Please help. Tomorrow I will be assigned to a patient with orders to flush the T-tube with 5 cc normal saline. The order reads "flush forward only." Forward? Which direction is this? After I unscrew the two parts of the drainage tube, do I flush the smaller tube (the other end would be in the patient), or do I flush the larger tube (the other end would be in the drainage bag)? This situation does not occur too often in LTC. Thanks!

Blondie,

Although I am not yet in nursing school I do have some knowledge when it comes to tube feeding. My fiancee had one put in shortly before he passed away and while in the hospital I watched the nurses do many things with the tube. I can't guarantee you that I am 110% sure of my answer but I feel very confident in my information. I'm not sure about the "flush forward" part but with my fiancee they would unscrew the two ends and flush the tube that is in the patient. They did this quite often after he got the tube inserted to make sure that his stomach was absorbing the "food" properly. I'm not really sure if this answered your question but if not I'm really sorry. I just thought I'd offer what information I do know. Good luck tommorow.

Kimberly

The only T-tube I know of is inserted into the common bile duct to drain bile after someone has had a cholecystectomy with common bile duct exploration. I've seen them come from the wound with the external end connected to a bile bag (drainage bag). I've never seen orders to flush them.

Would the order to "flush forward only" mean to flush with 5 cc saline, but not to pull the saline back out? In other words, flushing, but not aspirating?

I'm probably way off on this because the tube you describe sounds different from what I've seen. Is this tube a feeding tube? Will be watching to see if I can learn something here, too!

We always flush bile drainage tubes. We attach the tube to the drainage bag with a stopcock and usually flush 5cc towards the patient and 5cc towards the bag. If I had to guess I would say that flushing foward is towards the bag.

My questions are the same: where is the tube and what is its purpose? My take on this (IF it's a T-tube in the bile duct) is different, researchRN. We're usually the ones to put the tubes in (Radiology Nurse here), and do T-tube cholangiograms on ones that surgery leaves in. IMHO, "flush forward" is flushing thru the tube, toward the pt, to keep the tube patent/free of "gunk," so it will continue to drain what it's spozed to. I agree that "flush" is flush only, not irrigate (flush and pull fluid back out). I would get clarification from other staff members who have done it (not always 100% fool-proof even at that), or get clarification from the MD. Always a learning experience! :) :) Let us know. -- D

For clarification, it's a t-tube for biliary drainage. I asked a couple of other nurses last night, and there was some confusion. The frst nurse said she didn't know, and the second nurse said she flushes toward the patient because that's what she was told to do by yet another nurse. She said she was concerned that she might be flushing unwanted stuff back into the patient, but that's what she was told to do. In my mind, "forward only" means with the flow of drainage, and that would be away from the patient. I'm on my way in now, so, hopefully, I'll find out.

I have one of these in place. I have had it since september. You need to flush 5cc in to the paitent slowly. Do not draw back at all it could be fatil. Bile will leak out the tube when you disconnect it so be prepared. If the saline shoots back out after you remove syringe there is a blockage. Report that asap.