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Tubes

Tubes NG tube

Levin Tube Salem Sump tube

Purpose To prevent aspiration and to decompress the stomach. Can also administer medications Single Lumen -Only to suction intermittently Double Lumen -One is air vent and the other is main lumen. Used for decompression AND suctioning

Considerations

Removal of NG tube Take a deep breathe and HOLD as the tube is removed

GASTROintestinal tubes

For feedings

Intestinal tubes such as Cantor Tube or Miller abbott tube

To decompress the intestines/remove secretions from the intestines

Sengstaken-blakemore tube

For esophageal varices It has three ports 1) inflates gastric balloon 2) inflates esophageal balloon 3) prevents

Air vent tube must be kept above the level of the patients stomach. If leakage occurs through the air vent , instill 30 mL of air into the airvent and irrigate the main lumen with NS. Irrigation for NG tubes: - irrigate every 4 hours -pull back plunger to check patency -30-50 ml of NS for irrigation Aspirate before administer feeding. IF it is less than 100=GOOD. If more than 100mL=BAD then do bowel sounds and hold feeding if no bowel sounds aspirate should be 3.5 or lower. warm the feeding to reduce cramps . Clogged tubes- flush with NS When client vomits from gastrointestinal feeding- 1) stop infusion 2) side lying Placement is determined by radiograph not aspirate If tube is blocked: tell doctor Position client on right side to facilitate movement Removing of the intestinal tubes is gradual- every 6 inches at a time Assess abdominal girth On the end of the tube, one balloon compresses the cardioesophageal to prevent blood from going to esophageal

gastric aspirate

Lavacutor tube/ewald Urinary catheters

Ureteral and nephrostomy tubes

Gastric Lavage to remove toxic substances Single, double, and triple lumens Single- one time, doubleregular indwelling catheter, triple- requires constant irrigation Never clamp

Endotracheal tubes

For mechanical ventilation

Oral tracheal (endo)

Used for obstruction in the nose (nosebleed) and inserted through the mouth

Nasotracheal (endo tube)

Inserted through the nose and doesnt allow patients to bite it. However, more uncomfortable

Extubation of intubation

To remove the endotracheal tube

varices, and another compresses the esophageal varices . Radiograph confirms placement -in addition, nasogastric tube is inserted to prevent esophageal aspiration One port irrigates and one suctions Care: Cleanse around perineal area with soap, cleanse along catheter with soap and water Bag must be below the level of the bladder Irrigation can be done with 5ml max of NS Monitor output closely. Less than 30 ml per hour is bad If mechanical ventilation is needed for more than 14 days, resort to tracheostomy Must have ambu bag Patient may bite the tube Tubes position should change daily due to mouth care and to prevent necrosis. Done by two people Must have ambu bag at bedside Avoided in bleeding disorders. Placement confirmed by x ray film and/or auscultating the chest Secure the tube with adhesive tape Monitor tube at skin, nose, lip Must have ambu bag at bedside 1) oxygen 2) suction 3) deflate the cuff; client is asked to inhale, and at the peak of inspiration, remove the tube 4) monitor for respiratory difficulty sore throat normal

Tracheostomy

Establish an airway

Complications of Trach

Chest tubes

Remove air/fluid from plueral cavity Air drainage tube: between 3rd to 4th intercoastal space Blood drainage tube= between 8th and 9th intercoastal space

Assess respirations Encourage deep coughing Semi fowler position Monitor for bleeding/nerve damage/pneumothorax Before suctioning: 1) give oxygen 2) sit client up 3) assess stoma 4) clean inner canula with H2O2 5) humidified oxygen 6) remove old ties holding trach 1) tube obstruction 2) tube dislodgement 3) never insert a DE-cannulated plug until cuff is deflated Three chambers: 1st chamber: suction chamber: gentle bubbling= suction present 2nd chamber- water sealbubbling up and down from inhalation and exhalation= good. however constant bubbling = airleak. No fluctuation= obstruction 3rd chamber- drainage chamber.notify physician if more than 70-100mL .

Radiograph determines position of tube Occlusive sterile dressing always present Assess respiratory/lungs When drainage system breaks, take off tube and put it in a sterile water when removing the tube, ask the patient to tke a deep breath and hold it. Once removed, use petroleum gauze/telfa dressing to cover it when tube is dislodged by accident, put occlusive dressing on it, with 2 inch tape, then call physician ASAP

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