Wednesday, February 17, 2016

How Surgical Ward Nurses Should Care For A Drain Tube After Surgery

By Donna Hayes

Whenever a surgical operation involves opening up a body cavity, it is common practice to leave a drain tube in position for a couple of days. This is to facilitate the drainage of various fluids that may accumulate within the cavity. These include blood, serous fluid and pus. Different tubes exist to be used for different types of surgeries and wounds. This article addresses ways of maintaining a drain tube after surgery.

Fluid removals achieved by one of two mechanisms: passive and active methods. In the former type of mechanism, the fluid is made to flow freely under the influence of gravity. The active mechanism, in contrast, relies on a vacuum or a suction machine. The choice depends on a number of factors such as the type and the amount of fluid to be removed.

When the patient is released to the ward from the operating theater, the nurse on duty should perform the initial inspection. Things to look out for during this initial inspection include the presence of leakages, oozing or redness at the site. They should ensure that the drain has been firmly secured with a suture or a tape. It should be patent without any kinked or knotted areas. All the findings must be properly documented.

During subsequent ward rounds, the same routine should be repeated. In addition signs of sepsis need to be monitored. These will include for instance, the presence of fever, redness at the site of insertion, increased tenderness and increased ooze. The other members of the surgical team have to be informed as well so as to institute the next form of management. Blood cultures may have to be done so as to identify the organism involved.

Ensure that you observe for patency at the beginning and at the end of your shift and that you document appropriately. Ensure also that you observe the same after moving the patient. If a drain becomes blocked, there is a high probability that the fluids will accumulate within the cavity and lead to infections and pain. Consequently, the wound will heal at a much slower rate and the stay of the patient in hospital will be prolonged.

If you encounter a leakage, attempt to seal it using dressing reinforcement and more adhesive tape. Dislodgements and blockages are more difficult to deal with. Ensure that the head of the team is informed so that replacement can be done. Granulation tissue is a common cause of blockage and also makes removal difficult. Surgery is often needed.

The tube is usually removed when it stops draining or if the amount of fluid drained in 24 hours is less than 25 milliliters. One of the techniques used is gradual withdrawal (about 2cm) per day so that the insertion site also heals gradually. Take note that if the tube has been in position for a prolonged period of time, it may be difficult to remove. Warn the patient that there will be some discomfort.

Once the tube has been removed, dressing of the wound continues and the site has to be monitored for signs of infections. Minimal leakage may continue and the wound is expected to heal within a week after which dressing is discontinued. Patients should be educated on how to look for danger signs both before and after removal.

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