3. Roles and responsibilities
|
|
- Maude Carson
- 8 years ago
- Views:
Transcription
1 Nursing Procedure: Underwater seal chest drainage in the Highly Dependent or Critically Ill Infant or Child 2. The nurses role in ongoing chest drain management Lead Manager: Ms. Elaine Johnstone, Lead Nurse Responsible Director: Dr Neil Spenceley, Clinical Director, Critical Care Author(s): Jeanette Grady, Clinical Nurse Educator, Critical Care Approved by: PICU/HDU Clinical Guideline Group Date approved: September 2013 Date for Review: September 2015 Replaces previous version: June 2011 Chest Drain Ongoing Management Version: 2.0 Page 1 of 10
2 1. Introduction Chest drains and chest drainage systems are used frequently in the paediatric intensive care unit. There are many reasons for chest drain insertion but primarily they are used whenever there are specific conditions that interfere with the normal mechanism of lung expansion and altered intrathoracic pressures. Pleural chest tubes are inserted to evacuate blood, pus, air and fluid, from the thoracic cavity, to re-establish negative pressure in the intra pleural space and thereby expand the lungs following collapse resulting from surgery or trauma. Mediastinal chest tubes are placed in the mediastinum following open heart surgery, via a medial sternotomy in order to prevent accumulation of blood and clots around the heart, which could cause cardiac tamponade a life threatening situation. There are many different types of chest drains available including one-way flutter valve drains such as the Heimlich device or portable drains. However, for the majority of patients in the paediatric intensive care and high dependency units an underwater seal chest drainage system will be used. These systems provide an underwater seal, fluid collection chamber and suction chamber. In paediatric intensive care and high dependency, it is the bed side nurses role to ensure the patient is cared for safely once chest drains have been inserted. Although insertion of a chest drain may be necessary to help restore adequate oxygenation and promote lung re-expansion in the patient, there are potential risks and complications that the nurse must be aware of. This guideline is intended as a resource for staff involved in caring for childen in the Paediatric Intensive care and High Dependency units that require an underwater seal chest drain in situ. The guideline has been constructed after literature search and review of sourced textbooks, national guidelines (N.I.C.E.), Medline and CINHAL, and external nurse expert peer review and opinion. Further information on chest drainage in: Tutorial Notes-Chest Drainage Maxwell (unpublished 2008, reviewed 2010) and additional chest drain system resource at: See also recommendations and further information at end of this guideline. 2. Scope This nursing procedural guideline is intended to be followed by nurses involved in caring for the highly dependent or critically ill infant or child requiring underwater seal chest drainage within the Paediatric Intensive Care and High Dependency Units at R.H.S.C. Yorkhill. 3. Roles and responsibilities All nursing staff involved in caring for infants or children requiring underwater seal chest drainage in Paediatric Intensive care and High Dependency should be familiar with this nursing procedural guideline. Chest Drain Ongoing Management Version: 2.0 Page 2 of 10
3 4. BODY OF POLICY OR PROCEDURE Equipment : Available for ongoing management or in case of any untoward event* (*separate guideline) Fig. 1. Bed side equipment Available at bed side: Clamps (x1 each drain) Suction tubing-if required Suitable dressing (for ongoing site care) Sterile scissors Disposable apron Disposable gloves Wall suction gauge-if required (low flow *See Fig. 2) Occlusive dressing (E.g. sterile swabs) Tape (to secure occlusive dressing) Sterile gloves Sterile water Chlorhexidine 2% & 70% alcohol (swab suitable for urgent event) On chest drain trolley: Chest drain unit Fig. 2. *Low flow suction unit Chest Drain Ongoing Management Version: 2.0 Page 3 of 10
4 PROCEDURE Vital signs & patient observations: The infant or child with a chest drain(s) in situ must have the following observations monitored frequently & documented: Respiratory rate, effort & work of breathing Air entries Heart rate & pulse Oxygen saturations (SpO2) Blood pressure Temperature If a suitable invasive monitoring line is in situ then regular arterial or venous blood gases should be done. Chest drain site care: the nurse must ensure the drain site is checked regularly for the following: Drain is properly anchored with appropriate suture(s) and secured to child s chest wall Drain site is dry, clean & covered with dry non-adherent dressing Drain site dressing should be inspected for signs of leakage or odour Area around drain site inspected for signs of leakage, inflammation, infection or subcutaneous emphysema RATIONALE Frequent monitoring of vital signs is important in detecting any alterations from previously documented normal values as these may indicate problems such as haemorrhage, unresolved pneumothorax, tension pneumothorax, sepsis, infection and ventilation-perfusion mismatch. Suggestions for monitoring vital signs ranges from ¼ hourly immediately post drain insertion/admission, to ½ hourly to hourly whilst drain is in situ. The frequency of monitoring specific vital signs and blood gas analysis will be determined by the child s clinical status with any deterioration in the child s vital signs being reported to the nurse-incharge and medical team immediately. The drain must be well secured after insertion to prevent it becoming dislodged, slipping or falling out. Large amounts of tape and padding may restrict chest movement and prevent regular inspection of the drain site for complications. A dry non-adherent dressing, non-occlusive is most suitable. The drain site and dressing should be reviewed daily and the dressing should not need redressed for 2-3 days unless leakage apparent. Chest drainage unit (CDU) care: the nurse must check the under water seal chest drainage system frequently to ensure it is working correctly and to avoid potential problems: *see Fig. 5 Any signs of complications such as infection should be documented and reported and appropriate action taken. E.g. wound swab or medical team review. Chest Drain Ongoing Management Version: 2.0 Page 4 of 10
