Chapter 10. Tubes and Attachments
When patients have tubes and attachments to aid in their recovery, health care providers are required to understand the type, purpose, precautions, complications, and interventions to ensure treatment is effective and to prevent patient harm. Each tube and attachment is unique, and the function of the tube, care of the patient, and safety precautions must be understood. This chapter reviewed many common types of tubes and attachments found in the acute and community setting, and reviewed the care and maintenance of nasogastric tubes, indwelling catheters, ostomies, urostomies, chest tube drainage systems, and tracheostomies.
- Specific guidelines and procedures must be followed when working with tubes and attachments to prevent complications from the device.
- Patients with tubes and attachments are more at risk for infection. Take care to maintain sterility of all tubes and ensure device insertion sites stay dry and intact, and all connection points stay intact.
- Be aware of potential complications of each tube and attachment, and prevention strategies. Regularly assess the patient and the device for complications.
- If unfamiliar with a specific device, review all policies and procedures prior to using the device to prevent harm to the patient.
- Know the purpose, type, and special precautions for all tubes and devices that are used in your agency. Complete all training as required.
Suggested Online Resources
- ATI Nursing Education: Airway management. This resource provides information and videos on the types of airway management devices, suctioning (open and inline), and endotracheal and tracheostomy care.
- ATI Nursing Education: Closed chest tube drainage systems. This resource provides information and videos on the types of chest tube drainage systems, how to manage a chest tube, how to manage complications, how to replace a closed chest tube drainage system, and how to change a dressing on a chest tube insertion site.
- ATI Nursing Education: Nasogastric intubation. This resource provides information and videos on the insertion, care, gastric compression, and removal of an NG tube.
- ATI Nursing Education: Ostomy care. This resource provides information on caring for an ostomy and urostomy, draining an ostomy, changing a pouching system, and colostomy irrigation.
- ATI Nursing Education: Urinary catheter care. This resource provides information and videos on the insertion of indwelling and straight catheters, applying a condom catheter, and removing an indwelling catheter.
- Ostomy Canada Society: Library of ostomy information. This is a resource for individuals and their families living with ostomies. The website contains up-to-date information on ostomy care, research, new items, blogs, events, information about ostomy supplies, support and advocacy groups, healthy living tips, and personal journeys and stories about individuals living with ostomies.
ATI. (2015a). Inserting a nasogastic tube. Retrieved from ATI Nursing Education: Nasogastric intubation. http://www.atitesting.com/ati_next_gen/skillsmodules/content/nasogastric-intubation/viewing/insert-naso-tube.html?id=undefined
ATI. (2015b). Tracheostomy care. Retrieved from ATI Nursing Education: Airway management. Retrieved on Aug 24, 2015, from http://www.atitesting.com/ati_next_gen/skillsmodules/content/airway-management/viewing/trach_care.html
ATI. (2015c). Managing complications. Retrieved from ATI Nursing Education. Closed chest drainage. Retrieved on Aug 24, 2015, from http://www.atitesting.com/ati_next_gen/skillsmodules/content/closed-chest-drainage/equipment/managing.html
Bauman, M., & Handley, C. (2011). Chest tube care: The more you know, the easier it gets. Retrieved on Aug 26, 2015, from http://www.americannursetoday.com/assets/0/434/436/440/8172/8174/8176/8256/1d298438-82c6-439d-8b2e-77ffaf165fca.pdf
Berman, A., & Snyder S. J. (2016). Skills in clinical nursing (8th ed.). New Jersey, New York: Pearson.
British Columbia Institute of Technology (BCIT). (2015a). NURS 1186: Patient care for sonography. Vancouver: BCIT.
British Columbia Institute of Technology (BCIT). (2015b). NURS 2020: Clinical techniques. Vancouver: BCIT.
British Columbia Institute of Technology (BCIT). (2015c). NURS 3020: Clinical techniques. Vancouver: BCIT.
Centers for Disease Control and Prevention. (2015). Healthcare associated infections. Retrieved on Aug 26, 2015, from http://www.cdc.gov/HAI/ca_uti/uti.html
Durai, R., Hoque, H., & Davies, T. W. (2010). Managing a chest tube and drainage system. Retrieved on Aug 26, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/20152201
Gogakos, A. et al. (2015). Heimlich valve and pneumothorax. Retrieved on Aug 26, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381465/
Gould, C. V., Umscheid, C. A., Agarwal, R. K., Kuntz, G., Pegues, D. A., & Healthcare Infection Control Practice Advisory Committee. (2009). Guidelines for Prevention of Catheter Associated Urinary Tract Infections 2009. Center for Disease Control. Retrieved on Aug 26, 2015 from www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf
Halm, M. A. (2007). To strip or not to strip? Physiological effects of chest tube manipulation. Retrieved on Aug 26, 2015, from http://ajcc.aacnjournals.org/content/16/6/609.full
Halm, M., & Krisko-Hagel, K. (2008). Instilling normal saline with suctioning: Beneficial technique or potentially harmful sacred cow? American journal of critical care, 17(5), 469-472.
Morris, L. L., Whitmer, A., & McIntosh, E. (2013). Tracheostomy care and complications in the intensive care unit. Retrieved on Aug 26, 2015, from http://www.aacn.org/wd/Cetests/media/C135.pdf
Ostomy Canada Society. (n.d.). Passing gas with an ostomy. Retrieved on Aug 24, 2015, from http://stolencolon.com/passing-gas-farting-ostomy/
Perry, A. G., Potter, P. A., & Ostendorf, W. R. (2014). Clinical skills and nursing techniques (8th ed.). St Louis, MO: Elsevier-Mosby.
Rajan, C. S. (2013). Tube thoracostomy management. Retrieved on Aug 26, 2015, from http://emedicine.medscape.com/article/1503275-overview#a7
Registered Nurses Association of Ontario. (2009). Ostomy care and management. Toronto: Registered Nurses Association of Ontario.
Salmon, N., Lynch, S., & Muck, K. (2013). Chest tube management. Retrieved on Aug 26, 2015, from http://ajcc.aacnjournals.org/content/16/6/609.full
Teleflex Medical Incorporated. (2009). Chest drainage systems. Retrieved on Aug 26, 2015, from http://www.teleflex.com/en/usa/ucd/chest_drainage_systems.php
United Ostomy Association of America. (2011). Ileostomy guide. Retrieved on Aug 24, 2015, from http://www.ostomy.org/uploaded/files/ostomy_info/IleostomyGuide.pdf?direct=1
Vancouver Coastal Health. (2006). Tracheostomy and endotracheal tubes – suctioning. Vancouver: Vancouver Coastal Health.
Vancouver Coastal Health. (2012a). Tracheostomy: Care and management of a patient with a tracheostoma. Vancouver: Vancouver Coastal Health.
Vancouver Coastal Health. (2012b). Tracheostomy tubes: Dressing changes and inner cannula cleaning. Vancouver: Vancouver Coastal Health.
VCH Professional Practice. (2014). Indwelling urinary catheter: Procedure for insertion and removal (adult). Vancouver: Vancouver Coastal Health.