2. DEFINITION
Tool used to
drain (remove) a collection of fluid in the human body.
Apposition of tissues to remove a potential space by suction
Monitor fluid output
Pus
Blood
Bile
Urine
Saliva
Lymph
Bowel anastomosis leak
4. OPEN SYSTEM:
Uses:
drain dirty wounds.
for superficial cavities to remove pus, hematomas.
Some superficial abscess.
post-thyroid surgery (but closed system is preferred).
5. OPEN SYSTEM:
Disadvantages:
high risk of infection.
need for daily/ frequent dressing.
the discharge can’t be measured.
7. CLOSED SYSTEM :
Types :
1. Under gravity ( eg. NGT, Foley’s)
2. Under water –seal ( chest tube)
3. Under vacuum ( Jackson pratt)
4. Under suction
8. CLOSED SYSTEM :
Advantages :
1. Minimal risk of infection
2. No frequent dressing
3. Can measure the amount drained
9. WHENTO REMOVETHE DRAIN :
* it depends on :
1. Type of the fluid drained
2. Amount of fluid drained
• If pus.fecal , bile : amount must be nil( ultrasound)
• If serous , chyl, blood : must be <50 cc/day
• For open system : until the dressing is dry
10. DISADVANTAGES OF DRAINS (IN
GENEERAL(
* Mechanical:-
• Trauma
• Erosion
• Perforation
• * Physiological:-
• Bacterial colonization
• Loss of fluid and electrolytes
• Pain
• Restrict motility
11. DRAI N MALFUNCTION
1. Change in content
2. Blocked drain
Irrigation
Kink
Surrounding skin
12. 1- CHESTTUBE :
Inserted in 2 methods :
1. Open ( without trocher)
Complete incision must be made
13. CHESTTUBE
2. Closed method :
With trocher
Only the skin is incised before insertion
23. FOLY’S CATHETER
Contraindications :
In urethral injury
1. Blood on external meatus
2. High Ridge prostate
3. Ecchymosis of the scrutom
4. Resistance to insertion
24. 3- NGTUBE
have a closed end with side holes.
can be with or without radioopaque lines.
Diagnostic andTherapeutic uses .
27. 3- NGTUBE
Appropriate insertion is checked by:
Appearance of stomach contents.
CXR.
blowing on the tube and listening with a stethoscope.
Duration:
Maximum 3 weeks
33. 4- SUCTIONTUBE
have an open end and a side hole to
control pressure (when you close the hole
the pressure increase)
34. 4- SUCTIONTUBE
Uses:
to clear airways (ex: after RTA, in new born)
at the site of surgery (to clear the field) (recommended not to
use intraperitoneally to avoid omental adhesions).
assist in labor
35. 5- JACKSON-PRATT (READIVAC)
Attached to suction bulb “grenade”
Side holes must be within the
closed space.
Inserted under vision
The collector functions by
“thumping”
39. 6- RECTALTUBE
Uses:
Diagnostic rectal enema
high-washout rectal enema (empty or
clean the bowel)
To decompress volvulus
Used only for few hours
Contraindications: diverticulitis
40. 7- ENDOTRACHEALTUBE
inserted orally via laryngoscope
(look for vocal cords) “intubation”
Or by tracheostomy
TwoTypes:
41. 7- ENDOTRACHEALTUBE
Size is determined by age:
(Age+16)/4
If by tracheostomy,
endotracheal tubes are
inserted ideally 1 cm above
the carina (bifurcation of the
trachea at the sterna angle).
42. 7- ENDOTRACHEALTUBE
Indications:
to secure airways (ex: coma pts -glaucoma scale less than 8)
respiratory insufficiency
for anesthesia (especially for muscle relaxant)
Prophylactic
Allergy anaphylaxis
Epiglottitis – elective-
Inhalation of irritants
44. 8- CENTRAL LINE
Inserted in a central vein.
the subclavian (under midclavicle)
internal jugular (between heads of SCM)
external jugular
axillary vein
femoral (1cm medial to femoral pulse) veins.
47. 8- CENTRAL LINE
Indications:
TPN
Chemotherapy
Dialysis
When we want to give a fluid with osmolarity >12.5 osmol/L
calculating central venous pressure
monitor fluid loss in pancreatitis
shock for rapid fluid replacement
when peripheral line can’t be inserted (ex: in neonates)
48. 8- CENTRAL LINE
Complications:
Thrombosis
infection (if line kept over 3 weeks)
Hematoma
penumo/hemothorax
cardiac fibrillations
air embolus (embolism)
nerve injury (ex: vagus, phrenic)
Cardiac injury
Arrhythmia (better to use ECG)
49. 8- CENTRAL LINE
Contraindications:
burn at site of injury
skin infections
coagulopathies
patients with arrhythmias.
Duration: 3 weeks
Editor's Notes
When to remove the drain
Page 2 التلخيص
Open drains are ؟“open” on one end (one end in the human body) and exposed to the atmosphere/dressing on the other end (no collecting system)
Penrose (rubber-tube) Corrugated (same but with a radioopaque line)
Yeast اسطوانات
No clinical difference between them (used according to preferred)
post-thyroid and breast surgery
Point 3:
But you can measure the weight of dressing before and after
Softness and lower tendency to be blocked
Nasogastric tube (feeding tube)
ت
See surgical recall
What test should be performed before feeding via any tube? High abdominal x-ray to confirm placement into the GI tract and NOT the lung!
Duration (( until appetite return and bowel sounds present)
Duration same as et tube
Normal gastric juice is transparent
في كمان 3 نقاط بالتلخيص
Point 2 : ng tube aspiration in upper gi bleeding is coffle colored blood while in lower gi bleeding the aspirate is food particles
esophageal atresia: causes the esophagus to end in a blind-ended pouch rather than connecting normally to the stomach
??See surgical recall
Flush the tube with 10 ml of normal saline, to ensure that the tube doesn’t contain stomach contents that could irritate tissue during removal
“take a deep breath” ?
كمان نقطتين بالتلخيص
If inserted too deep in the airway, it can cause laryngospasms
منضغطه
Negative pressure
حتى نفضي كل الهوا ثم نرخله
Then it will start suctioning
Thyroidectomy and breat .. Most imp
Can be used intra abdominally
النقطة التانية بالتلخيص
What are the “three S’s” of Jackson–Pratt drain removal? 1. Stitch removal
2. Suction discontinuation (مننفسها
3. Slow, steady pull (cover with 4 × 4 to reduce splashing)
نوتس بالتلخيص
cuffed (with a balloon valve) or non-cuffed. Cuffed tubes have a higher risk of pressure necrosis, and non-cuff have a higher risk of air leaks.
شوف التلخيص
Mendelson's syndrome is chemical pneumonitis or aspiration pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.
During pregnanc . Acid increase
Aspiration contents may include gastric juice, blood, bile, water or an association of them
Possible sites of insertion
Double for dialysis and chemotherapy
To insert the central line,
spread lidocaine on area of insertion.
Put wire through the distal line (usually brown) and attach syringe to large needle.
Advance and aspirate as you enter slowly. When needle reached vein remove syringe.
Advance until 30 cm of the wire has been inserted.
