Catheters and Drains

Stars and Highlights

Catheters

  • can be placed intraoperatively or post-operatively

  • areas of placement: at the end of an incision

  • Robinson catheter: straight, red, usually made of latex, can be used to drain a bladder or retract the uvula during tonsilectomy, irrigate a duct. Considered a temporary drain

  • coudes

  • suprapubic catheters

  • T-Tubes

  • arterial catheters: placed temporarily, used to draw blood for labs, provide intra arterial blood pressure (A-lines), perform various procedures, perform diagnostic studies

Drains

  • drains: used to remove fluid or air, can decrease dead space and fluid accumulation, assists in wound healing

  • can be anchored with nonabsorbable nylon sutures, tape (not used to secure tubing, just near drain site)

  • leg drainage bag attached to upper or lower leg

  • safety pin placed through penrose drains to prevent them from getting sucked into the body

  • balloon always filled with sterile water

  • know gastrostomy, cystostomy, nephrostomy

  • chest tubes: inserted percutaneously via a “stab wound”, inserted into the thorax to treat hemothorax or pneumothorax, attached to exterior wall of the chest with a non-absorbable suture, connected to a closed water-seal drainage device

Active drains

  • hemovac drains: uses negative pressure created by a vacuum

Collection Devices

  • gauze dressings: simplest and most common

  • drainage bag: keep below level of draining area

  • reservoir

  • bedside drainage device (powered)

Safety Considerations

  • when emptying collection device, always wear proper PPE

  • always use aseptic technique when draining the collection unit

  • Marks must be made (usually with a marker) to monitor and document the amount of drainage before emptying the collection device

  • Drain the collection unit as little as possible, as extra handling increases risk of infection

  • Maintain the position of the device below the site that it is draining after it has been emptied

Study Guide

According to Alexander’s, what do drains control, and provide exits for?
2. What type of pressure do portable, self-contained closed wound units provide?
3. How does negative pressure affect the fluid in the wound?
4. What is a disadvantage of wound drains?
5. What are the factors that determine using a simple vs. closed drainage system?
6. What are the four drains shown on page 260 in Alexander’s? Which drain by gravity?
Which represent closed drainage system?
7. Catheters, tubes and drains serve many patient care functions. Where can they be placed
and what is it that they assist with doing?
8. What are catheters used for?
9. What materials are catheters made from?
10. A red rubber catheter, also known as a Robinson catheter, is mentioned in your reading
in AST. What can the Robinson be used for?

emptying the urinary bladder or obtaining a specimen of urine, can also be inserted into the nose, comes out through the mouth, and can retract the uvula during adenoidectomies


11. AST has urinary catheters classified according to use and according to placement. What
does the book have listed?

  • self-retaining

  • nonretaining (can come in two or three way)


12. There are two-way foley catheters and three-way foley catheters. How many ports does
a two-way foley have? What are they used for? How many ports does a three-way foley
have? What are they used for?

  • two-way Foley catheters: have an outlet for draining and and inlet for balloon inflation via syringe

  • three-way Foley: used for continous bladder drainage, irrigates the bladder to prevent obstruction. often used after prostatectomy, helps tamponade to prevent excessive bleeding. Has a balloon port, a urine drainage port, and an irrigation port


13. Which catheter requires the use of a gravity drainage bag?

Foley catheters


14. Where is the gravity drainage bag placed to promote bladder drainage and prevent
reflux?

Below the level of the bladder


15. Where is a suprapubic catheter placed and how?

  • Placed into the bladder through a surgical opening in the abdominal wall

  • Requires the use of a drainage bag


16. What are some examples listed in AST that may be used suprapubically?

  • Mushroom (Pezzer) catheters

  • Malecot (batwing) catheters

  • Foley


17. Could a suture be used to secure a suprapubic catheter?

Yes, can be sutured in place with a non-absorbable (heavy nylon) suture on the exterior abdominal wall


18. Ureteral catheters are placed where? What is used to assist with their placement?

  • Inserted into the ureters through a cystoscope that has been inserted into the urinary bladder via the urethra (placed into ureters only!)

  • Have radiopaque markers at the ends to confirm placement

  • Placement is verified by kidney, ureter, or bladder X-ray


19. What are intravascular catheters used for according to AST?

  • hemodynamic monitoring

  • injection of contrast materials to outline vessels/heart chambers for diagnostic purposes

  • infusion of fluids

  • obtain a diagnosis

  • monitor body functions

  • remove thrombi


20. What methods are used to insert intravascular catheters?

  • percutaneously or by cutdown


21. What is a fogarty catheter?

  • balloon-tipped catheter used to remove obstructions within the lumens of arteries, veins, and ducts

  • Fogarty biliary: inserted into the biliary system for the removal of gallstones

  • Fogarty arterial embolectomy: inserted into an artery to remove an obstructing blood clot

  • Fogarty venous embolectomy: used to remove clots from veins

  • (slides) inserted and placed beyond thrombi, inflated, then pulled back out slowly, removing the obstruction as the catheter comes out (all you need to know)


22. What is a cholangiocatheter?

  • inserted into the common bile duct

  • Can be performed through laparoscopes as well as open laparotomies


23. How is the cholangiocatheter used and for what?

  • Used to inject contrast media under x-ray so that calculi can be outlined


24. As stated in AST, central venous pressure is monitored with a single-lumen or multi-
lumen radiopaque catheter. Which catheters are most frequently used?


25. Which catheter is used for intermittent or continuous peritoneal dialysis?
26. Tubes are used to remove air and fluids from the gastrointestinal tract. What else can
tubes be used for?


