Drainage system and tubes PDF

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Summary

This set of notes goes over the different drainage systems and tubes that can be used in surgery
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Drainage system and tubes

 Active drainage- drainage attached to an external source of vacuum to create suction in the cavity; a constant gentle negative pressure evacuates tissue fluid, blood, or air through the passage  Bougie- instrument for exploring and dilating canals, especially the male urethra and the esophagus  Catheter- tube passed into or through the body for evacuating or injecting fluids into body cavities  Drain- exit for discharge or abnormal fluid accumulations or to draw of fluid  Drainage tube- tube inserted into a body cavity to drain away fluid contents  Indwelling- any catheter that is allowed to remain in place in a vein, artery, or body cavity  Lumen- hollow opening through a tube or catheter  Passive drainage- drainage that provides a path of least resistance to the outside; functions by overflow and capillary action and can be assisted by gravity  Self-retaining- catheter or tube that remains in place due to its design such as a Foley  Tube-long, hollow, cylindrical structure o Examples- eustachian, fallopian, esophagus, endotrachial NOTE: these may be used both prophylactically (for preventions as in drainage of the bladder to prevent trauma during surgery) and therapeutically (for treatment as in antibiotic irrigation)  Catheters o Used to allow a method for instillation of irrigations or medications o Used to remove obstructions (such as clots or stones) from lumens or small ducts or vessels o Used as splints in urology for ureters the urethra o Used as a route to instill dye in diagnostic studies  Drains o Used for elimination of fluid accumulation and collection of this fluid o Used to eliminate dead spaces o Used to allow apposition of tissues o Used to prevent formation of hematomas

o Used to prevent wound margin necrosis by eliminating air pressure on uppermost margins of the wound which allows wound to heal from inside out o Used for gentle retraction of tissue during operative procedures to allow better visualization of the operative site o May be used to prevent abscess formation on trauma patients  Tubes o Used to maintain an opening such as in the trachea o Used to decompress the gastrointestinal tract o Used to evacuate the pleural cavity and maintain a negative pressure so lungs can expand Placing and securing catheters, drains, and tubes  Catheters and tubes o Gastrointestinal tubes and urinary catheters may be placed in body cavities pre, intra, and post operatively o Self-retaining catheters and tubes are held in place internally by an inflatable balloon o They are usually secured outside the body with tape depending on the doctor’s order  Drains o Usually inserted intraoperatively by the surgeon o May be placed in the cavity and exteriorized through a separate wound called a stab wound o May be left free or attached securely with suture to the patient’s skin o The exposed end of the drain may or may not be attached to a reservoir or collecting system Types of drainage mechanisms  Capillary action- movement of fluid along a solid object o Penrose drain  Gravity- movement from high pressure to low pressure o Urinary catheters, t-tubes  Manual suction- self contained negative pressure device o Hemovac, Jackson-Pratt  External suction- machine or wall mounted o Salem sump, chest tubes Types of gastrointestinal tubes and their descriptions  Levine tube- single lumen tube used for gastric decompression connected to gravity drainage or intermittent suction

o Sizes 14-18 French and 125 cm long o Used for stomach decompressing, withdrawing specimens, washing the stomach free or toxic substances, and irrigating the stomach and treat upper GI bleeds o Can be used to administer meds and/or feedings  Sump tube- double lumen tubes used for gastric decompression connected to gravity drainage or constant suction o Most common nasogastric tube o Used for irrigation of stomach and tube feedings o Sizes 14-18 French o 120 cm long o If suction is needed, connect the larger bore to suction o Blue vent is always open to air for continuous atmospheric irrigation o Prevent reflux by having the blue vent port above patient’s waist  Tracheal airway tubes o Tracheostomy tube  Placed in a temporary or permanent opening in the trachea to allow air to enter the bronchi and lungs  These tubes have three parts  Obturator- provides a smooth tip during tube insertion to prevent trauma to the tracheal wall  Primary tube (outer cannula)- maintains the patent airway  Inner cannula- removable part that allows cleaning to prevent blockage of airway by crusting or secretions  Has a built-in soft cuf that is inflated to eliminate any free space between the primary tube and the tracheal wall  Endotracheal tube o Placed in the trachea to maintain a patent airway during loss of consciousness o These tubes are used for administration of anesthetics o These tubes are predominately the concern of anesthesia personnel o Adult tubes are cufed, and the cuf is inflated to allow snug fit of the tube as it extends into the trachea o Pediatric and infant tubes are non-cufed since pediatric patient’s tracheas are smaller and might be damaged by snug fitting tubes o These tubes require no collecting device; however, oxygen may be administered via the tube and respiratory secretions may need to be removed by suctioning

 Pharyngeal airway tube o Inserted through the mouth and extends through the oral pharynx o Maintains airway by preventing patient’s tongue from falling back into the oral pharynx  Nasal airway tube o Inserted through the nasal passage and extends through the oral pharynx o Maintains an open nasal airway when mucus membranes may be swollen or when patient has had extensive oral surgery Chest tubes and their characteristics  Chest tubes are used to evacuate hemothorax, pneumothorax, or hemopneumothorax, and to drain pleural abscess or empyema  Chest tubes are required on most cases in which the thoracic cavity is entered  If two chest tubes are used, one is placed higher in the chest for evacuation of air, and the other is placed lower for evacuation of blood and serious drainage  These tubes are always connected to an underwater sealed drainage system which may be connected to suction  Underwater sealed drainage is available as o Self-contained, plastic, disposable unit o Glass- bottle system which may consist of 1, 2, or 3 bottles  Self-contained drainage system units are known as pleur-evac or Thora-seal  For units that are not self-contained, a gomco or an emerson pump is frequently used for suction source Types of wound drains and their uses  Penrose drain- used to drain abscess cavity and if leakage is anticipated; no collection device needed since allowed to drain onto dressings  Cigarette drain- used as a Penrose, but gauze allows for wick actions on accumulated fluid  T-tube- used after common bile duct exploration to ensure patency of duct; connected to bile bag and drained by gravity  Malecot or pezzer catheter- used to drain hollow organs such as bladder, may be used as gastrostomy tube, and may be placed in large abscess site; connected to drainage bag and drained by gravity

 Hemovac- used to drain wound after extensive dissection or where moderate to large amounts of drainage are expected; has selfcontained collecting device and manual suction  Jackson-pratt-used to drain wound where small to moderate amounts of drainage are expected; has self- contained collecting device and manual suction Common types of urethral catheters  Urethral catheters come in various French sizes from 6 fr to 30 fr with varying sizes of inflatable balloons measured in cc’s  Non retaining o Robinson (plain) (red rubber) (robnel) o Coude o Whistle tip o Multieyed o Self- retraining (indwelling) o Two-way (double channel) Foley o Three-way (triple lumen) Foley o Pezzer (mushroom) o Malecot (2 or 4 winged) o Look at page 285 in AST book for more details about these ...