5 Keep chest drainage system and tubing below the level of the patients chest Perform initial inspection of connections & tubing. Thereafter inspect CDU tubing & drain connections regularly (suggested hourly) and keep tubing free from bed-sides/cotsides Ensure tubing & drain(s) are secure but not pulling. Try not to secure tubing to child s bed, linen or loose clothing (Fig. 3) Aim to lay tubing horizontally across bed before dropping it vertically into drainage system to facilitate drainage avoid dependent loops or kinking of tubing (Fig. 4) Ensure chest drainage unit is secured upright on floor beside or at the end of the bed/cot. Check water seal chamber (B)* maintained at 2cm level The chest drainage system must always be kept below the level of the child s chest to prevent fluid re-entering the pleural space syphonage. Regular inspection of the drain and tubing is vital to ensure that the system is still intact the drain has not slipped, connections have not come loose or tubing has become kinked. Securing tubing to clothing or bedding is not advised as sudden movements by the child or change of bed-linen could dislodge the drain. Dependent loops or kinking of tubing can impede drainage, block tubing and cause high pressures at chest tube and drainage tube connections, potentially resulting in clinical complications such as tension pneumothorax. Securing the drainage system to the floor with tape may be necessary to prevent tipping of system. Water in the water seal chamber (B)* can evaporate and under water seal will be lost. The level must be checked regularly and topped-up as per manufacturers instructions. Monitor and record any bubbling or swinging in the water seal chamber of the CDU. Report any changes to nurse-in-charge. If chest drain in pleural cavity, observe and record any fluctuations in water seal level of CDU with respiratory effort/ventilation tidalling Ensure suction chamber (A)* filled to -20cmH2O level in CDU. Persistent bubbling may suggest visceral pleural air leak, a drain on suction that has one of the drain eyelets open to air or with mediastinal drains patient with open chest. Swinging of the water seal level with respirations indicates drain patency and confirms drain position in pleural cavity. If suction is required, a low pressure system must be used as excessive Chest Drain Ongoing Management Version: 2.0 Page 5 of 10
6 If suction required - Check suction tubing connected to low flow regulated suction & suction control stopcock at CDU switched on. Check negative pressure on suction is set low enough to give gentle bubbling in the suction chamber no excessive bubbling Ensure suction filter attached changed when indicated Check fluid collection chamber (D)* frequently (15 min. intervals to 30min., then hourly) and document volume, type and colour of drainage. E.g. fresh blood, serous, cloudy. Always label chest drain(s) and drainage units clearly. E.g. Left pleural 1 or Right mediastinal 2. Specific nursing care issues: The nurse should assess the child s level of pain or discomfort regularly and administer analgesia as prescribed Reposition the child regularly as tolerated ensuring drain and tubing secure throughout a two nurse procedure. negative pressures may cause perpetuation of air leaks. If suction is required for more than one chest drain then a separate suction unit is advised for each chest drain. Turbulent bubbling is unnecessary, will not improve fluid drainage and will result in increased evaporation of water in the chamber. Frequent assessing and documenting of fluid volume and type drained and from what site is essential, as this may help the nurse determine if the child has any of the following: Persistent or fresh bleeding Infection Chylothorax Tamponade Frequency of checking tubing and drainage will range from every 15 minutes initially (for first 6 hours) post admission from cardiac or thoracic surgery, to 30 minutes (6 hours) then hourly once child stabilised. This is provided there is no other evidence or suspicion of bleeding or tamponade present. Pain from having a chest drain in situ can inhibit the child s movement and breathing which can slow their recovery. Therefore, regular pain assessment is vital to ensure the child receives adequate analgesia while the drain is in situ. Repositioning and improving mobility can facilitate drainage, aid breathing and lung expansion and reduce complications associated with immobility. Repositioning the infant/child with a chest drain in situ should involve at least two nurses in order to prevent accidental disconnection or kinking of drain and/or Chest Drain Ongoing Management Version: 2.0 Page 6 of 10
7 Avoid excessive chest tube handling/manipulation such as milking or stripping unless specifically instructed. (see Chest Drainage tutorial book for more details) Avoid routine clamping of chest drain tube unless specifically instructed by senior physician (see Chest Drainage tutorial book for more details) Fig. 3 Tubing secure tubing. Routine manipulation of chest drain tubing by milking or stripping the tubing has been common practice in the past in an attempt to prevent mediastinal drains from blocking with clots and causing cardiac tamponade. However, this type of tubing manipulation is thought to cause significant increases in negative intrathoracic pressures, may not be of proven benefit and may cause tissue damage. Routine clamping of chest drains is not recommended especially if bubbling, as it prevents the escape of air or fluid from the chest or mediastinum, leading to an increased risk of tension pnuemothorax or cardiac tamponade. Fig. 4 Avoid dependent loops FURTHER INFORMATION AND RECOMMENDATIONS: Practical chest drainage system issues: When there is no air leak, the water level in the water seal chamber should rise and fall with the patient's respirations, reflecting normal pressure changes in the pleural cavity during respiration. During spontaneous respirations, the water level should rise during inhalation and fall during exhalation. If the patient is receiving positive pressure ventilation, the oscillation will be just the opposite. Oscillations may be absent if the lung is fully expanded and suction has drawn the lung up against the holes in the chest tubes. Chest Drain Ongoing Management Version: 2.0 Page 7 of 10
