This document discusses percutaneous tubes that are commonly encountered by nursing teams. It defines percutaneous tubes as those inserted through the skin and lists examples such as chest tubes, gastrostomy tubes, and tracheostomy tubes. For each type of tube, the document describes their purpose, potential indications for use, and nursing considerations for care and management, including site care, securing the tube, addressing complications, and patient education. The goal is to maintain tube patency, skin integrity, and patient comfort while preventing issues.

1. THOSE TROUBLESOME
TUBES:
TUBE MANAGEMENT
FOR THE NURSING TEAM
KELLY JASZAROWSKI, MSN, RN,
CNS, CWOCN, ANP

2. Objectives
 Define percutaneous tubes
 Identify percutaneous tubes frequently
encountered by the nursing team
 Explore conditions that may necessitate the
need for tube placement
 Describe patient care in relation to type of
percutaneous tube
 Describe skin care strategies to protect the
peritube skin

3. Defined
 Percutaneous: effected or performed
thru the skin
 Tube: a hollow cylindrical organ or
instrument

4. Examples of Percutaneous
Tubes
 Chest tubes
 Gastrostomy tubes
 Nephrostomy tubes
 Biliary tubes
 Cecostomy tubes
 Tracheostomy tubes
 PIC lines

5. General Objectives
 Maintain patency
 Maintain peritube skin integrity
 Eliminate/reduce pain
 Patient/significant other(s) education

6. General Nursing Care
 Assess drainage
 Maintain closed system
 Assess and maintain skin integrity
 Promote patient comfort
 Provide education

7. Chest tubes
 Purpose
 Maintain ventilation; negative pressure
 Remove pathological collections of air
or fluid
 Enable lung expansion

9. Chest tube: Indications
 Pneumothorax
 Empyema
 Hemothorax
 Pleurodesis
 Thoracotomy

10. Chest tube: Nursing
Management
 General
 Positioning
 Straight line
 Semi-Fowler’s
 High-Fowler’s
 Turning

11. Chest tube: Nursing
Management
 Dressing
 Sterile versus aseptic technique
 Insertion site air tight seal
 Split 4x4 dressings
Ranse, J (August 2003). “Nursing management of a patient with an: intercostal catheter and underwater drainage system” slideshare.net

12. Chest tube: Nursing
Management
 Other
 Securement
Ranse, J (August 2003). “Nursing management of a patient with an: intercostal catheter and underwater drainage system” slideshare.net

13. Tracheostomy Tubes
 Purpose
 Airway maintenance
 Secretion removal
 Indications
 Obstruction
 Inability to breath on own
 Abnormality
 Paralysis
 Trauma

14. Tracheostomy Tube

15. Tracheostomy tube:
Nursing Management
 Site Care
 Promote skin integrity
 Prevent infection
 Securement
 Evidence supports two person technique
 Trach tube holders

16. Tracheostomy tube:
Nursing Management

17. Nephrostomy tubes
 Placed into renal pelvis
 Goal: Preserve kidney function
Hautman, S.& Leveille, R. (Dec 2011). “Nephrostomy”. emedicine.medscapre.com/article

18. Nephrostomy tube:
Indications
 Blockage
 Access
 Creatinine level
 Disorders

19. Nephrostomy tube: Nursing
managment
 Site care
 Securement

20. Feeding tubes
 Goal
 Enhance nutrition
 Hydration
 Use of gut

21. Feeding tube: Indications
 Strictures
 Swallowing difficulties
 Disorders/disease
 Pediatric
 Disorders/disease
 Delays

22. Feeding tubes: Types
 Gastrostomy tube
 Low profile gastrostomy device
 Gastrojejunostomy
 Jejunostomy

23. Gastrostomy tubes
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Textbook of Medical Surgical Nursing. Lippincott Williams & Wilkins.

24. Feeding tube: Gastrostomy

25. Feeding tube: LPGD
Smeltzer, S., Bare, B., Hinkle, J., & Cheever, K. (2010). Textbook of Medical Surgical Nursing. Lippincott Williams & Wilkins.

26. Feeding tubes:
Gastrojejunostomy
www.stillmilestrip.com

27. Feeding tubes:
Jejunostomy
Quilici, P. (Ed). (2002) Interventional laproscopy: the state of the art for the new millennium. Online laproscopic technical manual (2003), “Laproscopic
millennium.
placement of jejunostomy tube”.

