Drain tube care 引流管護理

 “No drain at all is better than the ignorant employment of it”

“When in doubt, drain”

Capillary vs. Tube        /        治療性或預防性

                   Open                                                   Close

        Active           Passive                   Active                       Passive

        Sump               Penrose                        Hemovac                    Foley

                                Silastic tube                 Chest tube T-tube

                                NG tube                      J-P drain                     PCN

        雙向管道               盡量避開手術傷口              穩固的固定               遠離吻合處

        避開無法忍受結蒂組織地區造成Pressure necrosis ：韌帶或血管

        Closed drain for prosthesis

        引流管並不能針對大量的出血引流，術中的止血最重要

移除

        Therapeutic – until subside or Output between 20~50ml/day

理想的引流管

        Soft and smooth pathway                         Separate incision

        Firm enough                                                    Radio opaque

        Wide open wound                                        Straight in pathway

        Dependent position in passive drainage

1.          NG tube

1.  引流胃液及空氣，放置時一定要確定暢通。

2. 併發症：潰瘍、逆流性食道炎、耳下腺炎、咳嗽反應、脫水、中耳炎。

2.          Chest tube

1.  引流積血、水、空氣或開放性胸部傷口，單側全肺切除後不可用，不可與大氣相通。

2.  設計考量：

                             i.                Underwater seal 15cm below and 2cm underwater

                           ii.                Suction apparatus 15-20cm water in negative pressure

3.          Percutaneous drainage (Penrose)

1.  Abscess (gram stain)

2.  Well defined/ nonlobulated abscess

3.  Safe route ;  PT/APTT ;  Antibiotics