TUBES AND DRAINS

SURGERY TRANS TEAM 2B 2018

TUBES

Slides and pictures with stars are

actual samples from the upper batch
SURGICAL TUBES
Used to evacuate fluids and/or air and to
instill fluid or air into a body cavity, a
visceral organ or an organ which has its
own internal circulation, such as the biliary
tree and the urinary tract
Placement and management are specific
for each kind of tube
AIRWAY MANAGEMENT
TUBES USED FOR AIRWAY
MANAGEMENT
Oro-nasal airway
Endotracheal Tubes (ET)
o Adult
o Infant/Pediatric
Tracheostomy Tube
o Metal
o Plastic
Chest Tube/ Thoracic catheter
Suction Catheter
A) ORO-NASAL AIRWAY
 A laryngeal mask
airway also known as
laryngeal mask and
supraglottic airway is
a medical device that
keeps a patient's airway
open during anaesthesia
or unconsciousness

Temporary airway
before inserting ET
C) ENDOTRACHEAL TUBES (ET)

Used to assist in airway management

Placed when
o An airway obstruction has occured
o The patient is unable to breath
spontaneously and may need
mechanical ventilation
Provides a route to deliver oxygenated air
from a ventilator
 Consist of a semi-rigid plastic tube
Proximal portion is attached to a standard
size adaptor which can be connected to an
ambu-bag or ventilator tubing
On the distal portion is a cuff which is
inflated to seal off the lower airway to
prevent aspiration
The inflated cuff also provides a seal that
is necessary for mechanical ventilation
 Endotracheal tube by default
refers to the adult type of ET tube.
Adult ET So in the practical exam just write
Endotracheal tube

Infant/
Pediatric
ET
No
inflatable
cuff and
pilot tube
PARTS OF ET
Machine End
Connector

Bevel
Pilot Balloon

Inflatable Cuff / ET Cuff

Patient End
Murphy's eye High volume Low volume
Hole on the lateral side of the Low pressure cuff High pressure cuff
distal end of the ET tube
Designed to allow gas passage if
the bevel lumen is occluded
 Connector

Inflatable cuff
Pilot balloon

Murphys eye
ENDOTRACHEAL INTUBATION
Placement of a flexible plastic tube into the trachea
to:
o Maintain an open airway
o Serve as a conduit through which to administer certain
drugs
Performed in critically injured, ill or anesthetized
patients to:
o Facilitate ventilation of the lungs, including mechanical
ventilation
o Prevent the possibility of asphyxiation or airway
obstruction
INDICATIONS:
1. For supporting ventilation in patient with pathologic
disease:
Upper airway obstruction
Respiratory failure
Loss of consciousness
2. For supporting ventilation during general anesthesia:
Type of surgery:
o Operative site near the airway
o Thoracic or abdominal surgery
o Prone or lateral surgery
o Long period of surgery

3. Patient has risk of pulmonary aspiration

4. Difficult mask ventilation
LARYNGOSCOPE

Blade Handle
INTUBATION WITH LARYNGOSCOPE

ET is inserted with the use of laryngoscope

D) TRACHEOSTOMY TUBES

Inserted through the tracheostomy to

maintain a patent airway
Secured in place by tapes tied around the
neck
Usually placed through tracheal opening
to provide an airway and to remove
secretions from the lungs
 Metal tracheostomy tube

Outer cannula Inner cannula Obturator

Plastic tracheostomy tube

Metal tracheostomy
tube
TRACHEOSTOMY
A surgical opening in the anterior wall of
the trachea just below the larynx
It provides an alternative airway,
bypassing the upper passages.
INDICATIONS:
To provide and maintain a patent airway
To enable the removal of tracheobronchial
secretions
To permit long term positive pressure ventilation
To improve patient comfort
To decrease the work of breathing and
increase volume of air entering the lungs
CRICOTHYROIDOTOMY
 ADULT AMBU (ARTIFICIAL MANUAL BREATHING UNIT)
BAG

Both ET and Tracheostomy tube

can be connected to a bag
valve mask (BVM) and
sometimes known by the
proprietary name Ambu bag,
for manual ventilation.
E) THORACIC CATHETER /
CHEST TUBE
aka Blau drain or intercostal catheter
Used in thoracentesis
Insertion requires a thoracentesis kit which
has a needle connected to a drainage
bottle
Thoracostomy drainage brings back the
negative pressure in the thoracic cavity
 Allows drainage fluid or the release of an
abnormal accumulation of air in the
thoracic cavity
It is connected to a three-way bottle
drainage
Trocar
THORACOSTOMY DRAINAGE
3-way bottle drainage
THORACENTESIS
An invasive procedure to remove fluid or air
from the pleural space for diagnostic or
therapeutic purposes using a cannula, or
hollow needle (thoracentesis needle) carefully
introduced into the thorax generally after
administration of local anesthesia
TRIVIA (Accdg. to DR. MATA): may use
CONDOMS as drainage bags (so may silbi ang
paglalagay ng condoms sa mga wallet ng mga
boys LOL) :p
F) SUCTION CATHETER