8 A patient with only mediastinal tubes (and a closed chest) should have no bubbling or fluctuations in the water seal chamber, since these tubes are not in contact with the pleural cavity. As one of the risks of accumulation of fluid, blood or clots around the heart is cardiac tamponade, it is particularly important for nurses caring for patients with mediastinal chest tubes to be watchful for signs of cardiac tamponade with special attention paid to the drainage collection chamber. Fig. 5. Underwater seal chest drainage unit Suction chamber(a) Underwater seal chamber(b) Collection chamber(d) 5. Review This nursing procedural guideline should be reviewed every two years from date of approval. 6. References Allibone, L (2003) Nursing Management of chest drains. Nursing Standard, Vol.12 (17), pp Allibone, L (2005) Principles for inserting and managing chest drains. Nursing Times, Vol. 101 (42), pp Atrium (2012) A personal guide to managing chest drainage. Available from: Chest Drain Ongoing Management Version: 2.0 Page 8 of 10
9 Balfour-Lynn, IM Abrahamson, E Cohen, G Hartley, J King, S Parikh, D Spencer, D Thomson, AH Urquhart, D (2005) Draft - BTS guidelines for the management of pleural infection in children. Thorax, Vol. 60, Suppl.I, pp. i1-i21. Bar-El, Y Ross, A Kablawi, A Egenburg, S (2001) Potentially dangerous negative pressures generated by ordinary pleural drainage systems. Chest, Vol. 119 (2), pp Briggs, D (2010) Nursing care and management of patients with intrapleural drains. Nursing Standard, Vol. 24 (21), pp Coughlin, AM Parchinsky, C (2006) Go with the flow of chest tube therapy. Nursing, Vol. 36 (3), pp Crawford, D (2011) Care and management of a child with a chest drain. Nursing Children and Young People, Vol.23 (10), pp Day, TG Perring, RR Gofton, K (2008) Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interactive Cardiovascular and Thoracic Surgery, Vil. 7, pp Duncan, C Erikson R (1982) Pressures associated with chest tube stripping. Heart and Lung, Vol. 11 (2), pp Halm. MA (2007) To strip or not to strip? Physiological effects of chest tube manipulation. American Journal of Critical Care, Vol. 16 (6), pp Havelock, T Teoh, R Laws, D Gleeson, F (2010) British Thoracic Society Pleural Disease Guideline: Pleural procedures and thoracic ultrasound. Thorax, Vol. 65, (Suppl. 2): ii Horrox, F (2002) Chest drain management. In: Manual of Neonatal & Paediatric Heart Disease, Whurr, London. Scmelz, JO Johnson, D Norton, JM Andrews, M Gordon, PA (1999) Effects of position of chest drainage tube on volume drained and pressure. American Journal of Critical Care, Vol. 8 (5), pp Sullivan, B (2008) Nursing management of patients with a chest drain. British Journal of Nursing, Vol. 17 (6), pp Wallen, M Morrison, A Gillies, D O Riordan, E Bridge, C Stoddart, F (2002) Mediastinal chest drain clearance for cardiac surgery. Cochrane Database of Systematic Reviews, Issue 2, CD Chest Drain Ongoing Management Version: 2.0 Page 9 of 10
10 A Communication and Implementation Plan R.H.S.C. Nursing Policy Group PICU/HDU Clinical Guidelines group PICU/HDU Lead Nurse PICU/HDU ANP s, Band 7 and Band 6 senior nursing staff and nursing teams PICU/HDU Lead Consultant PICU/HDU Consultants and junior medical staff B Monitoring Compliance monitored by Lead nurse, ANP s and Senior clinical nurses in PICU/HDU. Datix and critical incident reporting of adverse events or incidents C Impact Assessment EQIA not relevant to this nursing procedural guideline as there are no discriminatory practices identified in implementing this guideline. Chest Drain Ongoing Management Version: 2.0 Page 10 of 10
N26 Chest Tubes 5/9/2012
Thoracic cavity, pleural space 1 Conditions requiring chest drainage_1 Air between the pleurae is a pneumothorax Occurs when there is an opening on the surface of the lung or in the airways, y, in the
More informationCHEST TUBES AND CHEST DRAINAGE SYSTEMS
CHEST TUBES AND CHEST DRAINAGE SYSTEMS Central Nursing Orientation April 2008 Revised September 2011 OBJECTIVES Describe common tubes and indications for use at LHSC Review indications and contraindications,
More informationINTERDISCIPLINARY CLINICAL MANUAL Policy & Procedure
INTERDISCIPLINARY CLINICAL MANUAL Policy & Procedure TITLE: Section: Source: Distribution: Chest Drainage and Chest Tube Management Respiratory/Thoracic Joy Tarasuk, CNE, Thoracic Surgery Capital Health
More informationNHS FORTH VALLEY Chest Drain Insertion by Seldinger Method (Pigtail drains)
NHS FORTH VALLEY Chest Drain Insertion by Seldinger Method (Pigtail drains) Date of First Issue 12/12/2012 Approved 12/12/2012 Current Issue Date 12/12/2012 Review Date 12/12/2014 Version 1 EQIA Yes 14/12/2012
More informationRATIFIED BY NNPDG SEPTEMBER 2006 FOR REVIEW 2009
NOTTINGHAM UNIVERSITY HOSPTIALS/RUSHCLIFFE PCT NURSING PRACTICE GUIDELINES GUIDELINES FOR CARE OF A PATIENT WITH A WOUND DRAINAGE SYSTEM CONTENTS PAGE Introduction and Types of Drains 1 Procedure for Applying
More informationCaring for a Tenckhoff Catheter
Caring for a Tenckhoff Catheter UHN A Patient s Guide What is a Pleural Effusion? There is a small space between the outside of your lung and the chest wall (ribs). This space is called the pleural space.
