Protocol For Pancreatic Drain Tube Care

[Jay-Jay, RN]

This week I saw a patient with Ca. of the pancreas. She has a drain tube in place, which the doctor has ordered flushed PRN with normal saline.

Supplies were delivered for this yesterday: a large 500 ml. bottle of NS and a 60 cc. catheter tipped syringe.

I have cared for pancreatic drains before, and I do not feel these supplies are appropriate. The large bottles of NS are for wound care, not for flushing directly into the body. Our standard protocol is to refrigerate the NS after opening, then dump it after 3 days. I have serious concerns about the safety of using this type of NS for flushing her drain. Also, the catheter tip syringe is useless to me, as her drainage bag does NOT have that type of a fitting. There is a luer lock up where the bag's tube joins the drain tube, and what I wound up doing on Friday was drawing up a syringe of the NS we use for flushing IV lines, locking the syringe onto the luer fitting, and flushing. I was also wearing sterile gloves, and had a sterile 4x4 spread out directly underneath the fitting.

What is YOUR company/unit's policy for care of these drains? Also, what type of dressing do you use on them, and how often is it supposed to be changed (assuming no leakage from the insertion site) Do you use a transparent dressing, such as Tegaderm or Opsite, or just cover it over with tape and gauze? (I've seen both...prefer the Opsite, so I can see what's going on with the tube and the skin around it.)

What type of drain tube fasteners do you use? I like the Niko fasteners, though the hospitals tend to use Statloks.

Your feedback is much appreciated! These tubes can be a real pain to care for, and everyone I talk to seems to have a different routine!

[Jay-Jay, RN]

This week I saw a patient with Ca. of the pancreas. She has a drain tube in place, which the doctor has ordered flushed PRN with normal saline.

Supplies were delivered for this yesterday: a large 500 ml. bottle of NS and a 60 cc. catheter tipped syringe.

I have cared for pancreatic drains before, and I do not feel these supplies are appropriate. The large bottles of NS are for wound care, not for flushing directly into the body. Our standard protocol is to refrigerate the NS after opening, then dump it after 3 days. I have serious concerns about the safety of using this type of NS for flushing her drain. Also, the catheter tip syringe is useless to me, as her drainage bag does NOT have that type of a fitting. There is a luer lock up where the bag's tube joins the drain tube, and what I wound up doing on Friday was drawing up a syringe of the NS we use for flushing IV lines, locking the syringe onto the luer fitting, and flushing. I was also wearing sterile gloves, and had a sterile 4x4 spread out directly underneath the fitting.

What is YOUR company/unit's policy for care of these drains? Also, what type of dressing do you use on them, and how often is it supposed to be changed (assuming no leakage from the insertion site) Do you use a transparent dressing, such as Tegaderm or Opsite, or just cover it over with tape and gauze? (I've seen both...prefer the Opsite, so I can see what's going on with the tube and the skin around it.)

What type of drain tube fasteners do you use? I like the Niko fasteners, though the hospitals tend to use Statloks.

Your feedback is much appreciated! These tubes can be a real pain to care for, and everyone I talk to seems to have a different routine!

[dianah, ASN]

Working in Radiology, I've helped put many drains in, but this one sounds like it was placed during surgery. I think you did the right thing, using the gloves, 4X4 and the syringe (with sterile NS) that would fit on the luer lock connection.

You sound like you're headed in the right direction too, to get clarification for flushing procedure for this one.

BTW, we used Statloks in Radiology too. It's walking a fine line, to get a dressing that is easy to use, anchors the tube in place securely yet allows viewing of the exit site. Most securing devices don't give you the best of all worlds. Some of the tubes we placed had a locking device to prevent its being inadvertently pulled out, and others the Radiologist chose to leave unlocked, for safety reasons. Those unlocked ones needed to be secured WELL, so they weren't dislodged. Again, a tough situation.

I'd be interested to hear others' comments on this, and if you were able to get orders clarified. Sounds like the prn order was just to keep the drain from becoming plugged with drainage; seems like a q 8hr order, rather than a prn order, would accomplish this, rather than waiting till the tube was plugged then trying to irrigate it. Just my 2 cents. -- Diana

[dianah, ASN]

Working in Radiology, I've helped put many drains in, but this one sounds like it was placed during surgery. I think you did the right thing, using the gloves, 4X4 and the syringe (with sterile NS) that would fit on the luer lock connection.

You sound like you're headed in the right direction too, to get clarification for flushing procedure for this one.

BTW, we used Statloks in Radiology too. It's walking a fine line, to get a dressing that is easy to use, anchors the tube in place securely yet allows viewing of the exit site. Most securing devices don't give you the best of all worlds. Some of the tubes we placed had a locking device to prevent its being inadvertently pulled out, and others the Radiologist chose to leave unlocked, for safety reasons. Those unlocked ones needed to be secured WELL, so they weren't dislodged. Again, a tough situation.

I'd be interested to hear others' comments on this, and if you were able to get orders clarified. Sounds like the prn order was just to keep the drain from becoming plugged with drainage; seems like a q 8hr order, rather than a prn order, would accomplish this, rather than waiting till the tube was plugged then trying to irrigate it. Just my 2 cents. -- Diana