Long flexible tubes that are used to

remove fluids (by suction) from the mouth
and airways
It is distinguished by the presence of the
suction-control valve
CONNECTING TUBE
Conduit from which suction instruments
evacuate fluid and debris into a vacuum
canister (suction machine)
It has no special length markings or any distal
end holes
It has a larger diameter size when compared
to NGT. NGT also has special length markings
and holes at the distal end.
 Connecting
Tube

NGT
SUCTION MACHINE
Suction catheter is connected to a
connecting tube and then to a
suction machine
DIGESTIVE SYSTEM/GIT
A) NASOGASTRIC TUBES (NGT)

Aka feeding tube

Primarily inserted for decompression of the
stomach
Types of tubes
o Levin
o Salem Sump
o Dobhoff or Duo
 Used to evacuate secretions and
swallowed air form the stomach
Can be used for diagnosing acid
secretions and presence of blood in the
stomach
Therapeutic:
o Decompression
o Gastric Lavage for prevention of
bleeding
o Gavage (feeding tube)
LEVIN
Aka Adult NGT
Single lumen tube
SALEM SUMP
Double lumen tube
For continuous
drainage of
gastric contents
 DOBHOFF OR DUO
Used when oral feeding is
contraindicated hence for enteral
feeding
With slit at one end
1st tube: balloon
act as anchor

2nd tube:
feeding tube

3rd tube:
aspiration and
lavage tube
PEDIATRIC NGT /
INFANT FEEDING TUBE

Characteristic: with COVER

(plastic tube at its end)
vs. regular NGT Tube
For feeding of low birth
weight infants
Remember: COVER at
the plastic end
No cover but the tube has a small diameter
BLAKEMOORE-SENGSTAKEN TUBE
Used for compression or control
bleeding of esophageal varices
Have a stomach and esophageal portion
Inserted into the esophagus up to the
cardiac stomach
With multiluminal plastic tube with 2
inflatable balloons
o With a balloon that applies pressure
directly on ruptured veins when inflated
BLAKEMOORE-SENGSTAKEN TUBE
Used for decompression of air or
remove excess flatulence
o It facilitates passage of excessive flatus
(presence of abnormal amounts of gas in
the GI tract)
Also used in barium enema diagnostic
use
o A special x-ray of the large intestine,
which includes the colon and rectum)
BLAKEMOORE-SENGSTAKEN TUBE

Gastric content
aspiration openings
B) INTESTINAL TUBES

Long intestinal tubes serve several

purposes:
o Decompression
o Splinting
o Determination of obstruction site
Types of tubes
o Miller-Abbott
o Cantor
MILLER-ABBOTT TUBE
CANTOR TUBE
C) RECTAL TUBE
Same as NGT but
SHORTER
The end of the tube is
immersed at water-filled
kidney basin
Distinguishing char. from
straight catheter is the
blunt end
D) T-TUBE

Used to drain common bile duct during

cholecystectomy
For edema on sphincter of Oddi
GENITOURINARY TRACT
A) STRAIGHT / NELATON CATHETER

Aka Robinson catheter

Single lumen without balloon
Inserted in urethral meatus
Drain urine temporarily
Used for spinal anesthesia when the
patient can not urinate on his own
Used after difficult urination
B) FOLEY CATHETER

Aka 2-way Foley Catheter/ Double Lumen

Catheter/ Indwelling Catheter
Mostly used
2 LUMEN
o 1st Lumen drain urine
o 2nd Lumen for inflation of balloon using sterile
water
To drain urine for longer period and
monitor urine output (measure hourly urine
output)
 Urine drainage port

Bladder opening

Inflatable balloon
Balloon port
C) 3-WAY FOLEY CATHETER

Aka Triple Lumen Irrigation Catheter

Same as Foley catheter but with an addition
of a third lumen which is for infusion of air
irrigating solution
3 LUMEN
o 1st Lumen drain urine
o 2nd Lumen irrigation of fluid
o 3rd Lumen for inflation of balloon using
sterile water
 Used when there is bloody discharge present
Uses:
o For drainage of urine
o For installation of continuous drainage of
fluid especially after surgery like after
prostatic surgery or pubic prostatectomy
o Prevent clotting of blood in urinary tract
o Cystoclysis

TRIVIA:

Silicone made: can be used up

to 1 month
Rubber made: used only by
not more than a week
D) URETERAL CATHETER

For diagnostic purposes

Inserted into the ureter to help drain urine
Inserted at the ureteral opening
o Landmark: TRIGONE in the urinary bladder
Inserted by using Cytoscope/Bladder
scope to locate the bladder
 If there is obstruction of ureter: use BOUGIE
to dilate the ureter (so as to insert the ureteral
catheter)
Used in retrograde pyelography
o Radiologic study of the kidney, ureters and usually
the bladder, performed with the aid of a contrast
agent
URINE DRAINAGE BAG
URIMETER
To measure
urine
accurately
INFUSION/VENOCLYSIS
A) IV SET / VENOSET / VACOSET
(MACRODRIP)
Large valve
B) IV SET (MICRODRIP)

Small Steel Valves

Small Steel Valves
C) BLOOD TRANSFUSION (BT) SET
Note: Do NOT write BT set with filter Distinct feature: FILTER
D) SOLUTION SET / SOLUSET

For accurate
infusion of
fluid/medication
Larger than the
BT filter
E) BUTTERYFLY NEEDLES
Note from 2A-2016: Hindi porket
may pakpak, butterfly needle na.
This is an IV cannula.
F) ANGIOCATHETER / VENOCATH

With case

Without case

Catheter

Needle
G) IV CANNULA
H) SPINAL NEEDLES

Stylet - a thin wire inserted into a

catheter to maintain rigidity or into a
hollow needle to maintain patency
I) CVP CATHETER

Single lumen Double lumen Triple lumen

J) 3-WAY STOPCOCK

Used to direct the flow of fluid

K) SWAN GANZ CATHETER

Use: To measure PCWP (Pulmonary

Capillary Wedge Pressure), preventing
fluid overload
Sites
o Internal Jugular vein
o Subclavian vein
o Femoral vein
DRAINS

Slides and pictures with stars are

actual samples from the upper batch
SURGICAL DRAINS
Drains are inserted to:
o Evacuate establish collections of pus, blood or
other fluids (e.g. lymph)
o Drain potential collections
SURGICAL DRAINS
Arguments for their use include:
o Drainage of fluid removes potential sources
of infection
o Drains guard against further fluid collections
o May allow the early detection of anastomotic
leaks or hemorrhage
o Leave a tract for potential collections to drain
following removal
SURGICAL DRAINS
Arguments against their use include:
o Presence of a drain increases the risk of
infection
o Damage may be caused by mechanical
pressure or suction
o Drains may induce an anastomotic leak
o Most drains abdominal drains infective within
24 hours
 Drains can be:
o Open or closed
o Active or passive
Drains are often made from inert silastic
material
They induce minimal tissue reaction
Red rubber drains induce an intense tissue
reaction allowing a tract to form
In some situations this may be useful (e.g.
biliary t-tube)
OPEN DRAINS
Include corrugated rubber or plastic sheets
Drain fluid collects in gauze pad or stoma bag
They increase the risk of infection

CLOSED DRAINS
Consist of tubes draining into a bag or bottle
They include chest and abdominal drains
The risk of infection is reduced
ACTIVE DRAINS (Jackson Pratt drain, Hemovac
drain, etc)
Maintained under suction
They can be under low or high pressure

PASSIVE DRAINS
Have no suction
Function by the differential pressure between body
cavities and the exterior
A) PENROSE DRAIN

Classification: Open and Passive

Soft , tubular rubber tube

Have no suction
Function by the differential pressure
between body cavities and the exterior
B) CIGARETTE DRAIN

Classification: Open and Passive

Drain with wick (gauze)
A cigarette-shaped gauze wick enclosed in
rubber dam tissue or rubber tubing for
draining wounds
C) SUMP DRAIN

Classification: Open and Passive

Drain within a drain
Consisting of a smaller tube within a larger tube
through which fluid passes as a result of suction
The outer tube has multiple perforations that allow
fluid and air to pass into its interior and be carried
away through the suction tube
Drains by gravity
A lumen is the space inside a tube that allows for
maximal fluid removal with the simultaneous flow of air
to the area
D) JACKSON-PRATT DRAIN

Classification: Active and Closed

aka JP drain or Bulb drain

Used to pull excess fluid from the body through
continuous suction
Usually after mastectomy
 Tube

Drainage holes Drainage tube

Stopper / Emptying cap

Emptying port

Collection reservoir / Drain

bulb
E) COLOSTOMY / STOMA BAG

Also called ostomy pouching system

Provides a means for the collection of waste
from a surgically diverted biological system
(colon, ileum, urinary) and the creation of a
stoma
Associated with colostomy, ileostomy, and
urostomy
 Skin barrier,
Wafers or baseplates
(adhesive part)

Pouch
F) URINE DRAINAGE BAG
G) HEMOVAC

Classification: Active and Closed

A round drain, with springs inside that needs to
be compressed to establish proper suction
H) ASEPTO SYRINGE

Usually used in lavage

Used as suction
 SUMMARY OF DRAINS

PASSIVE AND OPEN ACTIVE AND CLOSED

1. Penrose 1. Jackson-Pratt
2. Cigarette 2. Hemovac
3. Sump
4. Stoma