00:00
So, now you know what a T-tube is, where we place it,
and what you should be watching for when caring for this patient.
00:06
But what happens when we send a patient home with a T-tube?
Well, we actually do that. The T-tube can be left in place for several weeks
because it may take that long for the duct to heal.
00:18
So, when does this thing come out of my body, your patient may ask you?
Well, that's a fair question.
00:24
The duct has to heal and the healthcare provider would do a chest x-ray.
00:28
They'll take a look and make sure the duct is healed
and there are no more stones before they take the T-tube out.
00:34
You wanna be sure once it comes out, there's no reason to ever put one back in.
00:39
For most people, a T-tube is not connected to a drainage bag by the time they leave the hospital.
00:44
So, they're just gonna be capped off.
00:46
But remember, educate them the same thing you're looking for in the hospital,
you want them to watch for at home.
00:53
Now, the likelihood of this happening at home hopefully is small,
but you always want patients to be aware.
00:59
Look for signs of the tube not functioning, if you've got sudden abdominal pain, nausea, chills, fever.
01:05
I know we keep repeating that over and over again because we want to help you study.
01:10
We wanna make sure you're very clear on the dangerous sign for a patient after a cholecystectomy procedure.
01:17
Now, if the T-tube has a bag, you see I've got that over on the right for you.
01:22
If the T-tube is closed or clamped off, I've got the instructions on the left.
01:26
So, this is the most common one. Let's start without one.
01:29
If a T-tube is just closed or capped off,
it's the most common way patients are discharged after an open chole.
01:36
Remember, that drainage should be down to a pretty minimal level.
01:40
Now, you want the patient to know how to flush it.
01:42
1-2 times a day with 20 mL of sterile saline. Why are they doing that?
Well, we wanna make sure that T-tube stays open so things can flow.
01:52
So, you're gonna have to teach the patient how to clean the cap
and the end of the tube with alcohol before they inject the saline.
01:59
It's fairly simple, but remember, you're a nurse. This is a patient in their own body.
02:04
So, take time with them, show them how to do it,
and then ask for a return demonstration.
02:10
That's the most effective way to teach a patient a new skill.
02:13
Now, what if you happen to have a patient who goes home with a T-tube connected to the bag?
This may happen to you occasionally.
02:21
The bag will need to be emptied at least twice a day.
02:24
Kind of like how often we flush the tube.
02:26
Now, if the patient needs it more often, that's something you need to be aware of.
02:30
So, you wanna encourage the patient.
02:32
Hey, if you're having to empty this more than twice a day, you need to contact your healthcare provider.
02:37
Okay, most patients go home with just a cap, but if they go home with a bag,
you're gonna have to do a little extra special teaching to show them what to do.
02:45
So, first, you're gonna instruct them.
02:47
They're gonna wash their hands, then they're gonna take the closure
or the cap at the bottom of the bag, open it.
02:52
They're gonna drain the fluid into a measuring cup.
02:55
Now, you're gonna send them home with a special measuring cup in mL.
03:00
You don't want them grabbing something from the kitchen to measure their fluid.
03:03
Now, encourage the patient to record the amount of fluid each time they empty the bag.
03:08
They'll share this information with the healthcare provider on their very next visit.
03:12
After they've drained the bag, they replace the closure on the bottom of the bag,
wash their hands again, that's it. It's really just that simple.
03:20
I want you to understand how we take care of the T-tube dressing in the hospital
and so you will know how to explain to patients when they go home.
03:29
Now, you'll change the T-tube dressing every day or if it becomes wet or soiled.
03:34
Remember, we don't want to have wet right next to the skin because that can encourage skin breakdown.
03:40
So, in the hospital, we're changing it likely once a day,
keeping an eye on it if it gets wet or soiled. Same thing when your patient goes home.
03:47
They're gonna also need to change this very simple dressing once a day or if it ever gets wet or soiled.
03:54
So, walk them through the process.
03:56
Tell them, first, you have to wash your hands, then you're gonna take off the old bandage,
and then wash your hands again.
04:02
Then they can take a cotton swab or they can take some gauze
and they can dip it some normal saline or hydrogen peroxide.
04:10
Then they're gonna gently cleanse around the incision tube site.
04:14
So, what they're gonna do is move right from the cleanest,
right around the tube, and circles outside around that tube.
04:20
So, they can use soap and water, they can use saline, or they can use hydrogen peroxide,
but after they're done, they need to pat it dry with a clean gauze.
04:31
Remember, you don't want wet skin underneath that dressing.
04:35
Now that you've got it cleaned, put the new bandage on the incision and the tube site.
04:39
You're good to go. Just make sure the bandage is large enough to cover the whole incision area.
04:45
Tape the bandage in place, you're all done.