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T-tube Care at Discharge (Nursing)

by Rhonda Lawes

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      Slides Gallbladder Cholecystectomy.pdf
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    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.


    About the Lecture

    The lecture T-tube Care at Discharge (Nursing) by Rhonda Lawes is from the course Gallstones and Cholecystitis: Treatment (Nursing) (quiz coming soon).


    Author of lecture T-tube Care at Discharge (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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