CARE OF DRAINS

NASOGASTRIC TUBE
FOLYS CATHETER
SUPRA PUBIC CATHETER
WOUND DRAINAGE

NG Tube Indications
Aspirate stomach

contents

Diagnostic or

therapeutic

Assessment of GI

bleeding
Determine gastric
acid content

NG Tube Indications
Treat paralytic ileus
Treat intestinal obstruction
Recurrent vomiting likely
Trauma
Overdose

Determine length of tube to be

inserted

Verifying Feeding Tube Placement and

Irrigation
Tube placement must be confirmed before use.
Following initial x-ray film confirmation; verify tube
position every 4 to 6 hours and as needed.
Observe characteristics of fluid aspirated from
tube.
Test the pH of aspirated fluid.
Tube irrigation maintains tube patency:
Before, between, and after medications and
feedings.
30 mL of plain water is the preferred irrigation
solution.
Allow gravity infusion of irrigating solution.

Confirm NG Tube Placement

X-ray
Most reliable if tube is radiopaque
Requires order from physician
Injecting air
60 cc catheter syringe
Place stethoscope over LUQ of abdomen
Inject air into lumen of tube
Listen for swoosh sound

Confirm NG Tube Placement

Test pH of gastric aspirate
pH < 4 = 95% chance that tip is in

stomach
pH > 6 = may be in lung or pleural
space

Nasogastric Tube Position

NG Tube Contraindications
Esophageal strictures
Alkali ingestion, caustic ingestions, esophageal burns

NG Tube Contraindications
Trauma patients with:
Cervical or intracranial bleeding
Increased intracranial pressure

Recent surgery of the following types:

Oropharyngeal
Nasal
Gastric

Complications
Excessive coughing, motion, gagging may
aggravate the following:
Neck injuries
Increased risk for C-spine injuries

Penetrating neck wounds

May increase hemorrhage

Tube misplacement
Pulmonary
Intracranial

Evaluation
Note location of external site marking on the tube
Documentation
Size of tube, which nostril and clients response.
Record length of tube from the nostril to end of tube
Record aspirate pH and characteristics

X-ray of misplaced NG tube

CARE OF PATIENT

FOLYS CATHETER

URINARY
CATHETERS

CATHETER - A TUBE USED

TO DRAIN OR INJECT
FLUID THROUGH A BODY
OPENING
INSERTED THROUGH THE
URETHRA, INTO THE
BLADDER TO DRAIN THE
URINE.
CAN BE TEMPORARY OR
LEFT IN PLACE
A BALLON IS INFLATED TO
HOLD THE CATHETER IN
PLACE

WHICH PATIENT NEEDS A URINARY CATHETER

TOO WEAK

DISABLED

POST SURGICAL

PROTECT WOUNDS OR PRESSURE ULCERS

FREQUENT URINARY MEASUREMENTS

DRAINAGE BAG
THE END OF THE

CATHETER IS
ATTACHED TO A
DRAINAGE BAG

NURSING CARE FOR PATIENT WITH AN

INDWELLING CATHETER
LEAVE THE SYSTEM CLOSED AS MUCH AS

POSSIBLE
DO NOT ALLOW THE BAG OR TUBING TO
TOUCH THE FLOOR
ALWAYS KEEP THE DRAINAGE BAG BELOW
THE LEVEL OF THE BLADDER
KEEP THE CATHETER AND DRAINAGE
TUBING FREE OF KINKS
ATTACH THE DRAINAGE BAG TO THE
BEDFRAME NEVER THE SIDERAIL

 THE DRAINAGE TUBING IS COILED ON THE BED AND

CLAMPED TO THE BOTTOM LINEN TO PREVENT

KINKING OF THE TUBING.
SLACK IS LEFT ON THE CATHETER TO PREVENT

PULLING.

 NOTICE THE
CATHETER TAPED TO
THE INNER THIGH.

NOTICE THE DRAINAGE

BAG HOOKED ON THE
BEDFRAME.

USE OF LEG BAG

USE A LEG BAG ONLY

WHEN THE PERSON IS

AMBULATORY OR
SITTING IN A CHAIR
NEVER WHEN IN BED

A LEG BAG HOLDS

ABOUT 1000 CC OF
URINE, A DRAINAGE
BAG HOLDS 2000 CC.

IF A DRAINAGE SYSTEM IS ACCIDENTALLY

DISCONNECTED:
Tell the nurse at once.
Do not touch the ends of the catheter or tubing.
Practice hand hygiene and put on gloves.
Wipe the end of the tube with an antiseptic wipe.
Wipe the end of the catheter with another antiseptic wipe.
Do not put the ends down.
Do not touch the ends after you clean them.
Connect the tubing to the catheter.
Discard the wipes into a biohazard bag.
Remove the gloves and practice hand hygiene.

