Tubes, Catheters And Drains

Surgical tubes, catheters, and drains are used to drain a wound effectively in the postoperative period. Draining wounds can help prevent infections and other related symptoms after surgery. This topic thus becomes very important as it will help you score top ranks in competitive exams like NEET-PG/ FMGE and INICET and help you in hospital postings.

Let us read about these in detail. It is highly recommended that you watch the videos from the surgery subject in the PrepLadder app, as this is a high-yield topic.

Romovac Suction Drain

Structure It is a closed suction drain. It has corrugations. When these corrugations are compressed, suction is created, and only then is the tubing attached. Uses Thyroidectomy Mastectomy Flap & Reconstructive surgery

Jackson-Pratt Drain

It is a closed suction drain. The bulb is pressed to create the suction.  Parts include: Grenade shape bulb  Stopper Flexible tubing  Drainage end  Use: to collect body fluids in post-operative periods.

Ryle’s Nasogastric Tube

• This is a very commonly used equipment for an intern’s/doctor's life.
• This simple tube is life-saving in cases such as perforation and poisoning.
• The ideal position for inserting Ryle’s tube in a conscious patient: Sitting position with neck flexed.
• The ideal position in a comatose patient is a supine position with the neck flexed.
• The required length of Ryle's tube is measured from nose to ear to Xiphisternum.
• Various markings in Ryle's tube will tell you where it can reach the stomach:                                                                                          
• 40 cm- GE junction 
• 50 cm- Body of stomach
• 60 cm- Pylorus 
• 65 cm- Duodenum 

Infant Feeding Tube

Have no marking/shots It is shorter than Ryle’s tube. Used in infants and children Indications: Similar to Ryle's tube in infants, Children

Kehr's T-Tube

• They are used in bile duct surgeries, especially after Choledochotomy. 
  • There is a co-axial blood supply mainly from the inferior direction.
  • Hence, we have to go for a longitudinal incision to perform a choledochotomy. 
  • After the incision, the T tube is inserted, and the repair is done.
  • Here, the T-tube acts as a stent.
  • On the 7^th to 10^th day, a T-tube cholangiogram is done in such patients.
• T-tube is retained for 4-6 weeks in the distal filling defect.

Sengstaken Blakmore Tube   

• It is a double-balloon & Triple lumen tube.
• The most common complication during insertion is aspiration 
• The airway should be protected by endotracheal intubation to avoid this complication.
• It is used to work like a tamponade. 
• For the inflation of the balloon, only air is used as it is easy to inflate and deflate the balloon with air.
• The total amount of air used to inflate the gastric balloon is 300 ml
• Maximum pressure exerted by the oesophageal balloon: 35 to 40 mmHg (maximum)  
• Beyond this pressure, the perfusion stops, and there is ischemia. 
• Every 12 hours, the oesophageal balloon should be deflated.

Uses 

• Used when variceal bleeding is not controlled by medicines alone. 
• To control bleeding during transportation to a higher center.

Minnesota Tube 

• They are used for esophagogastric tamponade therapy (hence, they control bleeding with compression and pressure).
• There are 2 balloons (gastric and oesophageal balloons) and 4 lumens.
• The 4 lumens include gastric balloon port, esophageal balloon port, gastric aspiration port, and oesophageal aspiration port (hence, aspiration can be done below the balloon and above the balloon).
• Aspiration can be done from the stomach and esophagus 
• It helps in aspiration of the content below and above the balloon, so for esophagogastric tamponade therapy, the Minnesota tube is preferred over the Sengstaken tube.

Linton Nachlas Tube 

It has a single (gastric) balloon and 3 lumens. The amount of air used to inflate the gastric balloon is 400-700 ml  Used for treatment of bleeding gastric varices.

Foley's Self-Retaining Balloon Catheter

2-way Foley catheter: Main channel: For drainage of urine  Small channel: For inflating balloon  3-way Foley catheter: Main channel: for drainage of urine

• Made of LATEX - Less irritation & crust formation on prolonged use.
• Capacity of the balloon: 5-50 ml
• 10 ml saline is inflated in the balloon - For self-retaining
• 30-50 ml of saline is inflated in the balloon - For hemostatic compression effect:
  • The balloon is inflated with 30 to 50 ml of saline.
  • We pull the catheter and tape it to the inner aspect of the thigh.
• Outer diameter of catheter in mm = Fr/3 (Fr - French units) 
• For example, if the size of the catheter is 18 French, then diameter = 18/3 = 6mm

Various Sizes of Catheters                  

• In Paediatric patients = 4, 6, 8, 10 
• In Adults Patients = 12, 14, 16, 18 
  • The most commonly used size for males – 16 (orange in color) 
  • The most commonly used size for female - 14 (green in color) 
• These can be remembered using a Mnemonic Grey White GORY Valentine Babe.

Colors of Foley’s Catheter 

Uses of Foley’s Catheter

• To relieve urinary retention 
• To measure urine output 
• For administration of intravesical chemotherapy
• 3 ways catheter - for Irrigation after TURP
• It may be used for supra-pubic cystostomy 

Nelaton's Catheter 

Used for one-time emptying of the bladder during or after surgery  It is also used to determine the amount of urine in the bladder

Fogarty Embolectomy Catheter       

	It is a hollow tube with a balloon at the tip. It is used for embolectomy, as the name suggests. If a freshly formed embolus is present in any vessels, the catheter is inserted, and the balloon is inflated beyond the embolus before being removed.   It is inserted into the blood vessel through a clot and removed by inflating the balloon.

Malecot's Catheter 

It is self-retaining Has an umbrella/flower at the tip. Uses   It is draining of urine from the bladder.  Draining of urine from the kidney via Percutaneous Nephrectomy  Drainage of intra-peritoneal collection  It is also used as an intercostal drain (ICP)

Red Rubber Catheter  

Non-self-retaining urinary catheter (has no balloon) Tip: rounded & blunt  Uses  Temporarily used to drain urine from the bladder  Used to estimate the residual urine

Central Venous Catheter

Uses: Fluid, medication, nutrition administration  The tip of the catheter is situated in the superior vena cava.  Preferred veins Inside Operation Theatre(OT) — Internal jugular Vein Outside OT — Subclavian Vein In acutely injured, critically ill patients:  Femoral Vein Subclavian vein > Internal Juglar vein > Femoral vein: Order of preference. Complication The most common complication of CVC is catheter-related sepsis  The most dangerous complication is pneumothorax

Cannula

• These can be remembered using the Mnemonic (for size) ORG. GREEN PINK BY VIOLET

Chemoport         

Implantable venous access device. The veins used are the internal jugular vein and the subclavian vein. It is used for chemotherapy administration, as the name suggests.  It is retained for 1 to 2 years. In the chemoport, there are palpation pumps with which we can feel the presence of the septum. The catheter is placed beneath the skin.  Complications associated with insertion and retention: Catheter embolism  Port occlusion  Vascular thrombosis

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