JP Drain Hemovac CHECKLIST

Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
COLLEGE OF HEALTH SCIENCES
__________________________________________________________________________________________________________________________________________________
Name of Student: ___________________________ Grade: ___________________
Year & Section: _______________________ _____ Date: ____________________
PROCEDURE CHECKLIST
CARING FOR A JACKSON PRATT DRAIN
Instruction: Below is the grading scale which will be used in rating your performance.
5 - Excellent - 95-100
4 - Very Satisfactory - 88-94
3 - Satisfactory - 82-87
2 - Fair - 76-81
1 - Needs Practice - 70-75
ASSESSMENT
 Check doctor’s order on the notes
 Assess for the need to drain fluids.
PLANNING
 Wash hands and put on gloves if necessary.
 Plan for any assistance you may need.
 Gather equipments needed (Collection container, alcohol pads, gauze)
IMPLEMENTATION
PROCEDURE Done Not

Done
1. Review the physician’s order for drain and site care or the
NCP related to drain care.
2. Gather the necessary supplies.
3. Identify the patient. Explain the procedure to the patient.
Inquire about any known allergies, specifically related to
the products being used for wound care.
4. Perform hand hygiene.
5. Close the room door or curtains. Place the bed at an
appropriate and comfortable working height.
6. Assist the patient at a comfortable position that provides
easy access to the drain area. Use a bath blanket to cover
any exposed area other than the drain.
7. Put on clean gloves, don mask or face shield if indicated.
8. Place the graduated collection container under the outlet
valve of the drain. Without contaminating the outlet valve,
pull the cap off. The chamber will expand completely as it
draws in air. Empty the chambers contents completely into
the container. Use the alcohol pad to clean the chamber’s
spout and cap. Fully compress the chamber with one hand
and replace the plug with your other hand.
9. Check the patency of the equipment. Make sure the tubing
is free from twists and kinks.
10. Secure the JP drain to the patient’s gown below the
wound, making sure that there is no tension on the tubing.
11. Carefully measure and record the character, color and
amount of drainage. Discard the drainage according to
facility policy.
__________________________________________________________________________________________________________________________________________________
12. If the drain site has a dressing, redress the site.

13. If the drain site is open to air, observe the sutures that
secure the drain to the patient’s skin. Look for signs of
pulling, tearing, swelling, or infection of the surrounding
skin.
14. Gently clean the suture with gauze pad soaked in a normal
saline. Dry with a new gauze pad.
15. Remove gloves and all remaining equipment, place the
patient in a position of comfort with side rails up and bed In
the lowest position, and perform hand hygiene.
16. Record the procedure, your wound assessment, and the
patient’s reaction to the procedure using your institution’s
guidelines.
REMARKS:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Date & Time: __________________________

Clinical Instructor: ______________________
__________________________________________________________________________________________________________________________________________________
Name of Student: _____________________________ Grade: _________________
Year & Section: ____________________________ Date: ____________________
PROCEDURE CHECKLIST
CARING FOR HEMOVAC DRAIN
2 - Fair - 76-81
ASSESSMENT
 Check doctor’s order on the notes
 Assess for the need to drain fluids.
PLANNING
 Wash hands and put on gloves if necessary.
 Plan for any assistance you may need.
 Gather equipments needed (Collection container, alcohol pads, gauze, normal
saline)
IMPLEMENTATION
PROCEDURE Done Not

DOne
1. Review the physician’s order for drain and site care or the
NCP related to drain care.
2. Gather the necessary supplies.
3. Identify the patient. Explain the procedure to the patient.
Inquire about any known allergies, specifically related to
the products being used for wound care.
5. Close the room door or curtains. Place the bed at an
appropriate and comfortable working height.
6. Assist the patient at a comfortable position that provides
easy access to the drain area. Use a bath blanket to cover
any exposed area other than the drain. Place a water proof
pad under the drain site.
7. Put on clean gloves, don mask or face shield if indicated.
8. Place the graduated collection container under the pouring
spout the drain. Without contaminating the outlet valve,
uncap the valve. The chamber will expand completely as it
draws in air. Empty the chambers contents completely into
the container. Use the alcohol pad to clean the chamber’s
spout and cap. Fully compress the chamber by pushing the
top and bottom together with your hands. Keep the device
tightly compressed while you reinsert the plug.
9. Check the patency of the equipment. Make sure the tubing
is free from twists and kinks.
10. Secure the Hemovac drain to the patient’s gown below the
wound, making sure that there is no tension on the tubing.
__________________________________________________________________________________________________________________________________________________
11. Carefully measure and record the character, color and