CATHETER CARE
THE CATHETER SITE WILL NEED
REGULAR CLEANING TO HELP PREVENT
INFECTION
WEAR GLOVES AND FOLLOW
STANDARD PRECAUTIONS
WASH AWAY FROM THE
URINARY MEATUS

CLEAN FOUR INCHES DOWN THE CATHETER

USE A DIFFERENT PART OF THE
WASHCLOTH OR A CLEAN ANTISEPTIC WIPE
FOR EACH STROKE

EMPTYING THE URINARY

DRAINAGE BAG
EMPTY THE BAG AT THE END OF

EACH SHIFT
MEASURE AND RECORD THE

AMOUNT OF URINE PRESENT

RECORD THE AMOUNT ON THE

INTAKE AND OUTPUT SHEET

USE A GRADUATE TO MEASURE

THE AMOUNT OF URINE

CHECK THE AMOUNT OF URINE IN THE

BAG AT FREQUENT INTERVALS

FOLLOW STANDARD PRECAUTIONS AND

WEAR GLOVES

UNCLAMP THE SPOUT AND EMPTY THE

DRAINAGE BAG.

CARE OF PATIENT WITH SUPRA

PUBIC CATHETER

Why suprapubic catheterization ?

(indications)

May be used temporarily or long-term to drain the bladder.

When urethral diversion is needed
Urethral stricture or trauma.
Gynecologic or urethral surgery.
Urinary incontinence.

SUPRAPUBIC Vs URETHRAL

Preventing urethral complications

Increased comfort
Separating urinary and genital functions

WHAT TO DO
Provide privacy and explain the procedure to patient
Perform hand hygiene and put on sterile gloves
Tell the patient to lie down position.
Remove the dressing and assess the catheter insertion site

for signs and symptoms of infection such as redness and skin

excoriation.
Make sure the catheter is looped and taped securely to the
patient abdomen to prevent kinking or dislodgment inspect
the catheter for patency. Catheter may become occluded with
clots.
If the catheter becomes dislodged. Cover the site with a
sterile dressing and notify the health care provider
immediately.

Continuous.
Keep the drainage collection container below the level of

the patients bladder.

Assess the urines characteristics such as clarity,color and
odor if look for cloudy urine or other signs of urinary tract
infection.
Measure urine output at least every 8 hours.
Notify the health care provider immediately if the patient
develops abdominal pain,hematuria,fever,puslike drainage
if urine leaked on the dressing or if the catheter stops
draining.
Document your nursing care the appearance of catheter
site, skin integrity, urine amount and characteristics.

Whats happening in there?

A SPC is a urinary drainage catheter inserted into the bladder via an

incision through the anterior abdominal wall, approx. 2cm above the
pubic bone.

COMPLICATIONS
Bowel injury.
Bleeding.
displacement.
Infection.

INFECTION catheter insertion site

CARE OF WOUND DRAIN

INDICATIONS

To prevent accumulation of fluids.

To prevent accumulation of air.
To find characteristic of fluids.

SPECIFIC EXAMPLES OF DRAINS AND

OPERATIONS
Breast surgery
Orthopedic procedures
Chest surgery
Infected cysts
Pancreatic surgery
Thyroid surgery
Neuro surgery

Surgical Drains
Prophylactic
Remove pus, blood, serous exudates, chyle or bile.
Form a controlled fistula (e.g. t-tube after bile duct exploration)

Surgical Drains
Therapeutic
Drain pus, blood, serous exudates, chyle or bile.
Drain air from pleural cavity.
Drain Ascitis.

Advantages of Surgical Drains

Advantages for their use include:
Drainage of fluid removes potential sources of infection
Drains guard against further fluid collections
May allow the early detection of anastomotic leaks or haemorrhage
Leave a tract for potential collections to drain following removal

Surgical Drains
Disadvantages their use include:
Presence of a drain increases the risk of infection
Damage may be caused by mechanical pressure or suction
Drains may induce an anastomotic leak

Classification
Open System
Closed System

Penrose Drain

Pezzer Catheter

Pig-tail catheter

Pig Tail Catheter

T-tube

Chest tube

jackson pratt (JP) drain

NURSES RESPONSIBILITIES
If active drain it can be attached to a suction source.
Ensure the drain is secured.
Accurately measure and record drainage output.
Monitor changes in character or volume of fluid.
Identify any complication resulting in leaking fluids.
Use measurements of fluid loss to assist intravenous

replacement of fluids.