28. Feeding tubes:
Nursing Management
 Traction
 Rotation
 Site Care

29. Feeding tube:
Complications
 Dislodgement
 Migration
 Skin irritation
 Hyperplasia
 Infection

30. Securement
 Purpose:
Allow movement without discomfort
 Goal:
Prevent displacement
 Methods:
Dressings
Taping
Devices

31. Insertion site dressings
 Considerations
 Dressings
 Type
 Technique
 Solutions

32. Insertion site dressings
www.livingwithgp.com
Soscia, J & Freidman,J. (May 2011). “A guide to the management of common gastrosotmy and gastrojejunostomy tube problems Pediatric
Child Health, 16(5).

33. Taping
 Factors to consider
 Age
 Complications
 Risk factors

34. Tape selection
 Google images

35. Tape selection
considerations
 Adhesive strength
 Pressure sensitivity
 Skin condition
 Tension free

36. Taping techniques
 Wrap method
 Tenting
 Montgomery straps
 Creative
Ranse, J (August 2003). “Nursing management of a patient with an: intercostal catheter and underwater drainage system” slideshare.net

37. Taping techniques
H or Goal Post
Borkowski, S. (Aug 2004). “Similar Gastrostomy Peristomal Skin Irritation: three pediatric patients”. Journal Wound, Ostomy, & Continence Nursing, 31(4).

38. Taping techniques
Slit Tape Method
Borkowski, S. (Aug 2004). “Similar Gastrostomy Peristomal Skin Irritation: three pediatric patients”. Journal Wound, Ostomy, & Continence Nursing, 31(4).

39. Devices

40. Devices

41. Devices
Baby bottle nipples
Medicine cups

42. Skin irritation
 Leakage
 Tube securement is key
 ? infection

43. Skin irritation management
 Match treatment to assessment
 Two fold
 Skin protection
 Leakage management

44. Skin irritation:
Skin Management
Fleischer, I. & Bryant, D. (Nov/Dec 2010). “Techniques for preventing and managing tube-related complications.” Journal Wound, Ostomy, Continence
Nursing, 36(6).

45. Skin irritation:
Leakage management
 Replacement
 Securement
 Scant to small amount drainage
 Securement
 Dressings
 Skin barrier ointment

46. Skin irritation:
Leakage management
 Moderate to larger amount drainage
 Pouching
Hanlon, M. & Lochbaum, L. (Nov 2001). “Patient with a chest tube and heimlich
valve”. Journal of Wound, Ostomy, & Continence Nursing, 28 (6).
Nursing,
 Pouching with tube access

47. Skin irritation:
Leakage management

48. Skin irritation:
Leakage management
Google images
Fleischer, I. & Bryant, D. (Nov/Dec 2010). “Techniques for preventing and managing tube-related complications.” Journal Wound, Ostomy, Continence
Nursing, 36(6).

49. Skin irritation:
Leakage management
Carmel, J. & Scardillo, J. Tube management. In Colwell, J., Goldberg, M., & Carmel, J. (Ed.) (2004). Fecal & Urinary Diversions. Mosby: St. Louis.
Diversions.

50. Skin irritation:
Leakage management
Securement plus pouching
Fleischer, I. & Bryant, D. (Nov/Dec 2010). “Techniques for preventing and managing tube-related complications.” Journal Wound, Ostomy, Continence
Nursing, 36(6).

51. Hyperplasia
 Overgrowth of tissue
 Moisture related
 Goal of treatment: remove/reduce
Soscia, J & Freidman,J. (May 2011). “A guide to the management of common gastrosotmy and gastrojejunostomy tube problems”. Pediatric Child
Health, 16(5).
Health,

52. Infection
 Candida or fungal
 Rash with satellite lesions
 Anti-fungal
Soscia, J & Freidman,J. (May 2011). “A guide to the management of common gastrosotmy and gastrojejunostomy
tube problems”. Pediatric Child Health, 16(5).

53. Teaching
 Type
 Purpose
 Care

54. Teaching
Body Image
www.livingwithgp.com

55. Keys to Managing
 Understanding type
 Tube securement
 Dressing selection
 Potential complications
 Teaching

56. Thank You
Kelly Jaszarowski, MSN, RN, CNS, CWOCN, ANP
jaszcwocn@yahoo.com

57. Thank you to our Sponsors:
 American Medical Supply & Service
 ConvaTec
 Dale
 Hollister
 UOAA
Premier Sponsor:
Coloplast