NG Tube.pdf

Surgical Operations 128 o Closed passive: Robertson's. Similar to T-tube o Closed Active J-Vac (mastectom y) (e.g. thyroidecto my) Closed suction system [Tube + bag + suct...

Surgical Operations 128 o Closed passive: Robertson's. Similar to T-tube o Closed Active J-Vac (mastectom y) (e.g. thyroidecto my) Closed suction system [Tube + bag + suction] o Open active Suction in peritoneum Pump Drains are inserted to: o Evacuate establish collections of pus, blood or other fluids o Drain potential collections Advantage s: o Drainage of fluid removes potential sources of infection o Drains guard against further fluid collections o allow the early detection of anastomoti c leaks or haemorrha ge o Leave a tract for potential collections to drain following removal Disadvant age: o Presence of a drain increases the risk of infection o Damage may be caused by mechanical pressure or suction o Drains may induce an anastomoti c leak o Most abdominal drains became infective within 24 hours Tubes and Drains NG tube: Decompres sion: o Remove gas at top of stomach Long term feeding: o 1 week/1 month o Silicon narrower and softer o Complex carbs/prote ins/polypep tides Used for acute poisoning Made of PVC or Latex (note - fibrosis in latex) 45 cm long (Esophagus ➔ 25 cm long) Indications : o Decompres s stomach o. Prevent aspiration o Long term feeding · o Poisoning Contra-indi cations: basal skull fracture Complicatio ns: o Pressure necrosis ➔ anosmia o Aspiration pneumonia /atelectasis o Sinusitis o Minor upper GIT bleed o Epistaxis o Pharyngeal irritation How to insert one: o Explain procedure to the patient o Measure from tip of nose around the ear lobes to xiphoid o Prepare equipment - sterile, lubricant gel etc o Ask patient to swallow as passing tube down (ice chips/wate r) o Gentle and firm continuous pressure o Confirm placement by Aspiration of contents Surgical Operations 129 Inject air and listen for sound with stethoscope Low chest x-ray Orogastric tube: Poisoning Massive upper GI bleed Basal skull fracture Foley Catheter: Uses: o Drain bladder in acute retention o Monitor output o Bladder surgery o Pelvic surgery e.g. C-section o Empty bladder before surgery Self-retaining 2 channels or 3 channels Balloon Side arm and valve mechanism ensures balloon stays inflated 3-way is wider and harder o Can't be left in too long o Used for continuous irrigation of bladder in hematuria Materials: o Latex: change in 3 weeks o Silicone: 3 months o PVC: intermittent self catheterization Complications: o UTI's Prevented by Continuous drainage Avoiding stasis Drink a lot of fluids Change regularly o Strictures o Stone formation o Reduced sphincter tone o Paraphimosis o Blockage o By-passing Endotracheal tube: Clear/transpare nt Cuffed/uncuffed o Cuffed Aspiration protection. Adults o Uncuffed ➔ children. Size ➔ internal/outer. Graded. Radio-opaque line. One use only. Other types: o Double lumen. o Reinforced. o Laser. Cuffed endotracheal tube