More informationCHEST TUBE REVIEW Orientation Package
Return Test By: 1 CHEST TUBE REVIEW Orientation Package Reviewed 2011 Created by M Gordon, CNE Surgery (2008) Adapted from the Chest tubes package by Nicky Holmes (2002), ICU/CCU, NYGH OBJECTIVES: 2 After
More informationX-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary
X-Plain Subclavian Inserted Central Catheter (SICC Line) Reference Summary Introduction A Subclavian Inserted Central Catheter, or subclavian line, is a long thin hollow tube inserted in a vein under the
More informationPaediatric Intensive Care Unit Nursing Procedure: Care of Arterial Lines.
Paediatric Intensive Care Unit Nursing Procedure: Care of Arterial Lines. Definition: Arterial Line Placement of an indwelling arterial catheter for the purpose of continuous monitoring of intra arterial
More informationNEEDLE THORACENTESIS Pneumothorax / Hemothorax
NEEDLE THORACENTESIS Pneumothorax / Hemothorax By: Steven Jones, NREMT-P Pneumothorax Pneumothorax is a collection of air or gas in the pleural space of the lung, causing the lung to collapse. Pneumothorax
More informationThe planners of the educational activity have no conflicts of interest to disclose.
Chest Tube Management Two (2.0) Contact Hours Course Expires: 11/01/2016 First Published: 08/30/2007 Updated: 08/30/2010 Updated: 11/01/2013 Reproduction and distribution of these materials is prohibited
More informationInformation for patients and nurses
Information for patients and nurses Rocket IPC Pleural Catheter Indwelling Catheter Rocket Indwelling Pleural Catheter (IPC) Contents Contact Information...03 What s in the Rocket Dressing Pack and Bottle
More informationManagement of Chest Tubes and Air Leaks after Lung Resection
Management of Chest Tubes and Air Leaks after Lung Resection Emily Kluck PA-C The Johns Hopkins Hospital Baltimore, MD AATS 2014, Toronto, CAN April 2014 Management of Chest Tubes 1 Overview Review the
More informationTunnelled indwelling pleural catheter (TIPC)
Tunnelled indwelling pleural catheter (TIPC) A patient s guide 1 What is a tunnelled indwelling pleural catheter? A tunnelled indwelling pleural catheter is a specially designed small tube to drain fluid
More informationTroubleshooting a Patient with a Chest Drain. A Simulation Workshop
Troubleshooting a Patient with a Chest Drain. A Simulation Workshop Outline This is a simulation session that aims to improve skills at assessing a patient with a chest drain. It is undertaken using a
More informationOxygenation. Chapter 21. Anatomy and Physiology of Breathing. Anatomy and Physiology of Breathing*
Oxygenation Chapter 21 Anatomy and Physiology of Breathing Inspiration ~ breathing in Expiration ~ breathing out Ventilation ~ Movement of air in & out of the lungs Respiration ~ exchange of O2 & carbon
More informationCaring for a Hemovac Drain
Caring for a Hemovac Drain 269 12. Raise side rail. Lower bed height and adjust head of bed to a comfortable position. 13. Remove additional PPE, if used. Perform hand hygiene. These promote patient safety.
More informationPatient Information Guide Morpheus CT Peripherally Inserted Central Catheter
Patient Information Guide Morpheus CT Peripherally Inserted Central Catheter IC 192 Rev C A measure of flexibility and strength. Table of Contents 1. Introduction 2. What is the Morpheus CT PICC? 3. What
More informationPATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly
PATIENT GUIDE Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Every drainage Weekly Clinician s Signature: ACCESS SYSTEMS Pleural Space Insertion Site Cuff Exit Site Catheter
More informationGuidelines for the Insertion and Management of Chest Drains
Guidelines for the Insertion and Management of Chest Drains Name and title of author Laura Di Ciacca, Physiotherapy Clinical Head of Acute Services Dr Matt Neal, Consultant Anaesthetist Dr Martin Highcock,
More informationPercutaneous Nephrostomy. Care of your Nephrostomy. Department of Urology
Percutaneous Nephrostomy Care of your Nephrostomy Department of Urology You may encounter some problems at home but these are usually easily overcome. Listed below are some questions patients commonly
More informationMeasuring central venous pressure
Elaine Cole Senior lecturer ED/Trauma, City University Barts and the London NHS Trust 1 Learning outcomes That the clinician can: Describe the sites of central venous catheterisation Understand why central
More informationEnables MDA Medical Teams to categorize victims in mass casualty scenarios, in order to be able to triage and treat casualties
