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Device-Related
Complications

Recognizing and managing problems with NG tubes, Foley catheters, and surgical drains.

NCLEX-RN

What Are Indwelling Devices?

Indwelling devices are tubes inserted into the body to drain, feed, or monitor. They improve care but carry risks if they become blocked, dislodged, or a source of infection.

Three Common Devices

NG Tube
Nose to stomach. Drains gastric contents (decompression) or delivers feeds/meds.
Foley Catheter
Urethra to bladder. Drains urine continuously into a closed collection bag.
Surgical Drain
Removes fluid/blood from a wound or cavity (e.g., Jackson-Pratt, Penrose).

Anatomy of a Closed System

Body Cavity / Bladder Patent Tubing Collection Bag Keep bag BELOW insertion site to use gravity

The Core Rule

Think of patency as a balance. Drainage out must keep pace with what is being produced:

$$\text{Output rate} \;\geq\; \text{Production rate}$$

When \( \text{Output} < \text{Production} \), fluid backs up: think distension, leakage, or pain.

Recognizing Obstruction

1
No output when output is expected (empty bag, no drainage).
2
Distension or fullness at the site (bladder, abdomen).
3
Leakage around the tube (fluid finding another path).
4
New pain or pressure the patient did not have before.

Dislodged vs. Occluded

Dislodged (out of place)
Tube has moved or fallen out. NG: verify placement before use. Foley: do not force back in. Drain: cover site, notify provider.
Occluded (blocked)
Tube is in place but not flowing. Check for kinks, clots, or dependent loops; reposition or irrigate per order.

Troubleshooting Steps

1
Look at the patient. Vitals, comfort, distension, breathing.
2
Trace the tubing. Check for kinks, clamps, dependent loops, and that the bag is below the site.
3
Verify placement (NG: pH/x-ray per policy) before instilling anything.
4
Intervene or escalate. Reposition, irrigate per order, or notify the provider.

Example: Foley with No Output

A patient has a Foley but the bag has had no urine for 2 hours. The patient reports lower abdominal pressure.

If patent and still no output, suspect true oliguria: assess intake, vitals, and notify provider.

Example: NG Suddenly Stops Draining

An NG tube to suction stops draining and the patient develops nausea and abdominal distension.

1
Check suction is on and tubing is not kinked.
2
Verify placement, then irrigate with saline per order.
3
If still blocked, notify provider; distension means stomach contents are backing up.

Example: JP Drain Output Change

A Jackson-Pratt drain that was draining serosanguineous fluid now drains bright red blood with rising volume.

Expected: drainage decreases and lightens over days. Reverting to brighter, heavier output is abnormal.

Common Mistakes

✕ Bag above the site
Hanging a Foley or drain bag above the insertion site causes backflow and infection risk.
✕ Instilling without placement check
Feeding/meds into an unverified NG tube can go to the lungs: aspiration risk.
✕ Forcing a dislodged tube
Never push a fallen Foley or drain back in. Cover and notify the provider.

Watching for Infection

Local Signs
Redness, warmth, swelling, purulent drainage, or foul odor at the insertion site.
Systemic Signs
Fever, chills, elevated WBC, cloudy/foul urine (CAUTI), or new confusion in older adults.

Device Summary

NG Tube Foley Drain
Main riskAspirationCAUTIBleeding
Verify firstPlacementPatencyOutput color
If blockedIrrigate per orderCheck kinksMilk per order
Red flagDistensionNo urineBright red ↑

Question 1 of 5

A Foley bag has had no urine output for 90 minutes. What should the nurse do first?

Question 2 of 5

Before instilling medication through an NG tube, the nurse must first:

Question 3 of 5

A JP drain changes from light pink to bright red with increasing volume. This most likely indicates:

Question 4 of 5

To reduce the risk of a catheter-associated UTI (CAUTI), the nurse should:

Question 5 of 5

A surgical drain is accidentally pulled out during repositioning. The nurse should:

Key Takeaways

1
Patient first, device second: judge complications by their effect on the patient.
2
Check reversible causes first: kinks, position, clamps, and bag height.
3
Verify NG placement before instilling; never force a dislodged tube.
4
Maintain closed systems and use aseptic technique to prevent infection.