I've bee a PCT on an abd tx unit for 2 months now. I figured drains should be emptied as often as possible/reasonable. Some RNs harass me to empty their pts drains when I am doing other things and it's not more than half full or near end of shift, while one told me something different. There is a pt on our unit with an abdominal jumbo JP that fills up less than an hour after you empty it. An RN told me only empty it Q4H to prevent the pt from losing too much albumin. I think the pt was already running low. However, no other RN has found this important even when I tell them what the other RN said. I'm wondering if this is situation specific or if there is a rule of thumb. I'll be asking my unit director, but I was hoping to get more opinions on the subject. This pt also has Alzheimer's and tends to run hyponatremic with confusion varying from mild to severe and aggressive/ anxious. I mention this because he has opened and spilled his JP a few times. Once when he was NPO and I was in the room and asked why he was trying to open it, he told me he thought it was a drink.
Any insight would be appreciated, as drains are something I've been struggling with. I've seen:
hemovac (always seen draining blood from site in orthopedic pts, why aren't JPs and hemovacs interchangeable?)
foley (recently saw foley-bag-bag with bladder irrigation... had to empty it every 30m-2h depending on the flow rate)
peg-tube (what is that draining?)
NG tube-feed or suction (those kind of scare me- I drained one and forgot to turn suction back on when I was done emptying until about 5 min later)
ostomy, fistula ostomy? (didn't assess her abdomen to check, but researched this and believe it is still an ostomy.. pt had tubing running down her pants leg and collection bad was tied to her ankle... when she was NPO it smelled like vomit, whereas when she was eating the odor was like any other ostomy... not sure if there's a connection.)
As far as I can tell, drains can go anywhere there is excess fluid or no other way to release fluid, and what drain/bag the surgeon/RN places is their call, although the amount of fluid putting out narrows it down. I guess my main question with drains is usually, what is that draining and when do you know your pt needs drainage? For example, I've seen distended abdomens where one pt had an NG-tube-suction putting out thicker, slightly chunky green fluid while one had a jumbo JP putting out yellow-orange fluid with occasional clots. Also, with so many bag types and sizes, how do you decide which to use if it is your choice as an RN and your facility carries different types? Is it just personal preference, MD orders, etc.?
Sorry, I'm not sure if this is a dumb thing to be stuck on but I'm a stickler for details. I failed an exam in OB lecture bc I got so caught up on how/why the menstrual cycle lines up with the hormonal cycle and the luteal cycle, I didn't study anything else!
Also please correct me if any terms I've used aren't nursing appropriate, as that is something else I'm struggling with in clinical. Thanks!
Aug 14, '11
Update: I saw two pts with pigtails draining to IV fluid bags. It seems to just be an alternative to a JP...
Sep 11, '11
from what i've learned on the job (i'm a nurse care tech on a rehab unit), wound drains should be emptied at least every shift. we usually empty them at the end of every shift. unless it needs to be emptied more often.
Sep 11, '11
As far as JPs go, the more fluid they collect, the lesser the suction that is applied to the wound. So a full JP will not be pulling very much fluid, while a freshly emptied JP will be pulling a lot more fluid from the wound. If the drains in question are filling up fairly quickly, the nurses may be having you empty them frequently to ensure suction is applied at a more constant rate. Emptying more often also allows you to assess the rate of drainage. Otherwise, there really isn't much of a need to empty drains any more often than once a shift.
Sep 27, '11
I don't know, but I have a horror story.
I don't know HOW it happened but this one patient that had a prostate resection and he had a JP drain. His foley wasn't draining and his JP drain was filling up crazy fast. Like I'd empty it and it would immediately fill up again.
Long story short his bladder was emptying into the JP drain. The doctor was able to fix it there at the bedside with a combination of pulling the foley line taut and flushing out the foley with saline.
I was given kudos from the doc for noticing that something was wrong.
Oct 6, '11
Our q8's are 6am, 2pm, and 10pm.
Obviously our q4's are those plus 10am, 6pm, and 2am.
We empty on q8's unless we know something filling up rapidly or we have specific instructions to do it more often.
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