All cardiac surgery patients have some drainage fluid to varying degrees after surgery. Due to different surgical measures in different hospitals, the types and amounts of blood products inputted after surgery, the presence of different oxygenators, filters, and catheters in the extracorporeal circulation system, heparin and its antagonists, perfusion temperature, and extracorporeal circulation time, the amount of bleeding in postoperative patients can vary. A good postoperative drainage tube nursing process can reduce the occurrence of complications, alleviate patient pain, and improve nursing quality.
Why is it said that nurses' observation and judgment in monitoring are exceptionally important?
Continuous bedside monitoring by nurses, evaluation of bleeding in drainage tubes, monitoring of heart rate, blood pressure, and volume, sharp judgment, and timely reporting and communication are crucial for actively managing patient bleeding and expected bleeding, avoiding coagulation disorders and additional complications caused by excessive blood transfusion.
Secondary thoracotomy is more likely to result in these complications: renal failure, sepsis, atrial fibrillation, prolonged mechanical ventilation, prolonged hospital stay, and increased mortality.
The nursing of drainage tubes in cardiac surgery
According to different surgical methods, postoperative routine requires the placement of thoracic drainage tubes or pericardial drainage tubes. The nursing of pericardial or thoracic drainage tubes is crucial for reducing infections, preventing pneumothorax, reducing pericardial tamponade, reducing pleural effusion and other complications.
1. Fixation of drainage tube
When the patient enters the department, carefully check whether the fixation sutures of the pericardial and mediastinal drainage tubes have fallen off or loosened, whether the drainage tube is firmly fixed, whether the length of the drainage tube is appropriate, and whether it does not affect the care of turning over. After the patient is properly placed, check whether the drainage tube is twisted, folded, and whether the height of the drainage bottle is appropriate. After the inspection is completed, the drainage port is covered with sterile cutting gauze.
2. Patient's position drainage
After surgery, raise the head of the bed at an angle of 30-45 ° C, rely on gravity for drainage, and intermittently turn over to promote drainage on both sides. Encourage patients to cough. When coughing, the pressure in the chest cavity increases, which can promote drainage. When coughing, instruct patients to cross their hands and hold a pillow in front of their chest, which can effectively reduce the pain caused by coughing. If the child is young and cannot cooperate, the back patting method can be used, which involves using hollow palms to tap from bottom to top on both sides of the back, avoiding the position of the central spine.
3. Squeezing of drainage tube
After surgery, the drainage tube needs to be intermittently squeezed, and the squeezing interval is determined according to the amount of drainage fluid. Generally, it is once every 3-4 hours. The squeezing method is to stand on the patient's side, pinch the drainage tube with both hands at a distance of 10-15 cm from the drainage port, fold the drainage tube with the left hand at the back to maintain a closed state, and squeeze the drainage tube with the right hand at the front. Then switch the right hand to the left hand at the back and fold the drainage tube. Repeat the squeezing action with the left hand, alternating between the two hands, with a fast frequency, so as to form air flow that repeatedly impacts the opening of the drainage tube, can break open blood clots, and maintain smooth drainage. For patients with excessive drainage volume and continuous large amount of drainage fluid flowing out during squeezing, it should be reported to the doctor in a timely manner, Is there any indication for secondary surgery to stop bleeding.
4. Care of drainage bottle
The drainage bottle and placement should be at an appropriate height, and attention should be paid to keeping the outlet of the drainage tube below the liquid level of the drainage bottle. The drainage bottle should be fixed in a safe place to prevent it from falling to the ground, as falling to the ground may cause the outlet of the drainage tube to be above the liquid level, leading to pneumothorax. When replacing the drainage bottle, be sure to clamp the drainage tube to prevent gas from entering the pericardium, mediastinum, or chest cavity from the outside.
5. Observation of drainage fluid characteristics and volume
The color of normal drainage fluid should be slightly lighter than that of blood on the day after surgery, gradually changing to light red or light yellow. The drainage volume is slightly higher on the first day and gradually decreases thereafter. If the drainage volume is>300ml/h for adults or>4ml/h for children, and the color is bright red, it indicates the possibility of active bleeding and should be reported to the doctor immediately. At the same time, attention should be paid to the patient's vital signs, such as rapid decrease in hemoglobin, blood pressure, and heart rate.
The characteristics of the drainage fluid and the condition of the drainage port also need to be observed. Attention should be paid to whether there is redness, swelling, secretion, subcutaneous wave sensation, and pain around the drainage port. If the drainage fluid appears cloudy or has abnormal odor, it should be promptly sent for drainage fluid culture or wound secretion culture, and monitoring of infection related indicators should be monitored.
6. Precautions for extubation
The patient's pericardial and mediastinal drainage tubes often use Y-shaped interfaces, and the two tubes eventually converge into one main tube. When extubating, be careful to clamp the tube that is pulled out later with hemostatic forceps, and do not clamp the main tube, because if not clamped, gas may enter the tube that was pulled out first and then the tube that was pulled out later, and then enter the chest cavity. If it is an adult patient, they can be instructed to take a deep breath, hold their breath, quickly remove the drainage tube, tighten the purse string suture, tie the knot, and cover the wound with gauze. If it is a pediatric patient, there is no need to hold your breath, and the operation process is the same as above. After extubation, pay attention to the patient's vital signs and observe a decrease in oxygen saturation. If there is a decrease in oxygen saturation, a follow-up chest X-ray is necessary to rule out the possibility of pneumothorax.
In summary, the care of drainage tubes after cardiac surgery is crucial. Good nursing habits and sharp bleeding judgment by nurses can effectively reduce the occurrence of complications, alleviate patients' pain, and improve prognosis.