Abdominal drainage tubes and gastrointestinal decompression tubes are necessary guarantees for successful postoperative surgery. Drainage tubes can remove accumulated blood, gas, pus, and stomach contents from the body. Observing the amount, color, and properties of the drainage can determine whether there is significant bleeding and the patient's recovery after surgery. Therefore, for patients who have postoperative indwelling drainage or gastrointestinal decompression tubes, proper care should be taken.
1、 Nursing points for abdominal drainage tubes: (1) According to the needs of the patient's condition, several types of drainage tubes may be placed in the abdominal cavity. After the patient is transferred to the ward, they must be pointed out clearly, marked according to their name or function, and the drainage bag should be properly fixed to prevent twisting, compression, and folding. (2) When connecting the drainage tube, pay attention to aseptic techniques. The drainage tube should be lower than the outlet plane to prevent retrograde reflux infection. Keep the drainage tube unobstructed and squeeze it every 30 minutes. If there is no liquid flowing out of the drainage tube, it may be blocked. Notify the doctor for treatment according to the actual situation. (3) Observe the amount, color, and quality of the drainage fluid separately. The normal color is light red, followed by yellow and clear fluid in the later stage, with a daily volume of 0-1000 mL. If the hourly volume is greater than 50 mL and lasts for 3 hours with a red color, it is abnormal, or if the plasma tube drainage fluid is bile colored or cloudy in color, it is abnormal. (4) Properly fix the catheter, and prevent the drainage tube from slipping out or breaking into the abdominal cavity when the patient turns over, gets out of bed, or defecates. The slider should be replaced with a new tube and inserted. (5) Those who require negative pressure drainage should adjust the required negative pressure and pay attention to maintaining the negative pressure state. When using closed negative pressure drainage, the negative pressure can reach 20kPa, which can reduce intra-abdominal cavities and clear fluid accumulation. (6) Those who use gauze and Vaseline gauze to stop bleeding should closely observe their overall condition. If it has stabilized, it should be removed within 24-72 hours or replaced with a new gauze before filling. If the intra-abdominal drainage tube cannot be removed within 2-3 days, the skin tube should be rotated once every 2-3 days to prevent secondary damage caused by long-term fixation. (7) If antibiotics or other drugs need to be injected into the external drainage tube or the tube cavity needs to be flushed, aseptic operation should be strictly followed. (8) If it is a double tube drainage tube, pay attention to keeping the exhaust tube unobstructed and do not fold it. Cover it with a thin film glove and leave a hole that cannot be tied tightly to facilitate exhaust and prevent collapse of the tube wall. (9) Observe the possible complications caused by the drainage material, such as compression tissue necrosis and bleeding, intestinal fistula, secondary infection, pain, etc., and promptly remove or replace the tube.
2、 Key points of T-tube care:
1. Sterility: Replace the drainage bag according to the principle of aseptic operation at regular intervals, perform bile routine and bacterial culture at regular intervals, and pay attention to the position of the drainage bag not being higher than the drainage port. When lying flat, it should not be higher than the midaxillary line to prevent bile reflux and increase the chance of infection. Ensuring sterility is an important part of T-tube drainage care. 2. Sealed and properly fixed: The entire drainage device should be tightly connected to avoid leakage. The T-tube should be fixed to the skin with sutures at the exit of the abdominal wall. In addition, additional fixation should be added to the abdominal belt and bed sheet. When performing various operations on the patient, do not tighten the drainage tube. When fixing, leave room for the patient to turn over and move around to prevent the drainage tube from pulling off. If the drainage tube accidentally slips out in the early postoperative period, it can lead to biliary peritonitis, with serious consequences. 3. Smooth flow: It is a prerequisite for effective drainage. During nursing work, the position of the drainage tube must be adjusted at any time to avoid folding and twisting. If the tube is blocked inside, it should be promptly contacted with a doctor for corresponding treatment. 4. Observe and record the color, quality, and quantity of bile: Normal bile is golden or brown in color, thick, clear in color, and free of residue, with a daily volume of 600-1000. The amount of bile drained after surgery generally increases from high to low, which is related to the disappearance of inflammatory edema at the lower end of the common bile duct and the ability of bile to be discharged into the duodenum. If bile suddenly decreases, the cause should be investigated, whether it is due to distortion, compression, or blockage of the bile duct lumen, and corresponding treatment should be taken; If the bile color is light and thin, liver dysfunction should be considered. If the bile is cloudy, it may indicate infection. Attention should be paid to the presence of sediment like stones and biliary bleeding in the bile. 5. Protect the skin around the drainage tube: disinfect the outlet of the abdominal wall drainage tube with 75% ethanol daily, wipe off secretions, and wrap a cut of gauze around the drainage tube. If there is bile leakage, replace the dressing in a timely manner; Apply zinc oxide ointment locally to reduce the irritation of bile salts to the skin.
3、 Nursing points for continuous bladder flushing and drainage: (1) When connecting the bladder fistula, it should be distinguished from the plasma drainage tube in the abdominal cavity. (2) During the flushing process, closely observe whether the drip rate of the flushing is consistent with the drip rate of the outflow. If the flow rate also slows down, it indicates blockage and the flushing should be slowed down or stopped. Pinch the drainage tube by hand, and if necessary, use a syringe to draw physiological saline until it is unobstructed before continuing flushing. (3) Observe and record the amount, color, and quality of the drainage fluid, accurately record the inflow and outflow, and the difference between the two is the urine volume. Therefore, the drainage fluid must be greater than the drip volume. If the color of the drainage fluid gradually becomes clear, it is normal. If the color of the drainage fluid deepens, or even there is a large amount of bright red fluid, it indicates severe bleeding and the doctor should be notified immediately. (4) Adjust the drip rate of the rinse according to the color of the effluent. (5) Replace the flushing bottle daily and disinfect the urethral opening twice.