CARE OF TUBES : SHORT NOTE FOR NURSES

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CARE OF TUBES

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1 NASOGASTRIC TUBES

  • Short tubes used to intubate the stomach
  • Inserted from nose to the stomach
  • Purpose is to decompress the stomach by removing fluids and \or gas to promote abdominal comfort
  • It provide nutrition by acting as a temporary feeding tube





TYPES OF TUBES

  • Levin tube – used to remove gastric contents via intermittent suction or to provide tube feedings
  • Salem stump tube – it is a double lumen tube with an air vent(pigtail) used for decompression with continuous suction.If leakage occurs through air vent, instill 30 mL of air into the air vent and irrigate the main lumen with normal saline.

– Perform irrigation every 4 hours to assess and maintain the patency of the tube

-For the removal of the nasogastric tube ask the client to take a deep breath and hold; remove the tube slowly and evenly over the course of 3 to 6 seconds

2 GASTROINTESTINAL TUBE FEEDINGS

TYPES AND ANATOMICAL PLACEMENT

– Nasogastric : Nose to stomach

– Nasoduodenal – nasojejunal : Nose to duodenum or jejunum

– Gastostomy : Stomach

– Jejunostomy : Jejunum

  • Position client in a high fowler’s position and on the right side if comatose
  • Assess tube placement by aspirating gastric contents and measuring the PH (should be 3.5 or lower)
  • Warm the feeding to room temperature to prevent diarrhea and cramps
  • For bolus feeding ,maintain the client in a high fowler’s position for 30 minutes after the feeding
  • For a continuous feeding , keep the client in semi-fowler’s position at all times
  • Always assess placement of the tube before feeding
  • Change the feeding container and tubing every 24 hours
  • Do not administer the feeding if residual is more than 100 mL

3 INTESTINAL TUBES

  • It is passed nasally into the small intestine
  • Position the client on the right side to facilitate passage of the weighted bag in the tube through the pylorus of the stomach and into the small intestine

4 ESOPHAGEAL AND GASTRIC TUBES

  • Used to apply pressure against esophageal veins to control bleeding
  • Sengstaken-Blakemore tube
  • It is a triple lumen gastric tube with an inflatable esophageal balloon, an inflatable gasric balloon, and a gasric aspiration lumen
  • If bleeding is not stopped with inflation of the gastric balloon , the esophageal balloon is inflated to 25 – 45 mm Hg
  • With sengstaken- blakemore tube, a nasogastric tube also is inserted in the opposite
  • Keep a scissors at the bedside
  • Minnesota tube -modified sengstaken blakemore tube with an additional lumen for aspirating esophagopharyngeal secretions

5 LAVAGE TUBES

  • Used to remove toxic substances from the stomach
  • Lavacuator – it provides continuous suction
  • Ewald tube – a single lumen large tube used for rapid one time irrigation and evacuation

6 URINARY AND RENAL TUBBES

  • Never clamp the tube
  • Maintain patency
  • Monitor output closely; urine out put of less than 30 mL\hr or lack of output for more than 15 minutes should be reported to the physcine immediately

7 ENDOTRACHEAL TUBE

An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal).


  • Used to maintain a patent airway
  • It is indicated when the client needs mechanical ventilation
  • Placement is confirmed by chest x-ray filim, correct placement is 1 to 2 cm above the carina
  • Keep a resuscitation (ambu) bag at the bedside at all times
  • Monitor cuff pressure atleast every 8 hours per agency procedure to ensure that they do not exceed 20 mmHg
  • An aneroid pressure manometer is used to measure cuff pressure
  • For extubation :
  • hyperoxygenate the client and suction the ET tube and oral cavity
  • place in a semi -Fowler’s position
  • deflate the cuff ;have the client inhale and at peak inspiration, remove the tube, suctioning the airway through the tube while pulling it out
  • inform the client that hoarseness or a sore throat is normal and that the client should limit talking if it occurs

8 TRACHEOSTOMY TUBE

A tracheostomy is a surgical procedure to create an opening through the neck into the trachea (windpipe). A tube is usually placed through this opening to provide an airway and to remove secretions from the lungs. This tube is called a tracheostomy tube or trach tube.

  • Tracheostomy can be temporary or permanent
  • Monitor ABG and pulseoximetry
  • Maintain a semifowler’s to high fowler’s position
  • Suction fluids as needed; hyperoxygenate the client before suctioning
  • Usually half-strength hydrogen peroxide is used for cleaning tracheostomy site and inner cannula
  • Never insert decannulation plug into a tracheostomy tube untill the cuff is deflated and the inner cannula is removed
  • Keep a resuscitation bag,obturator, clamps and a tracheostomy set at the bedside

9 CHEST TUBE DRAINAGE SYSTEM

A chest tube (chest drain, thoracic catheter, tube thoracostomy, or intercostal drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum.

  • The system returns negative pressure to the intrapleural space
  • System is used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.
  • Collection chamber :
  • It is located where the chest tube from the client connects to the system
  • Drainage from the tube collects in aseries of caliberated colums in this chamber
  • Notify the physician if drainage is more than 100 mL\hr or if drainage becomes bright red or increases suddenly
  • Mark the drainage at 1 – 4 hour intervals
  • Water seal chamber:
  • The tip of the tube is underwater,allowing fluid and air to drain from the pleural space and preventing air from entering the pleural space
  • Water moves up on inhalation and, moves down on exhalation
  • Excessive bubbling indicates an air leak in the chest tube system and notify the physician
  • Suction control chamber:
  • It provides suction
  • Gentle(not vigorous) bubbling in this chamber indicates there is suction and is normal
  • No bubbling is noted
  • When the orange floater valve is in the window ,the correct amount of suction is applied
  • Keep the drainage system below the level of the chest and the tubes free of kinks, dependent loops, or other obstructions
  • Encourage coughing and deep breathing
  • Do not strip or milk a chest tube unless specifically ordered
  • Never clamp a chest tube without a written order from a physician
  • If the drainage system cracks or breaks insert the chest tube into a bottle of sterile water, remove the cracked system , and replace it with a new system
  • If the chest tube is pulled out of the chest accidentally, pinch the skin opening together, apply an occlusive sterile dressing, cover the dressing with overlapping pieces of 2-inch tape and call the physician immediately
  • For removing chest tube , the client is asked to take a deep breath and hold it, and the tube is removed or valsalva’s maneuver is used depending on physician’s preference.

 

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