How should a chest tube be removed?

Chapter 16 / Drains and Tubes 99

1.Cut the stitch

2.Ask the patient to exhale or inhale maximally

3.Rapidly remove the tube (split second) and at same time, place petroleum jelly gauze covered by 4 4’s and then tape

4.Obtain a CXR

How should an NGT be placed?

How should an NGT be removed?

1.Use lubrication and have suction up on the bed

2.Use anesthetic to numb nose

3.Place head in flexion

4.Ask patient to drink a small amount of water when the tube is in the back of the throat and to swallow the tube; if the patient can talk without difficulty and succus returns, the tube should be in the stomach (Get an x-ray if there is any question about position)

Give patient a tissue, discontinue suction, untape nose, remove quickly, and tell patient to blow nose

What test should be performed before feeding via any tube?

How does an NGT work?

High abdominal x-ray to confirm placement into the GI tract and NOT the lung!

Sump pump, dual lumen tube—the large clear tube is hooked to suction and the small blue tube allows for air sump (i.e., circuit sump pump with air in the blue tube and air and succus sucked out through the large clear lumen)

How can you check to see if the NGT is working?

Should an NGT be placed on continuous or intermittent suction?

What happens if the NGT is clogged?

How should an NGT be unclogged?

Air and

gastric contents

Blue port will make a sucking noise; always keep the blue port opening above the stomach

Continuous low suction—side holes disengage if they are against mucosa because of the sump mechanism and multiple holes

Tube will not decompress the stomach and will keep the low esophageal sphincter (LES) open (i.e., a setup for aspiration)

Saline-flush the clear port, reconnect to suction, and flush air down the blue sump port

What is a common cause of excessive NGT drainage?

What is the difference between a feeding tube (Dobbhoff tube) and an NGT?

FOLEY CATHETER

Tip of the NGT is inadvertently placed in the duodenum and drains the pancreatic fluid and bile; an x-ray should be taken and the tube repositioned into the stomach

A feeding tube is a thin tube weighted at the end that is not a sump pump but a simple catheter; usually placed past the pylorus, which is facilitated by the weighted end and peristalsis

What is a Foley catheter?

What is a coudé catheter?

Catheter into the bladder, allowing accurate urine output determination

Foley catheter with a small, curved tip to help maneuver around a large prostate

What if a patient has a urethral injury and a Foley cannot be placed?

A suprapubic catheter will need to be placed

HRF

'0

4

What major complications result from placement?

In long-term central lines, what does the “cuff” do?

What is a Hickman® or Hickman-type catheter?

What is a Port-A-Cath®?

PTX (always obtain postplacement CXR), bleeding, malposition (e.g., into the neck from subclavian approach), dysrhythmias

Allows ingrowth of fibrous tissue, which: Holds the line in place

Forms a barrier to the advance of bacteria

External central line tunneled under the skin with a “cuff”

Central line that has a port buried under the skin that must be accessed through the skin (percutaneously)

If you try to place a subclavian central line unsuccessfully, what must you do before trying the other side?

Get a CXR—a bilateral pneumothorax can be fatal!