Chapter 10: Tubes and Devices
Critical Thinking Exercises: Questions, Answers, and Sources / References
- You observe a patient carrying their urinary catheter drainage bag on their shoulder. What should you do?
Answer: Explain to the patient how gravity promotes the flow of drainage from a cavity. Keep drainage tubes and collection bags at a lower level than the cavity being drained. Explain that this will help to reduce risk of urinary tract infection.
2. A patient is ambulating in the hall with their JP drain dragging on the floor. What is your response?
Answer: explain to the patient the need to secure the JP drain in a way that it won’t be accidentally removed. Securement to the dressing and / or patient gown may be sufficient. In addition explain that the floor is considered very dirty and not something to contaminate a drain with as this presents risk of infection to the patient.
Sources: Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical skills and nursing techniques (9th ed.). St Louis, MO: Elsevier-Mosby.
- A client has a nephrostomy tube inserted for an occlusion. Identify 5 points to discuss with clients about care of the drain. Answer:
|Secure tubes to the skin with securement device or tape (non-allergenic).||When tension is applied to the tube, the stress will be taken by the tape rather than by the tube.|
|Drainage bags should be secured to stretchers frame, patient gowns, etc., as appropriate.||This prevents undue stress on the drainage tube and/or accidental removal from the wound or body cavity.|
|Connect tube to sterile tubing and drainage receptacle. Do not clamp tubing unless ordered.||This helps keep wound or body cavity sterile and promotes flow of drainage.|
|To ensure continuous drainage, be sure tubing is not kinked, not caught in the bed rails, not underneath the patient, and free from tension when turning, etc.||Any kinks in tubing can stop drainage from the patient and cause further complications.|
|Dressing around tube, if any, should be clean and dry. Sterile technique is used if it is necessary to change the dressing.
Dressings around tubes should not be cut if the frayed fibres have the potential to get into the wound.
|This avoids irritation from tube rubbing the skin or from excessive drainage. Frayed fibres that enter wounds present increased risk of infection.|
|Record and report patency of tube and amount, colour, character, and odour of drainage. If an unusual situation occurs in your department. If the contents of a drainage tube are spilled, the approximate amount must be reported.||The character and volume of drainage provide insight into wound healing. Decisions about drain removal are often made in consideration of these things.|
|If you are unsure how to empty the container or how to close, seek help.||Most drainage tubes must have the ends kept sterile. Always follow agency regulations on how to clean up a blood or body fluid spill.|
|Know the purpose and location of the tube to understand the function and what to expect.||Some tubes are meant for drainage (JP, Hemovacs, penrose, T tube, percutaneous drains, foley catheters, nephrostomy), others for feeding. Feeding tubes can be nasogastric (NG) , nasojejunum (NJ) , percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic jejunostomy (PEJ).|
|The physician will advise when and who will remove the tube.||Most nephrostomies are pig tail drains. Some agencies have policies around removal of pig tail drains|
Anderson, R. (2018). Clinical Procedures for Safer Patient Care – Thompson Rivers University Edition. Adapted from Clinical Procedures for Safer Patient Care by G. R. Doyle and J. A. McCutcheon. Chapter 10.2 Caring for Patients with Tubes and Devices https://pressbooks.bccampus.ca/clinicalproceduresforsaferpatientcaretrubscn
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2017). Clinical nursing skills and techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
2. Put the following steps to emptying a JP drain in the correct order:
a. Cleanse the cap with alcohol
b. Compress the drain
c. Empty contents into an appropriate container
d. Document the volume in the patient chart
e. Apply clean gloves
f. Apply sterile gloves
g. Open the drain
h. Recap the drain
i. Perform hand hygeine
Answer: I, E, G, C, A, B, H, I, D