Daily management of discharging patients with severe acute pancreatitis with tube Placement of drainage tube for effective drainage is the soul of treatment of severe acute pancreatitis, especially in the stage of pancreatitis co-infection, its role is more prominent. However, according to the pathophysiological characteristics of severe acute pancreatitis, the treatment of pancreatitis is characterized by the placement of many drains, long duration of drains, easy recurrence of the disease, the need for repeated puncture and placement of drains, and the need for longer time for rehabilitation exercises. Correct and thoughtful drainage tube management plays an important role in improving the treatment effect of severe acute pancreatitis. The daily management of drains in patients with severe acute pancreatitis in our department is summarized to facilitate the standardized treatment and care of patients with drains after discharge and to promote early extubation and rehabilitation.
1.Pointer for drainage placement
According to the different purposes of drainage, drainage is divided into therapeutic drainage and prophylactic drainage. The pointers of therapeutic drainage in severe acute pancreatitis are often fluid, gas, pus, intestinal fistula, pancreatic fistula and pancreatic necrotic tissue in the abdominal cavity, etc. Preventive drainage is often used for close condition monitoring and setting observation windows to facilitate timely observation of changes in the condition.
2.Pointer for drainage extraction
The pointers for withdrawal of drainage are: drainage flow gradually decreases or disappears, there is no obvious change in the shape of drainage fluid, no purulent fluid is drained out, the patient’s general condition improves, there is no chills and fever, abdominal pain, increased blood count and other signs or symptoms of infection, there is no obvious exudate around the sinus tract; imaging examination indicates complete drainage of peripancreatic abscess, there is no encapsulated fluid, pus or blood, there is no pancreatic fistula intestinal fistula and bile duct patency on imaging examination.
3. Daily management of patients discharged with tubes for pancreatitis
Management of double trocars in the abdomen.
A. Ensure that the double trocars are in place and replace the fixation tape or 3M tape in time to prevent the double trocars from being dislodged.
B. Ensure that the negative pressure device is effective, and it is usually necessary to purchase a negative pressure vacuum machine at the time of discharge to adjust the appropriate negative pressure value and ensure that the drainage bottle is airtight to prevent insufficient negative pressure caused by air leakage.
C. Ensure that the double cannula works effectively, distinguish between water intake and negative pressure suction channels, and keep them open, and intermittently move the negative pressure inner cannula to ensure that there is no necrotic tissue blockage at the head end.
D. Change the external flushing bag in time to prevent dry suction.
E. Observe whether there is any change in the shape of drainage fluid, and calculate the amount of drainage in and out if necessary. If there is any change in the nature of the drainage fluid or the drainage volume, you need to contact the doctor in charge for consultation in time.
Management of abdominal pigtail tube.
A. Ensure that the pigtail tube is in place, and replace the fixation tape or 3M tape in time to prevent dislodgement.
B. Ensure smooth drainage. The use of pigtail tubes in our department is divided into simple drainage and co-drainage.
C. Simple drainage means that the drainage tube only drains one regional pus cavity and there is no other outlet for this pus cavity, which needs to be flushed and drained in the early stage and can be passively drained after the necrotic tissue is reduced in the later stage, but it is necessary to ensure the patency of the drainage tube, and the conventional method is to connect the tail end of the drainage tube with the drainage bag directly to the rubber tube and give intermittent squeezing to the rubber tube to promote the drainage of the pus cavity to keep the pipeline patency.
D. Cooperative drainage refers to the same drainage area with more than or equal to two drainage devices, usually these drainage tubes are interoperable and need to be intermittently connected with external flushing water for flushing in daily management to achieve the purpose of scrubbing, diluting pus, promoting thorough drainage of pus cavity and promoting the growth of granulation of pus cavity wall. When flushing, one inlet can be used and other drainage tubes can be used to drain the pus, and each drainage tube can be used alternately. If the flow rate of flushing and drainage fluid is slow, the drainage tube can be moved slightly (<2cm). When flushing need to pay attention to observation, to ensure that the drainage is smooth, to achieve "in and out, in and out of balance".
E, pay attention to observe the shape of the drainage fluid has not changed, if necessary, need to calculate the amount of drainage in and out. If there is any change in the nature of drainage fluid or drainage flow, you should contact the doctor in charge for consultation in time.
Out-of-hospital management of red catheter drainage tube.
A. Ensure the red catheter is in place and replace the fixation tape or 3M tape in time to prevent dislodgement.
B. Ensure smooth drainage, the use of red catheter drainage tube in our department is divided into simple drainage and co-drainage; the specific management method is the same as pigtail drainage tube.
C. Replacement of red catheter drainage tube is often late in the course of the disease, the sinus tract is basically mature, and the drainage tube can be moved more substantially during flushing to achieve the maximum drainage effect, but it is necessary to ensure that the position of the tube remains unchanged before and after flushing.
D. Pay attention to observation when flushing to ensure smooth drainage and achieve “in and out, in and out balance”.
E. Observe whether there is any change in the shape of the drainage fluid, and calculate the amount of drainage in and out if necessary. If there is any change in the nature of drainage fluid or drainage flow, contact the doctor in charge for consultation.
Management of nasogastric tube.
A. The role of nasogastric tube as a nutritional channel for critically ill patients is crucial in the treatment process.
B. The management of nasal-intestinal tube is carried out from two aspects.
First: consider from the nutrition tube itself: keep the tube usually, which requires careful and thoughtful flushing, timely discovery of poor and blockage of the tube, and timely and effective solution. Commonly used flushing solution is warm water, Coca Cola, sodium bicarbonate solution, etc. The flushing frequency is 1 time/hour to 1 time/4 hours; keep the tube in place, intermittently replace the fixed tape, pay attention to the protection of the nasal intestinal tube when moving to prevent pulling, dragging, shifting, etc.; Second: Consider from the nasal feeding technology: carefully choose the nasal feeding nutrition varieties, try to infuse thin and less residue food, because the condition requires infusion of food containing fiber If the condition requires infusion of food containing more fiber and more viscous food, the frequency of flushing should be increased appropriately; try to infuse continuously and uniformly, and if necessary, infuse with enteral nutrition infusion pump; try to avoid infusion of solid particle-like food, filtering before infusion and flushing after infusion; pay attention to the temperature of infused food, the interaction of infused food, the height of suspension of nutrition solution during gravity infusion and other factors.
4.Treatment of complications related to discharge with tube
Complications of abdominal drainage tube are common, such as line dislodgement, blockage, local bleeding, infection, gastrointestinal perforation, intestinal fistula, etc. Generally, the incidence is low, if the above situation occurs, you should immediately go to the nearest hospital for treatment, close observation, and actively contact the bedside doctor for consultation; the main complication of discharge with nasal intestinal tube is line blockage or dislodgement, if the above situation occurs, strengthen the flushing tube, and contact the bedside doctor. The doctor will recommend transgastric nutrition or repositioning of the nasogastric tube according to the condition.
Patients and their family members should be fully aware of it, master it, eliminate the sense of unfamiliarity and fear, and give patients meticulous and thoughtful management outside the hospital to promote the early recovery of the disease.