Anaestesia notes on Different drainage cares

1. EVD CARE,TRACHEOSTOMY TUBE
CARE AND CHEST TUBE CARE
PRESENTER: MAPUNDA, TEOPHIL F.
SUPERVISOR: DR. LUGANO WILSON

2. A:External Ventricular Drain(EVD) care
EVDs are life saving devices used in neurosurgical patients with
increased intracranial pressure(ICP) due to increased volume of
cerebrospinal fluid(CSF) as in hydrocephalus.
CSF is produced within ventricles of brain and circulates around the
brain and spinal cord, protecting them against injury and supplying the
neurons with nutrients.

5. EVD is normally inserted into one of the lateral ventricles of the brain
to remove excess cerebrospinal fluid.
Once inserted it requires a careful handling measures so as to prevent
introducing infections into CSF that may result into encephalitis or
deadly meningitis

6. EVD CARE PROTOCOL
1. Make sure Head of Bed(HOB) is always elevated 30 degrees and
head of patient is midline positioned
2. Depending on desired intracranial pressure, a pre-ordered EVD
cylinder height must be known and maintained through out
treatment. Open the drain when the pressure exceeds the
prescribed level.
e.g order “EVD at 11cm above the external ear canal(reference zero
point)”.Here you should align EVD cylinder by sliding connector bracket
to the 10cm mark on the measuring bar or in other words “Pressure
Level Line” should be at 10cmH2O.

7. 3. You should check and report any of the following;
-new drainage from surgical site
-Change in neuro status of patient
-if there is no any drainage into cylinder for ˃1 hour
-system disconnections
-Drainage exceeds ordered limits
4. Clamp when transporting patients to procedure or other units

8. B:Tracheostomy tube care
• Tracheostomy is one of common airway surgical procedures that is
performed in many hospital settings.
• In this procedure, an incision is made on anterior tracheal wall
normally between 2nd and 3rd tracheal rings then a tracheostomy tube
is inserted and secured.

9. Components of tracheostomy tube care
1.Suctioning of tracheostomy tube, this should be done as needed basis.
Always use the suction catheter that is no more than half of the inner
diameter of tracheostomy tube and remember to hyperoxygenate a patient
before and following suctioning so as to avoid hypoxemia and its associated
risks.
2. Cleaning of the suction catheter after use, a number 12 suction catheter
usually fits most patients.
3. Clean and if necessary replace the disposable inner cannula with new
one.

10. Components of tracheostomy tube care
4. Inspect and if necessary clean the skin surrounding the
tracheostomy tube.
5. Ensure the tracheostomy tube is well secured with tapes that is
there is enough tension on tapes to support the tube
6. Moisturize the patient air

12. C: Chest tube care
• Chest tubes also called thoracotomy tubes are inserted to relieve and treat
those conditions that may cause the lung to collapse, such as;
1. Air in the pleural cavity from trauma or air leaks from the lung into chest
cavity(Pneumothorax).
2. Blood or bleeding into the pleural cavity(haemothorax)
3.Lung abscesses or pus in in the chest cavity(empyema)
4. Following surgery of the chest to avoid pneumothorax or hemothorax

13. • The chest tube usually remains in place until the chest x-ray show that
all the blood, pus, fluid or air has drained completely from the chest
cavity.
• When the chest tube is no longer needed it can easily be removed and
patient may be given antibiotics to prevent site infections.
• The overall goal of chest tube therapy is topromote lung re-expansion,
restore adequate oxygenation and ventilation, and to prevent
complications.

16. Components of chest tube care
• Assess the patient every two hours and document a compressive
pulmonary assessment including respiratory rate, work of breathing,
breath sounds and arterial oxyhaemoglobin saturation.
• Assess and inspect the insertion site regulary and note if there is any
drainage, or signs of subcutaneous emphysema and tube migration.
• Keep the tube free of kinks and occlusions which can impede drainage

17. • To promote drainage, keep the chest drainage unit(CDU) below the
patient’s chest. Monitor water levels in the water seal and suction control
chambers as can evaporate so remember to add water periodically in both
water seal and suction chamber.
• At regular intervals( at least every 8 hours), document the amount of
drainage and its characteristics on clinical flow sheet
• Report sudden fluctuations or changes in chest tube output especially
sudden increase from previous drainage or changes in character especially
bright red which may indicate hemorrhage

18. • Frequent position changes, coughing and deep breathing help to re
expand the lung and promote fluid drainage.
• As a rule avoid clamping a chest tube as it prevent escape of air or
fluid increasing risk of tension pneumothorax.

19. REFERENCES
• Benjamin Mkapa Hospital ICU “TRACHE” bundle care
• Benjamin Mkapa hospital EVD care protocol
• https://www.americannursetoday.com/chest-tube-care-the-more-
you-know-the-easier-it-gets/

20. THE END!!!