MDA Disposable ALS + BLS Medical Ambulance Equipment Prices shown in CDN. Funds Items Description Picture Mass Casualty ID tag 1000 units = $350 Enables MDA Medical Teams to categorize victims in mass
More informationPICC & Midline Catheters Patient Information Guide
PICC & Midline Catheters Patient Information Guide medcompnet.com 1 table of contents Introduction 4 What is a PICC or Midline Catheter? 4 How is the PICC or Midline Catheter Inserted? 6 Catheter Care
More informationFlushing and Dressing a Peripherally Inserted Central Catheter (PICC Line): a Guide for Nurses
Flushing and Dressing a Peripherally Inserted Central Catheter (PICC Line): a Guide for Nurses Information for Nurses Introduction This information is for community nursing staffs who have been asked to
More informationBARD MEDICAL DIVISION UROLOGICAL DRAINAGE. Foley Catheter Care & Maintenance. Patient Education Guide
BARD MEDICAL DIVISION Foley Catheter Care & Maintenance Patient Education Guide WHAT IS A FOLEY CATHETER? Because of your medical problem, your body is having trouble completely emptying your bladder of
More informationAll About Your Peripherally Inserted Central Catheter (PICC)
All About Your Peripherally Inserted Central Catheter (PICC) General Information Intravenous (IV) therapy is the delivery of fluid directly into a vein. An intravenous catheter is a hollow tube that is
More informationCUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS
CUESTA COLLEGE REGISTERED NURSING PROGRAM CRITICAL ELEMENTS LEVELS I through IV A. OVERRIDING CRITICAL ELEMENTS Violation of an overriding area will result in termination and failure of the particular
More informationCardiac Catheterisation. Cardiology
Cardiac Catheterisation Cardiology Name: Cardiac catheterisation Version: 1 Page 1 of 7 Contents Page Number(s) 1. Introduction 3 2. Management pre operative 3 3. Management post operative 5 4. Discharge
More informationSimple Thoracostomy Avoids Chest Drain Insertion in Prehospital Trauma
Simple Thoracostomy Avoids Chest Drain Insertion in Prehospital Trauma Deakin, C. D. MA, MRCP, FRCA; Davies, G. MRCP; Wilson, A. FRCS Author Information From the Helicopter Emergency Medical Service, Royal
More informationX-Plain Foley Catheter Male Reference Summary
X-Plain Foley Catheter Male Reference Summary Introduction A Foley catheter is a tube that is put through the urinary opening and into your bladder to drain urine. Your doctor may have placed or may ask
More informationCentral venous catheters. Care of the site 88 CVP measurement 90 Removal of CVC (non-tunnelled) 93 Care of long-term CVCs 95
4 Central venous catheters Care of the site 88 CVP measurement 90 Removal of CVC (non-tunnelled) 93 Care of long-term CVCs 95 CARE OF THE SITE Preparation Patient Equipment/Environment Nurse Explain the
More informationIntroduction A JP Drain is a soft tube and container used to drain fluids that build up under the skin after surgery.
JP Drain Introduction A JP Drain is a soft tube and container used to drain fluids that build up under the skin after surgery. This reference summary explains what a JP Drain is and discusses how to take
More informationPATIENT GUIDE. Understand and care for your peripherally inserted central venous catheter (PICC). MEDICAL
PATIENT GUIDE Understand and care for your peripherally inserted central venous catheter (PICC). MEDICAL Introduction The following information is presented as a guideline for your reference. The best
More informationPICCs and Midline Catheters
Patient Education PICCs and Midline Catheters Patient s guide to PICC (peripherally inserted central catheter) and midline catheters What are PICCs and midline catheters used for? Any medicine given over
More informationNORTH CAROLINA BOARD OF NURSING NURSE AIDE II TRAINING MODULE
PART A: PREPARING FOR ADMINISTRATION OF IV FLUIDS All four parts of this module, including skills checklists must be successfully completed in order to complete this training module. This activity is a
More informationPATIENT GUIDE. Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Clinician s Signature: Every drainage Weekly
PATIENT GUIDE Care and Maintenance Drainage Frequency: Max. Drainage Volume: Dressing Option: Every drainage Weekly Clinician s Signature: ACCESS SYSTEMS Pleural Space Insertion Site Cuff Exit Site Catheter
More informationEpidural Management. Policy/Purpose. Scope
Fluid & Medications Management Policy/Purpose... 1 Scope... 1 Associated documents... 2 General... 2 Epidural Indications... 2 Contra-indications:... 2 Educational requirements... 3 Procedural Considerations...
