T-tube Care at Discharge (Nursing)

by Prof. Lawes

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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 Prof. Lawes is from the course Gallstones and Cholecystitis: Treatment (Nursing).

    Included Quiz Questions

    1. Flush 1–2x daily with 10 mL saline
    2. Clean the end of the tube with alcohol
    3. Do not flush
    4. Empty the bag daily
    5. Flush daily with tap water
    1. Change the dressing around the T-tube daily
    2. Change the dressing if it becomes wet or soiled
    3. Clean around the T-tube with hydrogen peroxide, normal saline, or soapy water
    4. Change the dressing only when soiled
    5. Scrub the area around the T-tube vigorously

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

     Prof. Lawes

    Prof. Lawes

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