Chest tube insertion (or)

intercostal drainage

Dr. Challa Venkata Rao

 Indications

1. Spontaneous Pneumothorax

2. Tension Pneumothorax.
3. Traumatic Haemothorax.
4. Haemo-pneumothorax.
5. Pleural effusion.
6. Empyema Thoracis.
TERIMA KASIH

THANK YOU
Foley Catheter Placement

Dr. Challa Venkata Rao

 Indications for a Foley Catheter

Obstruction of the urethra : prostate hypertrophy,

prostate cancer, or narrowing of the urethra

Urine output monitoring in a critically ill person

Nerve-related bladder dysfunction, such as after

spinal trauma, or intractable incontinence.

After surgery to monitor urine output

 Contraindications

Use cautiously in patients with a history of pelvic or

perineal trauma associated with perineal bruising
and swelling and/or blood at the meatus

Use cautiously in patients with a history of urethral

strictures or anatomically false passages.
 Procedure

 Put on sterile gloves, if you haven’t already done so.

 Check patency of balloon with saline filled syringe.

 Withdraw saline and leave syringe attached

 Open lubricant. Saturate distal end of catheter

 Procedure

Open the prepackaged Foley packet

Place packet outer container in a convenient location

Place drapes under patient’s hips-plastic side down

Place the fenestrated drape over the patient exposing

only the genitalia
 Procedure

Grasp the penis with your non-dominant hand

Clean the glans in a circular motion, starting at the

urinary meatus and working outwards.

Repeat the procedure two additional times.

 Procedure

 With your dominant hand pick up the lubricated catheter

 Straighten and stretch the penis to create a slight traction

 lift the penis to straighten the urethral canal

 Insert the tip of the catheter into the urinary meatus.

 Advance the catheter 6-8 inches until urine begins to flow.

 Procedure

 When urine stops flowing, inflate the balloon to keep the

catheter in place within the bladder.

 Never inflate the balloon without first establishing urine flow,

which assures you that the catheter has been correctly
inserted into the bladder
 Procedure

Position the collection bag at lower level to prevent

reflux of urine into the bladder and to facilitate gravity
drainage of the bladder.
.
Tape the catheter to the upper part of the thigh.
 Removing the
Indwelling Catheter

Explain procedure to the patient.

Wash hands and don gloves.
Position the patient. .
Attach the syringe to the inflation port on the
catheter tubing, and pull back on the syringe plunger
until all the fluid is aspirated.
Slowly pull out the catheter tubing.
Dispose of the catheter and drainage bag. .
TERIMA KASIH

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 Gastrointestinal Intubation
Nasogastric tubes

Dr. Challa Venkata Rao

 Types of Tubes

Short tubes: passed through the nose into the stomach

 Levin tube: range in size from 14 to 18 Fr, single lumen made of

plastic or rubber with holes near the tip.

 Gastric Sump (Salem): is radiopaque, clear plastic double lumen

 Indications for GI Intubation

To decompress the stomach, remove gas and fluid

To lavage the stomach and remove ingested toxins

To administer medications and feedings

To treat an obstruction and compress a bleeding site

To aspirate gastric contents for analysis

Example of Salem Sump
 Planning

 Explain procedure to client

 Position the client in a sitting or high fowlers
position. If comatose-semi fowlers.
 Examine feeding tube for flaws.
 Determine the length of tube to be inserted.
 Measure distance from the tip of the nose to the
earlobe and to the xiphoid of the sternum.
 Prepare NG tube for insertion.
 Implementation

Wash Hands and put on clean gloves

Lubricate the tube
Hand the client a glass of water
Gently insert tube through nostril to
back of throat (posterior nasopharnyx).
Have client flex head toward chest after
tube has passed through nasopharynx
 Implementation

Emphasize the need to mouth breathe and swallow

during the procedure.
Swallowing facilitates the passage of the tube
through the oropharnyx.
Advance tube each time client swallows until desired
length has been reached.
Do not force tube. If resistance is met or client starts
to cough, choke or become cyanotic stop advancing
the tube and pull back.
 Implementation

Check placement of the tube.

 X-ray confirmation
 Testing pH of aspirate

Secure the tube with a tape.

Nasogastric Tube Position
 Evaluation

 Observe client to determine response to procedure.

 Persistent gagging – prolonged intubation and stimulation

of the gag reflex can result in vomiting and aspiration

 Coughing may indicate presence of tube in the airway.

TERIMA KASIH

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