More informationGUIDELINE ON THE CARE OF CHILDREN WITH CHEST DRAINS
Date of Issue: 27 th July 2015 Page No: Page 1 of 5 GUIDELINE ON THE CARE OF CHILDREN WITH CHEST DRAINS Version Number 3 Date of Issue 27 th July 2015 Reference Number Review Interval Approved By Name:
More informationCaring for Your PleurX Pleural Catheter
Caring for Your PleurX Pleural Catheter A PleurX Pleural Catheter has been placed in your chest through a small incision in your skin into the pleural space (see picture below). This allows you to drain
More informationPARAMEDIC TRAINING CLINICAL OBJECTIVES
Page 1 of 21 GENERAL PATIENT UNIT When assigned to the General Patient unit paramedic student should gain knowledge and experience in the following: 1. Appropriate communication with patients and members
More informationRGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND
RGN JOY LAUDE WATFORD GENERAL HOSPITAL, ENGLAND Monitor patient on the ward to detect trends in vital signs and to manage accordingly To recognise deteriorating trends and request relevant medical/out
More informationAUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 RECOMMENDATIONS FOR THE POST-ANAESTHESIA RECOVERY ROOM
Review PS4 (2006) AUSTRALIAN AND NEW ZEALAND COLLEGE OF ANAESTHETISTS ABN 82 055 042 852 RECOMMENDATIONS FOR THE POST-ANAESTHESIA RECOVERY ROOM 1. INTRODUCTION A well-planned, well-equipped, well-staffed
More informationPolicies & Procedures. Care of
Policies & Procedures Title: SUPRAPUBIC CATHETER Care of Changing Removal Authorization: [x] SHR Nursing Practice Committee I.D. Number: 1021 Source: Nursing Date Revised: November 2014 Date Effective:
More informationStatus: Standard Procedure: specifies the procedures to be followed, only in exceptional circumstances should these not be followed
Page 1 of 6 Status: Standard Procedure: specifies the procedures to be followed, only in exceptional circumstances should these not be followed Title: Standard Procedure for the Irrigating (flushing) of
More informationby Patricia Carroll, RN, BC, CEN, RRT Used with Written Permission by Jeffrey P. McGill
Chest Tube and Drainage Management WWW.RN.ORG Reviewed March, 2015, Expires March, 2017 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2015 RN.ORG, S.A.,
More informationGoing Home with a Urinary Catheter
Going Home with a Urinary Catheter Doctor: Phone Number: About Your Catheter A urinary catheter is a small tube that goes through your urethra and into your bladder. This tube then drains the urine made
More informationYour Guide to Peritoneal Dialysis Module 3: Doing Peritoneal Dialysis at Home
Your Guide to Peritoneal Dialysis Module 3: 6.0959 in Preparing to do PD One of the most important things about PD is to keep the dialysis area and anything that comes in contact with the PD equipment
More informationWithin the Scope of Practice/Role of APRN RN _ X_LPN CNA
Wyoming State Board of Nursing 130 Hobbs Avenue, Suite B Cheyenne, WY 82002 Phone (307) 777-7601 Fax (307) 777-3519 E-Mail: wsbn-info-licensing@wyo.gov Home Page: https://nursing-online.state.wy.us/ OPINION:
More informationPERIPHERALLY INSERTED CENTRAL CATHETERS (PICC) Fong So Kwan APN, Haematology unit Medical Department, QMH
PERIPHERALLY INSERTED CENTRAL CATHETERS (PICC) Fong So Kwan APN, Haematology unit Medical Department, QMH 1 What is a PICC catheter? Primary vascular access device since their introduction in the mid-1970s,
More informationCare for your child s Central Venous Catheter (CVC)
Care for your child s Central Venous Catheter (CVC) This booklet is intended for general informational purposes only. You should consult your doctor for medical advice. Please call the clinic or your home
More informationAtrium Pneumostat Chest Drain Valve. Discharge Instructions
Atrium Pneumostat Chest Drain Valve Discharge Instructions Your Physician Name: Contact Number for Emergencies: Introduction Your physician has decided to change your chest drainage system to a smaller
More informationHow To Recover From A Surgical Wound From A Cast
Care of Your Wounds After Amputation Surgery by Paddy Rossbach, RN Depending on the reason for your amputation and the state of your limb at the time of surgery, definitive closure of the wound may take
More informationHow To Treat A Heart Attack
13 Resuscitation and preparation for anaesthesia and surgery Key Points 13.1 MANAGEMENT OF EMERGENCIES AND CARDIOPULMONARY RESUSCITATION ESSENTIAL HEALTH TECHNOLOGIES The emergency measures that are familiar
More informationSpinal Cord and Bladder Management Male: Intermittent Catheter
Spinal Cord and Bladder Management Male: Intermittent Catheter The 5 parts of the urinary system work together to get rid of waste and make urine. Urine is made in your kidneys and travels down 2 thin
More informationUnderstanding your Peripherally Inserted Central Catheter (PICC) Patient Information
Understanding your Peripherally Inserted Central Catheter (PICC) Patient Information The Purpose of this Information Sheet This information sheet has been written by patients, members of the public and
More informationGuy s, King s and St Thomas Cancer Centre The Cancer Outpatient Clinic Central venous catheter: Peripherally inserted central catheter
Guy s, King s and St Thomas Cancer Centre The Cancer Outpatient Clinic Central venous catheter: Peripherally inserted central catheter This information leaflet aims to help answer some of the questions
More informationREMOVAL OF A PICC. Possible Cause Nursing Actions Prevention
REMOVAL OF A PICC PICC lines are removed following a physician order, when therapy is completed or complications such as line sepsis, thrombosis or phlebitis, require removal. The removal of a PICC line
More informationClinical Guideline for: Aseptic Technique
Clinical Guideline for: Technique Summary This guideline provides the principles of, Non Touch, and Clean Techniques to be implemented in the hospital environment. Key Points The essential elements of
More informationTOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING
TOWN OF FAIRFIELD HEALTH DEPARTMENT PUBLIC HEALTH NURSING PROGRAM: School Health APPROVED BY: Board of Health School Medical Advisor POLICY: With Portable Suction Machine DATE: March 14, 1994 POLICY DEFINITION:
More informationCare of your central venous catheter A guide for patients and their carers. We care, we discover, we teach
Care of your central venous catheter A guide for patients and their carers We care, we discover, we teach This booklet contains information about central venous catheters (CVC). These are sometimes called
More informationGuidelines for Transport of the Critically Ill
Page 1 of 16 Guidelines for Transport of the Critically Ill Version Effective Date 1 May 1994 2 Feb 2002 3 Apr 2014 Document Number Prepared by College Guidelines Committee Endorsed by HKCA Council Next
More informationManaging Your Non-Tunneled (Percutaneous) Catheter: PICC, SICC, and JCC. What is a PICC catheter?
