T-Tube Care

موضوع: T-Tube Care الخميس مارس 10, 2011 10:00 am

T-Tube Care

Equipment

Preparation of equipment

Assemble the equipment at the bedside
Open all sterile equipment. Place one sterile 4”x4” gauze pad in each sterile basin
Using sterile technique, pour 50ml of cleaning solution into one basin and 50 ml of normal saline solution into the other basin.
Tape a small plastic bag on the table to use for refuse

Procedure

Verify the patient’s identity using two patient identifiers, such as the patient’s name and identification number.
Provide privacy and reinforce the explanation of the procedure to the patient
Wash hands

Emptying drainage

Put on glean gloves
Place the graduated collection container under the outlet valve of the drainage bag. Without contaminating the clamp, valve, or outlet valve, empty the bag’s *******s completely into the container and reseal the outlet valve.
Carefully measure and record the character, color, and amount of drainage.
Discard gloves

Clamping the T-tube

As ordered, occlude the tube lightly with a clamp or wrap a rubber band around the end. Clamping the tube 1 hour before and after meals diverts the bile back to the duodenum to aid digestion.
Monitor the patient’s response to clamping.
To ensure the comfort and safety, check the bile drainage amounts regularly.

Nursing Interventions

The T-tube usually drains 300 to 500 ml of thin, blood tinged bile in the first 24 hours after surgery.
To prevent excessive bile loss over 500ml in the first 24 hours or backflow contamination. Bile will flow into the bag only when biliary pressure increases.
Provide meticulous skin care and frequent dressing changes since bile is irritating to the skin.
Monitor for bile leakage, which may indicate obstruction.
Monitor tube patency and the condition of the site hourly for the first 8 hours.
Protect the skin edges and avoid excessive taping.
Monitor all urine and stools for color changes.
Reinforce with the patient that loose bowel occur commonly the first few weeks after surgery.
Remind the patient about signs and symptoms of T-tube and biliary obstruction and to report them to physicians.
Teach the patient how to care for the tube at home.
Reinforce with the patient that the bile stains clothing and is irritating to the skin.

Complications

Obstructed bile flow, skin excoriation or breakdown, tube dislodgement, drainage reflux, and infection