Tubes, drains, lines, and wound vacs What is this sh*t?! What is this sh*t?
Tubes Gastrostomy (PEGs/PEGJs/Open Gs and GJs) Jejunostomy NGT Dobhoff tubes (DHT) Chest tubes Tracheostomy
Gastrostomy tubes
Page #43 for the night Mrs. J on 9N pulled out her PEG tube What do you want to know?
Takes ~7-10 days for tract to form Before a week or so Stomach not pexied to abdominal wall and gastric contents leak into abdomen OR After this time -Immediately reinsert tube into tract (can start to close in 2-4h) --Foley catheter --Go to OR supply room and get PEG -MUST CONFIRM WITH KUB with gastrograffin (tube study)
Other tidbits G-tubes can be low-profile at Children s these are MIC-KEY buttons Used for meds, can bolus feed Leak around make sure balloon filled or can upsize If someone with g-tube is vomiting, put to gravity Postop orders (NPO/gravity x 24hrs/ok for meds/binder)
Jejunostomy tubes (J-tubes) Usually red rubber catheters Cannot bolus due to dumping syndrome Can cycle for approx 16 h Need to be on a pump (kangaroo pouch) SW/HH prior to discharge
More on J-tubes Get clogged more easily Can use viokase or coke down tube to dissolve clog Can be exchanged over wires if necessary PEG-J
NGT Many left postop Some even say DO NOT MANIPULATE If pulled out, please let someone know (ie: esophagectomies) NGT insertion while on call for high volume emesis or gastric distention Consider KUB Salem sump 2 lumens (one for suction/one for air) Always check on rounds to ensure function Always know how much came out & character High bilious output -? KUB (post-pyloric) Some don t like to clamp/gravity
Dobhoff tube Enteral feeds Weighted and Non-weighted Must be confirmed by KUB Can use: Cetacaine spray Lidocaine jelly 60cc syringe Yell swallow louder Endoscopic
Chest tubes
You should know. Is there an air leak? Is it on suction or water seal? How much came out of tube?
Some hints Once there s no air leak, usually water seal Get a film 4 hours later If no ptx, no air leak, and < 250cc output Pull To pull: Regular 4x4s, suture removal kit, plenty of tape, and a red bag for disposal http://www.mc.vanderbilt.edu/surgery/trau ma/tnp/ip-procedures/chest-tube- Removal.pdf Make them hum, deep breath pull FAST Just don t breath into the darn thing
Tracheostomy tubes Sizes: usually 8 cuffed (Shiley) Cuffed or Uncuffed (usually uncuffed) Fenestrated or nonfenestrated
Tracheostomy tubes Trach changes can usually happen after 7 days Trach collar and minimal secretions Downsize trach by either using a red rubber and sliding over or just changing out To decannulate, simply remove and place a dry gauze over stoma Speech consult for Passy Muir (needs to be a 6) May need swallow study prior to eating with trach
JP drains Use negative suction to close potential spaces (breast, plastics) Can be placed intraoperatively to evaluate for leaks (Carey) Blake/JP Round/Flat
For JPs Can strip them Know the output and character Good to know where they are located People (aka attendings) are protective of them Only pull if someone tells you to If someone needs to go home with them, order JP drain teaching Usually will come out when < 30cc/day When pulling, remember to: cut stitch, take off suction, and slow/steady pull Cover with gauze, tape (Stitch if ascites fountain)
Percutaneous drains Perc drain for fluid collections Placed by CT-guided drainage (need recent INR and a wizorder for them) These are pigtail catheters Must cut string or release screw to unravel string within before pulling!!!
Penrose Sump (Davol) Large silicone Can irrigate through Closed suction Large particulate matter (pancreas)
TLC Cordis/Introducer MAC Quad Cath PAC PICC Vascath Permacath Hickman Broviac A-lines Portacath Lines
ACCESS
Random Slide w/ Pictures SLIC (single lumen introducer catheter) QLIC (quad lumen)
Swan-Ganz (Pulmonary artery catheter)
Portacath
Arterial lines Radial, femoral, brachial
Wound Vac (EGS) Subatmospheric negative pressure dressings Attached to suction; collection/collects drainage