O4 · Drain, tube, or line problems
Risk Surgery and intensive care
Definition
Tubes and lines may block, slip out, kink, or be pulled.- Patient movement
- poor securing
- blockage
- kinks
- Pulled-out tube
- no drainage
- leaking
- pain
📋 Scenario
A restless patient with a chest drain and IV lines is about to be turned.
Subjective (S): "I will be careful."
Objective (O): Chest drain and IV line in place; restless; drain tubing not secured; no kinks seen yet; dressing dry.
Assessment tools for this scenario: CP-SURG Post-op & Critical Care Check
Validated scales to consider: RASS, CPOT, Aldrete
**CarePath diagnosis:** Drain, tube, or line problems related to patient movement and poor securing (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Secure tubes. | Secure tubes cannot be dragged, pulled out or kinked during turning or restless movement, which protects the drain and lines. |
| Check they are open. | A drain that is open and draining properly removes air or fluid, and a blocked tube can harm his breathing. |
| Teach the patient not to pull. | When he understands why the tubes matter, he is less likely to pull on them, especially when restless. |
| Keep drainage below the site. | Keeping the drainage system below the site lets fluid and air flow out and stops fluid running back into the chest. |
| Report problems. | Early reporting of kinks, leaks, blockages or displacement allows quick correction before harm occurs so a blocked or displaced drain does not harm the patient. |
**Expected outcomes**
- Drain and lines stay secured with no accidental removal.
- No infection or leakage.
- Patient states not to pull on it.
**Linking the data to the diagnosis**
The patient says, 'I will be careful.' He has a chest drain and an IV line, is restless, and the drain tubing is not secured. No kinks are seen yet and the dressing is dry, so no problem has occurred. This is why a risk statement fits, and it rests on patient movement and poor securing. It is chosen over a tube discomfort statement because no harm or distress is documented. The plan aims for the drain to be secure, no infection or leakage, and for the patient to state he will not pull on it.
CarePath diagnosis
Drain, tube, or line problems related to patient movement and poor securing (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Secure tubes. | Secure tubes cannot be dragged, pulled out or kinked during turning or restless movement, which protects the drain and lines. |
| 2. Check they are open. | A drain that is open and draining properly removes air or fluid, and a blocked tube can harm his breathing. |
| 3. Teach the patient not to pull. | When he understands why the tubes matter, he is less likely to pull on them, especially when restless. |
| 4. Keep drainage below the site. | Keeping the drainage system below the site lets fluid and air flow out and stops fluid running back into the chest. |
| 5. Report problems. | Early reporting of kinks, leaks, blockages or displacement allows quick correction before harm occurs so a blocked or displaced drain does not harm the patient. |
Expected outcomes
- Drain and lines stay secured with no accidental removal.
- No infection or leakage.
- Patient states not to pull on it.
Linking the data to the diagnosis
The patient says, 'I will be careful.' He has a chest drain and an IV line, is restless, and the drain tubing is not secured. No kinks are seen yet and the dressing is dry, so no problem has occurred. This is why a risk statement fits, and it rests on patient movement and poor securing. It is chosen over a tube discomfort statement because no harm or distress is documented. The plan aims for the drain to be secure, no infection or leakage, and for the patient to state he will not pull on it.