keep the drainage system at the level of the heart
report foul order and purulent drainage to the health care provider
remove the tube when drainage slows to less than 50 mL every 8 hours
do not clamp or irrigate the T-tube without orders from the health care provider
clamp the tube before meals and observe the client for abdominal distention or discomfort
Numbers 2, 4, and 5 are correct.
Rationale: Foul odor and purulent drainage should be reported, along with sudden increases in output. The T-tube should not be irrigated, clamped, or aspirated without an order. The tube should be clamped prior to meals. If nausea or vomiting occur, unclamp the tube. The drainage system should be kept below gallbladder level. The tube should not be removed without an order. The nurse should chart the amount, consistency, color, and odor of any drainage.