amount of drainage. Discard the drainage according to
facility policy.
12. If the drain site has a dressing, redress the site.
13. If the drain site is open to air, observe the sutures that
secure the drain to the patient’s skin. Look for signs of
pulling, tearing, swelling, or infection of the surrounding
skin.
14. Gently clean the suture with gauze pad soaked in a normal
saline. Dry with a new gauze pad.
15. Remove gloves and all remaining equipment, place the
patient in a position of comfort with side rails up and bed In
the lowest position, and perform hand hygiene.
16. Record the procedure, your wound assessment, and the
patient’s reaction to the procedure using your institution’s
guidelines.
REMARKS:
_________________________________________________________________
Date & Time: __________________________

__________________________________________________________________________________________________________________________________________________
Name of Student: _____________________________ Grade: _________________
Year & Section: ____________________________ Date: ____________________
PROCEDURE CHECKLIST
CARING FOR PATIENT FOR LUMBAR PUNCTURE
2 - Fair - 76-81
ASSESSMENT
1. Verify type of procedure scheduled, purpose, and procedure site with patient and
medical record.
2. Verify that informed consent was obtained before administering any analgesia or
antianxiety agents.
3. Review medical record for contraindications.
PLANNING
1. Expected outcomes following completion of procedure:
2. Explain steps of skin preparation, anesthetic injection, needle insertion, position
required.
3. If ordered, premedicate for pain 30 minutes before procedure.
IMPLEMENTATION
PROCEDURE Done Not

Done
1. Identify patient using two identifiers
3. Set up sterile tray or open supplies to make accessible
for health care provider.
4. Take “Time-Out” to verify patient’s name, type of
procedure scheduled, and procedure site with patient
and health care team.
5. Help patient maintain correct position. Reassure patient
while explaining procedure
6. Position in lateral recumbent (fetal) position with head 0
and
neck flexed
7. Explain to patient that pain may occur when lidocaine
(local anesthetic) is injected into tissues. Pressure may
also occur when tissue or fluid is aspirated.
8. Physician applies sterile gloves, mask, gown, and
goggles; cleans patient’s skin with antiseptic solution;
and drapes site with sterile drape.
9. Physician injects local anesthetic and allows time for
anesthesia to occur.
10. Physician inserts needle or trocar into spinal space or
__________________________________________________________________________________________________________________________________________________
body cavity involved

11. Nurse assesses patient’s condition during procedure,
including respiratory status, vital signs if indicated, and
any complaints of pain
12. Note characteristics of aspirate:
Record opening pressure; observe fluid for color,
cloudiness, or blood.
13. Properly label specimens in presence of patient and
transport to laboratory in proper containers. Label
specimens in order of collection
14. Physician removes needle/trocar and applies pressure
over insertion site until drainage ceases. If necessary,
help with direct pressure and application of gauze
dressing.
15. All team members in procedure remove protective
equipment, discard in appropriate receptacle, and
perform hand hygiene
REMARKS:
______________________________________________________________________
______________________________________________________________________
Date & Time: _________________________


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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Name of Student: _________ Grade: _

Year & Section: _____________________ _ Date: __________________

CARING FOR A JACKSON PRATT DRAIN

PROCEDURE Done Not

12. If the drain site has a dressing, redress the site.

Date & Time: __________________________

Name of Student: _____________ Grade: _

Year & Section: ________ Date:

CARING FOR HEMOVAC DRAIN

PROCEDURE Done Not

11. Carefully measure and record the character, color and

Date & Time: __________________________

Name of Student: _____________ Grade: _

Year & Section: ________ Date:

CARING FOR PATIENT FOR LUMBAR PUNCTURE

PROCEDURE Done Not

body cavity involved

Date & Time: _________________________

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