Managing Your Non-Tunneled The staff of the Procedure, Vascular Access, Conscious Sedation Service has written this information to explain your new PICC (peripherally inserted central catheter), SICC (subclavian
More informationPATIENT URINARY CATHETER PASSPORT
n PATIENT URINARY CATHETER PASSPORT A guide on how to look after your Catheter NHS Hertfordshire Patient Experience Team Charter House Parkway Welwyn Garden City Hertfordshire AL8 6JL Telephone: 01707
More informationPatient Information:
Patient Information: Care of an indwelling Urinary Catheter What is a Urinary Catheter? A catheter is a hollow, flexible tube designed to drain urine from the bladder. Following insertion into the bladder,
More informationTony Melendez Version 2013 LINES, TUBES, PORTS, WHAT TO DO WITH THEM
Tony Melendez Version 2013 LINES, TUBES, PORTS, WHAT TO DO WITH THEM Discusion of the following PICC Line Hickman Cath Chest Tubes PICC s & Midlines Classic PICC Line A PICC line is essentially a narrow
More informationLaparoscopic Colectomy. What do I need to know about my laparoscopic colorectal surgery?
Laparoscopic Colectomy What do I need to know about my laparoscopic colorectal surgery? Traditionally, colon & rectal surgery requires a large, abdominal and/or pelvic incision, which often requires a
More informationIndwelling urinary catheter. Information for patients and carers. RDaSH. Doncaster Community Integrated Services
Indwelling urinary catheter Information for patients and carers RDaSH Doncaster Community Integrated Services What is a catheter? A catheter is a hollow flexible tube designed to drain urine from the bladder.
More informationBladder Catheterization
Approved by: Bladder Catheterization Gail Cameron Senior Director, Operations, Maternal, Neonatal & Child Health Programs Dr. Ensenat Medical Director, Neonatology Neonatal Nursery Policy & Procedures
More informationTRANSPORT OF CRITICALLY ILL PATIENTS
TRANSPORT OF CRITICALLY ILL PATIENTS Introduction Inter-hospital and intra-hospital transport of critically ill patients places the patient at risk of adverse events and increased morbidity and mortality.
More informationPaediatric Intensive Care Unit Nursing Guideline: Chest Drains
Paediatric Intensive Care Unit Nursing Guideline: Chest Drains A chest drain is a tube inserted into the pleural space to drain its contents of air or fluid. The tube remains in place until drainage is
More information3100B Clinical Training Program. 3100B HFOV VIASYS Healthcare
3100B Clinical Training Program 3100B HFOV VIASYS Healthcare HFOV at Alveolar Level Nieman,, G, SUNY 1999 Who DO We Treat? Only Pathology studied to date has been ARDS Questions about management of adults
More informationAspira* Pleural Drainage Catheter
Aspira* Pleural Drainage Catheter Instructions For Use Access Systems Product Description: The Aspira* Pleural Drainage Catheter is a tunneled, long-term catheter used to drain accumulated fluid from the
More informationCHAPTER 1: THE LUNGS AND RESPIRATORY SYSTEM
CHAPTER 1: THE LUNGS AND RESPIRATORY SYSTEM INTRODUCTION Lung cancer affects a life-sustaining system of the body, the respiratory system. The respiratory system is responsible for one of the essential
More information404 Section 5 Shock and Resuscitation. Scene Size-up. Primary Assessment. History Taking
404 Section 5 and Resuscitation Scene Size-up Scene Safety Mechanism of Injury (MOI)/ Nature of Illness (NOI) Ensure scene safety and address hazards. Standard precautions should include a minimum of gloves
More informationEmergency Insertion of Temporary Trans-venous Pacing Catheter in ICU
TARGET AUDIENCE Junior Medical Staff Critical Care Trained ICU Nurses PURPOSE This document is intended as a basic guide to managing patients who require insertion of Temporary Trans-venous Cardiac Pacing
More informationACI UROLOGY NETWORK - NURSING BLADDER IRRIGATION GUIDELINES
ACI UROLOGY NETWORK - NURSING BLADDER IRRIGATION GUIDELINES The following pages provide examples of clinical guidelines to enable clinicians to develop their own resource material relevant to their hospital
More informationPLEUR EVAC CHEST DRAINAGE SYSTEMS. Great Innovations to Enhance Chest Drainage
PLEUR EVAC CHEST DRAINAGE SYSTEMS Great Innovations to Enhance Chest Drainage 2 INTRODUCTION Teleflex Great Innovations to Enhance Chest Drainage Trusted brands make Teleflex a reliable and strong partner.
