating into the wound
200
Yes-With Orders No-never
Can these tubes be irrigated? Can these tubes be aspirated?
200
Green or Yellow
What is the two most common colours of drainage of bile tubes?
200
For perioperative bleeding: 24-48hrs For serous collections: 3-5 days
When are drains typically removed post-op?
200
If the tract is immature (< 2 weeks) clean the exit wound with normal saline, apply a sterile dressing and contact the emergency department (1-4 hours) If the tract is mature (> 2 weeks) insert a similar size sterile Foley’s catheter & contact ER.
What should you do if gastrostomy tube/peg tube falls or is pulled out?
300
2 very common active drains used to continuously remove fluids against gravity in a post op surgical wound. Normal Saline, Dry gauze or drain gauze & tape.
What is a Jackson Pratt Drain & a Hemovac Drain, and what is used to dress them?
300
To Assess if fluid collection is infected; To Characterise type of fluid/drainage; For Symptom reiief caused by collection of fluid/bipass obstructions or blockages
What are the general indications for these types of tubes?
300
Drain bile Pre-Op or Post-Op; Relieve a blockage (e.g. stones or cancer); Bipass an opening in the bile drainage system.
What are the general reasons that you would need a bile tube placed?
300
Possible post-op infection: 1-5 days; Intestinal anastomosis: 5-7 days; T-tubes: 6-10 days but only after cholangiogram to ensure distal patency of bile ducts (& some surgeons will clamp tube 24hrs prior)
When can some typical drains and tubes be removed?
300
percutaneous endoscopic gastrostomy
What does PEG stand for?
400
Sanguinous-Serosanguinous-Serous; Empty Drain when half full & Record Amount/type q24hrs Reset Suction after emptying drain Strip tubing away from patients body
What is the normal progression of drainage post-op from JP or HMV drains, and how is this maintained, collected and monitored (by nurse or client)?
400
Aseptic technique; Orders indicating the Type of fluid, Volume, Frequency; Size of syringe to use. Use No force. Do not aspirate.
What is required to irrigate/instill into these tubes?
400
A sudden increase in the amount or a change in the character of drainge or leakage at the exit site
When would you notify the surgeon or the interventional radiologist at the hospital that the tube was inserted?
400
Chlorhexidine & Transparent dressing Weekly
What is typically used to dress an established tube tract, stable & non-draining exit site with a tube/drain insitu in VCH community?
400
Call colleagues to check if this is something known to community, Consult educator, Consult Practice leads, Check for clinical practice document, call surgeon, call discharging floor nurses for care plan, call acute care CNS/Educator, complete SLS (incident report) Consult clinical coordinator, consult manager on call, consult librarian for evidence
What do you do if you come across a tube/drain or equipment that you have never seen before on a client?
500
Drain cannot be flattened/reset; Drain falls out; Fluid remains/becomes purulent; Fever; Increased Redness or Fluid leak or abnormal drainage around exit site; There is no drainage or sudden increase in drainage.
What are the most common problems with drains that should be reported back to the surgeon
500
Keep Drain, Dressing & Tubing Secure (not dislodged); Free drainage tube from kinks; Check for blockage, Check for infection; Empty Drainage bag and record type and amount of fluids; Monitor site for leakage/drainage; Teach client to irrigate if necessary; When to go to ER & When to report to MD.
What do we teach the client or caregivers about these tubes or form part of our careplan?
500
First tubing is checked for kinks, shreds of mucous, or blood clots. Then tubing can be milked gently away from the patients body towards the drainage device & monitor for drainage.
What is done first, if there is no drainage noted or drainage stops?
500
Intact GI tract but unable to consume sufficient calories to meet nutritional needs; Impaired swallowing related to neurological conditions e.g. stroke, Parkinson’s Disease; and Obstruction related to neoplasm or surgery.
What are the indications for gastrotomy or gastrojejunostomy tubes?
500
What's the tube's purpose? How is it secured? How often should it be changed? How often should the drainage bag be changed? Orders for the care and maintenance of the tube? How do you confirm the proper location? How is patency maintained? What type and amount of drainage should you expect (if any)? How should you assess the patient and the equipment, and how often? What potential complications should you assess for? What should you teach the patient? What should you document? What follow up and to whom should occur?
What ideally should you know about a tube that you are caring for?