27. Gastrointestinal tubes are used to aspirate air and fluids from the gastrointestinal tract.
Where does the tube enter the body to reach the stomach or intestines?

  • inserted into the nose (nasogastric) or mouth (orogastric) to access the stomach or intestines

  • can also be inserted into the rectum


28. According to AST, the term sump refers to a dual (2) lumen tube. What is the purpose of
each lumen?

  • sump design uses air to pump out stuff inside- blue lumen is for air


29. AST mentions airway tubes that are used to maintain patency of the upper respiratory
tract. What types of airway tubes are listed? How do the tubes get placed into the body?

  • cuffed

  • uncuffed

  • inserted directly into the neck via an incision into the trachea (star)



30. How are chest tubes inserted?
31. What does a chest tube treat?
32. When two chest tubes are placed ipsilaterally (on the same side of the body), one is
higher than the other, what does the placement of each tube accomplish?
33. What type of suture anchors the chest tube in place?
34. What is the chest tube connected to?
35. A closed water-seal drainage system is similar to a urinary drainage bag in that it is
gravity drained and positioned in a way to prevent reflux. At what level must the closed
water-seal drainage collection unit be placed?
36. Drains evacuate air or fluid from a wound, surgical or otherwise and they function
passively or actively. How does a passive drain work? -star-

  • Open pathway allows the passage of fluid and/or air from an area of high pressure (inside the body) to an area of low pressure (outside the body) -star-

  • may be connected to a gravity collection device or the drainage may be contained within an absorbent dressing


37. According to AST, what are some examples of passive drains?

  • penrose drains

  • cigarette drain

  • gastro/nephro/cystostomy


38. Where is a:
a. T-tube placed? What does it drain?

  • drains the common bile ducts

  • long end goes further into the common duct

  • short end goes to the hepatic duct of the liver, and is cut at an angle

  • nylon suture holds it in place


b. Nephrostomy tube placed? What does it drain?
39. Active drains use negative pressure which is created by removing air from the
collection device either manually or mechanically. What are some examples of active
drains?

  • chest tubes

  • hemovac tubes

  • jackson pratt drains

  • blake drains

  • stryker drains



40. What reasons are intraarterial catheters inserted into the patient?
41. What can result from irritation of the vessel wall due to the insertion of an intraarterial
catheter?
42. Describe an intravascular catheter.

  • usually inserted before induction of anesthesia

  • can be inserted percutaneously or by cutdown

  • can be used for hemodynamic monitoring, administering blood, drugs, or nutrients


43. Intraoperative drainage can be used prophylactically. What can drainage and
decompression assist with?

  • prevent tissue trauma

  • restore organs to normal function


44. In gastrointestinal decompression, the anesthesia provider will place a tube into a
patient’s stomach. When the surgeon asks the anesthesia provider to insert a tube, what
are some indications as listed in B&K?

  • decompression of the gastrointestinal tract

  • relief of distention that obstructs the view of the surgical site

  • measurement of blood loss from gastric hemorrhage

  • evacuation of gastric secretions during intestinal anastomosis


45. According to B&K, urethral or ureteral catheters are inserted perioperatively to provide
constant drainage from the bladder or kidneys. What is the purpose for placement?

  • keeps bladder decompressed

  • prevents extravasation of urine into the tissues around the surgical site during and after genitourinary procedures


46. Post-operatively could the balloon of an indwelling catheter control bleeding after a
prostatectomy?
47. Why would drains be placed prophylactically according to B&K? What about
therapeutically?

  • therapeutically: presence of purulent or necrotic material

  • prophylactically: evacuate fluids, blood, or air from a wound or body cavity postoperatively


48. Are drains usually placed “in” the wound? If not, how are they placed?

  • drains are usually placed in a separate small stab wound adjacent to the surgical incision


49. How does a drain enhance wound healing?

  • eliminates fluid accumulation

  • obliterates dead space

  • allows apposition of tissues

  • prevents formation of hematomas or seromas

  • prevents tissue devitalization or wound margin necrosis

  • minimizes potential source of wound contamination

  • decreases postoperative pain

  • minimizes scarring


50. What is a cigarette drain?

  • drains fluids by wicking or capillary action via the gauze inside the drain itself

  • drains tissue spaces

  • usually no dressing is used to cover it

  • considered an open drain, meaning it does not require a collection bag



51. Why is a safety pin attached to a Penrose drain that has not been sutured in place? What
is done to the head of the safety pin?
52. According to B&K, a drain may be inserted for drainage by gravity flow from what
organs?
53. Is an active drain attached to an external source of vacuum to create suction in a wound?


54. When is a closed wound suction system used?
55. When can the drainage reservoir be attached?
56. What would a sump drain be used for?
57. If a sump drain is not attached to peripheral suction, can it function as a passive drain?
58. Drainage of the pleural cavity allows ______________ when using a chest drain?
59. After the chest tube(s) are inserted, how are they covered until it can be connected to a
sterile closed water-seal drainage system?


60. What does the water do in a closed water-seal drainage system?
61. Where is the collection unit kept in relation to the patient and why?

62. While getting ready to transport the patient with a chest tube and collection device. The
surgeon requests an instrument to occlude the chest tube. What type of clamp would you
use? What type of clamp would not be used?
63. Under Patient Care Considerations, what is #3?


References:
Alexander’s pages: 259 Start at Drains; Stop at Key Points
AST pages: 266 – 269 Start at Catheters, Tubes and Drains; Stop at Irrigators and Syringes
B&K pages: 524 - 525 intravascular cannulation / intravascular catheters; pages: 584 – 588
Start at wound management, stop at dressings
Lecture Slides: – Review any slide with a brain