More informationLevels of Critical Care for Adult Patients
LEVELS OF CARE 1 Levels of Critical Care for Adult Patients STANDARDS AND GUIDELINES LEVELS OF CARE 2 Intensive Care Society 2009 All rights reserved. No reproduction, copy or transmission of this publication
More informationSection 6: Your Hemodialysis Catheter
Section 6: Your Hemodialysis Catheter What you should know about your dialysis catheter How to change your catheter TEGO connectors Starting dialysis using a catheter End of dialysis using a catheter Changing
More informationLaparoscopic Cholecystectomy
Laparoscopic Cholecystectomy Removal of Gall Bladder Page 12 Patient Information Further Information We endeavour to provide an excellent service at all times, but should you have any concerns please,
More informationGOING HOME AFTER YOUR TAVR PROCEDURE
GOING HOME AFTER YOUR TAVR PROCEDURE HENRY FORD HOSPITAL CENTER FOR STRUCTURAL HEART DISEASE GOING HOME After your TAVR procedure, you will need help when you go home. It is hard to predict how much help
More informationSt. Louis Eye Care Specialists, LLC Andrew N. Blatt, MD
St. Louis Eye Care Specialists, LLC Andrew N. Blatt, MD 675 Old Ballas Rd. Suite 220 St. Louis, MO 63141 Phone: 314-997-3937 Fax: 314997-3911 Toll Free: 866-869-3937 PEDIACTRIC CATARACT SURGERY A cataract
More informationHome Care for Your Wound Drain
PATIENT EDUCATION patienteducation.osumc.edu When you go home after surgery, you may have one or more drains in place to help your wounds heal. Hemovac, Jackson Pratt (JP) and Blake are common drains used
More informationAfter care following insertion of a suprapubic catheter
Other formats After care following insertion of a suprapubic catheter If you need this information in another format such as audio tape or computer disk, Braille, large print, high contrast, British Sign
More informationChildren's Medical Services (CMS) Regional Perinatal Intensive Care Center (RPICC) Neonatal Extracorporeal Life Support (ECLS) Centers Questionnaire
Children's Medical Services (CMS) Regional Perinatal Intensive Care Center (RPICC) Neonatal Extracorporeal Life Support (ECLS) Centers Questionnaire Date: RPICC Facility: CMS use only Include the following
More informationVaxcel PICCs Valved and Non-Valved. A Patient s Guide
Vaxcel PICCs Valved and Non-Valved A Patient s Guide Information about your Vaxcel PICC is available by calling the Navilyst Medical Vascular Access Information Line 800.513.6876 Vaxcel Peripherally Inserted
More informationLocation: Clinical Practice Manual
Subject: Area: Classification: Relevant to: Bladder Management Clinical Practice All Clinical Staff Implementation Date: March 2001 Review Date: March 2004 Responsible for Review: Approved by: Distribution:
More informationAdministration of Medications & Fluids via a Peripheral Intravenous Cannula
Administration of Medications & Fluids via a Peripheral Intravenous Cannula Clinical S.O.P. No.: 22.0 Compiled by: Approved by: Review date: November 2016 Administration of Medications & Fluids via S.O.P.
More informationINTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS
INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS Description of Treatment A major difficulty in treating
More informationPeripherally Inserted Central Catheter (PICC)
Peripherally Inserted Central Catheter (PICC) Disclaimer This is general information developed by The Ottawa Hospital. It is not intended to replace the advice of a qualified healthcare provider. Please
More informationPeripherally Inserted Central Catheter (PICC) for Outpatient
Peripherally Inserted Central Catheter (PICC) for Outpatient Introduction A Peripherally Inserted Central Catheter, or PICC line, is a thin, long, soft plastic tube inserted into a vein of the arm. It
More informationInfection Prevention & Control Team. Your urinary catheter & how to care for it 0151 430 2452 / 0151 430 1384. Patient Information Leaflet
Contact details Infection prevention team - 0151 430 2452 This leaflet can be made available in alternative languages/formats on request. Infection Prevention & Control Team 0151 430 2452 / 0151 430 1384
More informationTRACHEOSTOMY TUBE PARTS
Page1 NR 33 TRACHEOSTOMY CARE AND SUCTIONING Review ATI Basic skills videos: Tracheostomy care and Endotracheal suction using a closed suction set. TRACHEOSTOMY TUBE PARTS Match the numbers on the diagram
More informationINTERNATIONAL TRAUMA LIFE SUPPORT
INTERNATIONAL TRAUMA LIFE SUPPORT NEEDLE DECOMPRESSION OF TENSION PNEUMOTHORAX Roy Alson, MD, PhD, FACEP, FAAEM and Sabina Braithwaite, MD, MPH, FACEP INTRODUCTION The purpose of this document is to update
More informationOxygen Therapy. Oxygen therapy quick guide V3 July 2012.
PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing
More informationSection Two: Arterial Pressure Monitoring
Section Two: Arterial Pressure Monitoring Indications An arterial line is indicated for blood pressure monitoring for the patient with any medical or surgical condition that compromises cardiac output,
More informationForced vital capacity: maximal volume of air exhaled with maximally forced effort from a maximal inspiration.
SOP Spirometry 1. General considerations Spirometry serves as a physiological test to quantify pulmonary disease severity and to assess clinical change in respiratory function over time. Standard spirometric
More informationMANITOBA PATIENT SERVICE CENTRE STANDARDS
MANITOBA PATIENT SERVICE CENTRE STANDARDS February 2015 INTRODUCTION These Standards are derived from Z316.7-12 and are approved by the Council of the College of Physicians and Surgeons of Manitoba. These
More informationORAL ANTICOAGULANTS RIVAROXABAN (XARELTO) FOR PULMONARY EMBOLISM (PE)
ORAL ANTICOAGULANTS RIVAROXABAN (XARELTO) FOR PULMONARY EMBOLISM (PE) Information Leaflet Your Health. Our Priority. Page 2 of 6 What Are Anticoagulants And What Do They Do? This information leaflet has
More information