Introduction Show
Aim Definition of Terms Assessment Troubleshooting Removal Evidence Table Links IntroductionSurgical drains are tubes placed near surgical incisions in the post-operative patient, to remove pus, blood or other fluid, preventing it from accumulating in the body. The type of drainage system inserted is based on the needs of patient, type of surgery, type of wound, amount of drainage expected and surgeon preference. AimDefinition of Terms
AssessmentInitialAssess drain insertion site for signs of fluid or air leakage, redness or irritation to
the skin. Document site condition and notify treating team and AUM if any concerns. OngoingMonitor patient for signs of sepsis; if the patient is febrile, has redness, tenderness or increased ooze at the drain site, this could be a sign of infection, the treating team must be notified and blood cultures may need to be obtained. Drain patency and insertion site should be observed at the beginning of your shift and before and after moving a patient. If applicable, ensure suction is maintained. A blocked drain tube can lead to formation of haematoma, increased pain and risk of infection. Drainage needs to be documented at a minimum 4 hourly and more frequently if output is high. Regularly discuss removal plan with treating team. D rains should be removed as soon as practicable, the longer a drain remains in situ, the higher risk of infection as well as development of granulation tissue around the drain site, causing increased pain and trauma upon removal. Pain Assessments should be completed and documented regularly whilst the drain is in situ. Appropriate analgesia should be provided when necessary, particularly prior to removal. Please refer to the pain assessment and management guideline for more information. InvestigationsIf suspecting infection, notify treating medical team and ask if a swab of the insertion site or sample of any ooze should be collected for pathological investigation. EducationEducate patient/parent to ensure the drain is below the site of insertion but not pulling on the patient. Educate the patient/parent that there is a risk of dislodgement therefore requiring increased care when moving. Patient should be aware that moving whilst drain is in situ will cause some pain, but this can be minimised with regular analgesia. The patient should be encouraged to mobilise with supervision when appropriate. TroubleshootingReinstating SuctionShould
suction be lost when using vacuum drainage systems (i.e. Redivac), the treating doctor should be notified. When the Redivac™ drain is changed (to ensure suction reapplied) ensure “standard aseptic technique” is utilised, please refer the Aseptic Technique Policy for more information. This procedure must be approved by AUM or treating doctor. Moving a patient with a drain tubeAssess the patient including all drains and attachment sites prior to mobilising, ensuring drains are secured and will not dislodge/pull on patient. When appropriate, patient mobilisation with a drain should be encouraged to reduce risk of DVT. Reassess drains post mobilising to ensure dislodgement of drains has not occurred. At all times, ensure drainage tube is not entangled with other leads (IV tubing, O2 leads, etc.) as this could lead to inadvertent removal of the tube. LeakageIf leakage occurs at a surgical drain site, please notify the AUM and treating team and consider the following:
BlockageIf drainage is minimal, ensure the drain is not blocked, if blocked, notify the treating team and AUM. Inadvertent removal/Drain dislodgementIf the drain is suspected to have moved position, the drain should be secured and the treating team notified. RemovalEnsure plan for removal of drain tube is discussed with and ordered by the
treating team in the patient’s progress notes on EMR. Discuss and plan for procedural pain management and non-pharmalogical interventions to minimise pain and distress throughout procedure, assess analgesic requirements first and then consider the need for procedural sedation; please refer to the
procedural sedation ward and ambulatory areas at RCHprocedure for more information. If using analgesia ensure it is given 30-45 minutes prior to procedure to ensure it has taken peak effect. Please refer to the procedural pain
management guideline for more information. The following should be completed using a “Standard Aseptic technique” please refer the Aseptic Technique Policy for more information: Using standard aseptic technique, clean around the site and remove any sutures. Pinching the edges of the skin together, rotate tubing from side to side gently to loosen, then remove the drain using a smooth, but fast, continuous traction. Tie off any purse-string sutures and apply occlusive dressing. NB. Pigtail drains must be uncoiled prior to removal, failure to uncoil a pigtail drain can cause severe pain and/or tissue damage. To uncoil the pigtail drain the catheter/string should be cut to release the string that creates the pigtail coil. If required, cut the tip of the tube for cultures. Unable to remove surgical drainIf there is resistance and no movement of the drain tube despite gentle side-to-side rotation and a firm pull do not proceed further and notify the treating team/surgeon. There should be no excessive force when pulling the drain tube, doing so can lead to serious complications such as drain tube fractures or internal tissue damage. Drain Tube FracturesIf the tube fractures during drain removal and remnants of the tubing is left within the patient contact the treating team immediately. The surgical fellow should order an immediate X-ray of the drain tube site. The patient should be prepared for theatre, inform the parents and consider the need to keep the child nil by mouth in anticipation for surgical removal of the remaining drain tube. The whole drain unit should be kept in the patient’s room until surgical review and will need to be kept for collection to enable quality review. The piece of drain tubing that remains in the patient will also be kept once surgically removed to allow for appropriate follow up of the incidents cause. A VHIMS must be completed by the nurse delegated to remove the drain. For Theatre Staff involved in the surgical removal retained drain tube of the:In theatre, previous surgery is checked on EPIC regarding the LDA’s flowsheet of the drain that was inserted at that operation. NB. There can be multiple drains. After removal of retained drain, instrumentation nurse to superficially clean visible blood /serous fluid off the retained drain. Instrumentation nurse to measure length of retained drain before placing in a yellow top container. -Surgery is completed as planned. Scout RN to record length of retained item on patient’s UR label on container. Retained item's lot number and expiry that has been recorded in EPIC is to be transcribed onto the yellow top container with patient’s UR label. Scout RN to record in EPIC retained items details. Also check LDA's flow sheet for removal of drain/line details and update in comments section that residual item has been removed and record length with date and time stamp. Yellow top container to be kept together with the remaining drains until critical review process is completed and VHIMs documentation finalised. Post op X-ray to be reviewed by surgeons and open disclosure to family to be undertaken by surgeons. Link to Policy & Procedure: Surgical Wounds – Procedure for Missing/Non Intact Drains Post removalMonitor site for signs of infection, obtain swabs or samples if required. Evidence TableClick here to view the evidence table. Links
Please remember to read the disclaimer. The development of this nursing guideline was coordinated by Emily Gard, RN, Platypus, and approved by the Nursing Clinical Effectiveness Committee. Updated March 2020. What is the nurse's initial action when a chest tube becomes dislodged quizlet?If the chest tubing becomes disconnected, the nurse should immediately place a gauze dressing over the site. An occlusive dressing can also be necessary to prevent the redevelopment of a pneumothorax.
When caring for a client with a chest tube in place the healthcare provider maintains safety by keeping which items at the client's bedside at all times?Make sure that the dial and float at the chest tube system is at the correctly ordered level. Keep Vaseline gauze, 4x4s, padded hemostat, and sterile water (according to your facility policy and procedure) at the bedside at all times. Keep the head of the bed elevated to help with lung re-expansion.
What is a normal expected outcome following insertion of a chest tube quizlet?Every 15 minutes times 2, then every hour times 4, then every 4 hours. A. What is a normal expected outcome following insertion of a chest tube? Shallow, rapid respirations.
What is indicated by continuous bubbling in the water seal chamber with no bubbles noted in the suction control chamber of the drainage system quizlet?What is indicated by continuous bubbling in the water-seal chamber with no bubbles noted in the suction control chamber of the drainage system? A ~ Continuous bubbling in the water-seal chamber with an absence of bubbles in the suction control chamber indicates that there is a leak in the system.
|