Chapter 10. Tubes and Devices
10.7 Summary
When patients have tubes and attachments to aid in their recovery, health care providers are required to understand the type, purpose, precautions, complications, and interventions to ensure treatment is effective and to prevent patient harm. Each tube and attachment is unique, and the function of the tube, care of the patient, and safety precautions must be understood. This chapter reviewed many common types of tubes and attachments found in the acute and community setting, and reviewed the care and maintenance of nasogastric tubes, indwelling catheters, ostomies, urostomies, chest tube drainage systems, and tracheostomies.
Key Takeaways
- Specific guidelines and procedures must be followed when working with tubes and attachments to prevent complications from the device.
- Patients with tubes and attachments are more at risk for infection. Take care to maintain sterility of all tubes and ensure device insertion sites stay dry and intact, and all connection points stay intact.
- Be aware of potential complications of each tube and attachment, and prevention strategies. Regularly assess the patient and the device for complications.
- If unfamiliar with a specific device, review all policies and procedures prior to using the device to prevent harm to the patient.
- Know the purpose, type, and special precautions for all tubes and devices that are used in your agency. Complete all training as required.
References
Atrium. (2009). A personal guide to managing dry suction water seal chest drainage. Retrieved from https://co.grand.co.us/DocumentCenter/View/677/Oasis-Dry-Suction-Water-Seal-Chest-Drain-Managing-Dry-Suction-Chest-Drainage?bidId.
Bauman, M., & Handley, C. (2011). Chest tube care: The more you know, the easier it gets. Retrieved from http://www.americannursetoday.com/assets/0/434/436/440/8172/8174/8176/8256/1d298438-82c6-439d-8b2e-77ffaf165fca.pdf.
Bourgault, A. et al., (2014). Factors influencing critical care nurse adoption of the AACN practice alert on verification of feeding tube placement. American Journal of Critical Care, 23, 2. DOI: 10.4037/ajcc2014558
British Columbia College of Nursing Professionals [BCCNP]. (2018). Scope of practice for Registered Nurses. Retrieved from https://www.bccnp.ca/Standards/RN_NP/StandardResources/RN_ScopeofPractice.pdf.
British Columbia Institute of Technology (BCIT). (2015a). Patient care for sonography. In, NURS 1186. Vancouver, BC: BCIT.
British Columbia Institute of Technology (BCIT). (2015b). Clinical techniques. In, NURS 3020. Vancouver, BC: BCIT.
British Columbia Institute of Technology (BCIT). (2015c). NURS 3020: Clinical techniques. Vancouver: BCIT.
British Thoracic Society [BTS]. (2014). Standards for the care of adult patients with a temporary Tracheostomy; Standards and Guidelines. Intensive Care Society Standards. Retrieved from https://www.evidence.nhs.uk/search?q=Standards+for+the+care+of+adult+patients+with+a+temporary+tracheostomy.
Centers for Disease Control and Prevention. (2015). Healthcare associated infections. Retrieved from http://www.cdc.gov/HAI/ca_uti/uti.html.
Chung, D. (nd). Chest drain FAQ. Retrieved http://www.medicine-on-line.com/html/skills/s0001en.htm
Davis, C., Chrisman, J., & Walden, P. (2012). To scan or not to scan? Detecting urinary retention. Nursing Made Incredibly Easy!, 10(4), 53-54. doi: 10.1097/01.NME.0000415016.88696.9d.
Durai, R., Hoque, H., & Davies, T. W. (2010). Managing a chest tube and drainage system. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20152201.
Gogakos, A., Barbetakis, N., Lazaridis, G., Papaiwannou, A., Karavergou, A., Lampaki, S., . . . Zarogoulidis, P. (2015). Heimlich valve and pneumothorax. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381465/.
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practice Advisory Committee. (2009). Guidelines for prevention of catheter associated urinary tract infections 2009. Retrieved from Center for Disease Control website: www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf.
GrepMed (nd). How a chest tube drainage system works. Retrieved https://www.grepmed.com/images/3385/wallsuction-schematic-pleurevac-chesttube-waterseal-chambers-drainage
Halm, M. A. (2007). To strip or not to strip? Physiological effects of chest tube manipulation. Retrieved from http://ajcc.aacnjournals.org/content/16/6/609.full.
Halm, M. A., & Krisko-Hagel, K. (2008). Instilling normal saline with suctioning: Beneficial technique or potentially harmful sacred cow? American Journal of Critical Care, 17(5), 469-472.
Lewarski, J. (2005). Long-term care of the patient with a tracheostomy. Respiratory Care, 50(4), 534-537. Retrieved from http://rc.rcjournal.com/content/respcare/50/4/534.full.pdf.
Lilley, L., Rainforth Collins, S., Snyder, J., & Swart, B. (2016). Pharmacology for Canadian health care practice (3rd Canadian ed.). Toronto, ON: Elsevier.
Morris, L. L., Whitmer, A., & McIntosh, E. (2013). Tracheostomy care and complications in the intensive care unit. Retrieved from http://ccn.aacnjournals.org/content/33/5/18.
The Ohio State University, Wexner Medical Center. (2012). Fenestrated tracheostomy tube. Retrieved from https://patienteducation.osumc.edu/documents/fenestr.pdf.
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2018). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
Rajan, C. S. (2013). Tube thoracostomy management. Retrieved from http://emedicine.medscape.com/article/1503275-overview#a7.
The Royal Children’s Hospital Melbourne [RCH]. (n.d.). Tracheostomy guidelines. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Tracheostomy_Management_Guidelines/#Related%20Documents.
Salmon, N., Lynch, S., & Muck, K. (2013). Chest tube management. Retrieved from http://ajcc.aacnjournals.org/content/16/6/609.full.
Simons, S. & Abdallah, L. (2014). Bedside assessment of enteral tube placement: aligning practice with evidence. American Journal of Nursing,112(2). doi: 10.1097/01.NAJ.0000411178.07179.68.
Stewart, M. L. (2014). Interruptions in enteral nutrition delivery in critically ill patients and recommendations for clinical practice. Critical Care Nurse, 34(4), 14-22. https://doi.org/10.4037/ccn2014243.
St. George’s University Hospital. (n.d.). Tracheostomy tubes. Retrieved from https://www.stgeorges.nhs.uk/gps-and-clinicians/clinical-resources/tracheostomy-guidelines/tracheostomy-tubes/.
Teleflex. (2018). Chest drainage. Retrieved from https://www.teleflex.com/usa/product-areas/surgical/cardiovascular/chest-drainage/index.
Teleflex Medical Incorporated. (2009). Chest drainage systems. Retrieved from http://www.teleflex.com/en/usa/ucd/chest_drainage_systems.php.
Vancouver Coastal Health. (2006). Tracheostomy and endotracheal tubes – suctioning. Vancouver, BC: Vancouver Coastal Health.
Vancouver Coastal Health. (2012a). Tracheostomy: Care and management of a patient with a tracheostoma. Vancouver, BC: Vancouver Coastal Health.
Vancouver Coastal Health. (2012b). Tracheostomy tubes: Dressing changes and inner cannula cleaning. Vancouver, BC: Vancouver Coastal Health.
VCH Professional Practice. (2014). Indwelling urinary catheter: Procedure for insertion and removal (adult). Vancouver, BC: Vancouver Coastal Health.
Zisis, C., Tsirgogianni, K., Lazaridis, G., Lampaki, S., Baka, S., Mpoukovinas, I., . . . Zarogoulidis, P. (2015). Chest drainage systems in use. Annals of Translational Medicine, 3(3). https://dx.doi.org/10.3978%2Fj.issn.2305-5839.2015.02.09.