A penrose drain is a relatively flat, ribbon-like tube that creates a passage from a wound to the open air, which allows any excess fluid to simply flow outward (2). The study aimed to investigate the effect of the educational guidelines on nurses' performance regarding percutaneous nephrostomy tube. Source: www.semanticscholar.org Drains may also be placed to help remove fluid or air from body cavities. Sign up (new users) or Log in (existing users) to complete this course for credit and receive your certificate instantly. To flush the drain itself, a nurse would have to direct the saline toward the patient. Nobody wants to be the one to make that call to the doctor about a malfunctioning drain. Thus, it is important for physicians to work together to determine the appropriate treatment for each patient individually. PY - 2006/3/1/pubmed Lorenz, J. CT is considered the imaging modality of choice because of its ability to fully visualize the infection and surrounding structures as well as provide a pathway from the skin to the destination (9). You may use sterile antimicrobial split gauze if your child is allergic to chlorhexidine or younger than 2 months old. Two of the more common types of surgical drains are the hemovac or JP drain. Often, the physician will write orders to guide nursing staff while caring for these patients. The tip of the pigtail has several holes, which facilitate the drainage process. Pigtail drain tubes are widely used in australian hospitals to facilitate the drainage of body fluids such as urine, blood and bile. Drain) is a flexible plastic tube that is inserted through the chest wall and into the pleural space. The drain should be emptied no later than when it becomes half full, as it will lose suction and become ineffective (2). Drains may also be placed to help remove fluid or air from body cavities. Medical drains can be divided into multiple categories. Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess. A drainage bag is attached. Pigtail cut suture pigtail drain must be uncoiled prior to removal gently remove the drainage bag cut the catheter to release the string the drain in the pigtail formation. Share this article share with email share with. Nurses working in surgical wards should be aware of the design, purpose, care and removal of pigtail drains to reduce the risks of haemorrhage and infection associated with these drains. The drainage from an abscess may also be bloody at first before appearing purulent. If the nurse suspects a new infection of any kind or deterioration, notify the physician immediately. The first step is to review any written orders and become familiar with policies regarding drain flushing. The interventional radiologist uses a special type of drainage tube that is also sometimes called a pigtail. Take a look at the figure below (11). 2011;52(6 . Even with the addition of antibiotics, these situations were associated with significant morbidity and mortality (6). Additionally, sepsis is always a concern for the patient with an abscess (9). official website and that any information you provide is encrypted J Vasc Interv Radiol. If the drain is placed outside surgery, they numb the area where the drain is placed. Note that not all drains are meant to be flushed, especially those that do not contain a flush port and/or three-way stopcock. The most common indications for drains is to evacuate abscesses, infections, and/or excess fluids . Share this article share with email share with. Clean your hands again. Wipe the flush port with an alcohol pad and attach a new, sterile clave, if available. Ensure all connections are tight. This helps make sure the items stay free of germs. Not every infection or fluid collection requires percutaneous drain placement or even surgery. Nursing, 45(9):59-61, 01 Sep 2015 Cited by: 0 articles | PMID: 26287712. Prepare by applying gloves and laying out a clean towel or pad underneath to create a workspace and catch any drainage. Accessibility Data is temporarily unavailable. Empty the drainage bag as directed or as needed and document findings. Moderate to severe leakage can cause skin breakdown and is not normal. https://www.merriam-webster.com/dictionary/percutaneous#medicalDictionary, https://doi.org/10.1016/j.jvir.2009.12.398, https://www.cc.nih.gov/ccc/patient_education/pepubs/jp.pdf, https://www.stjude.org/treatment/patient-resources/caregiver-resources/patient-family-education-sheets/home-care-guidelines/caring-for-a-pigtail-drain.html, https://opentextbc.ca/introductiontosociology2ndedition/. Clipboard, Search History, and several other advanced features are temporarily unavailable. 1 NSW Health: Managing Pigtail Drains Safely. The physician may order imaging to assess the drains location (2). Hospitals or other organizations using this publication as a part of their own orientation processes should review the contents of this publication to ensure accuracy and compliance before using this publication. D'agostino hb, vansonnenberg e, sanchez rb, goodacre bw, casola g. A pigtail drain, also known as a pigtail catheter, is a flexible tube that connects to the genitalia or skin of patients to aid with the draining of waste fluids. Pigtail drain tubes: a guide for nurses. #SARELGAURMD discusses pigtail drainage catheters. On the next day, there was no improvement in the left pneumothorax so it is determined to remove the pigtail catheter. At this point, the switch is facing the flush port, which prevents fluid from exiting or entering. Childhood Cancer Survivor Stories: Meet the Patients, As often as your care team tells you to change it. Throughout the procedure, pictures are taken to ensure correct placement. If I Had Cancer, Will My Children Get Cancer? Show more Show more. Whichever direction the off switch is pointing closes that port so fluid cannot flow. Even though drains may look different, they function in similar ways, thus these considerations can be applied to both surgical and percutaneous drains. HHS Vulnerability Disclosure, Help Take off your sterile gloves. The drain should be emptied when it is approximately 25 percent full to maintain the pressure within the bulb (14). Drains can be intimidating, especially with little to no prior experience in drain management. This can be gently wiped away with clean gauze soaked with normal saline or warm, soapy water (10). Together powered by St. Jude Children's Research Hospital, Bone Marrow / Hematopoietic Cell Transplant, See more side effects of cancer treatment, Learn more about psychology and mental health services, Relapse - When Childhood Cancer Comes Back, Communicating with the Palliative Care Team, Learn how to navigate the healthcare experience, Katie's Story: Building Relationships with Health Care Providers, Learn more about being your own health care advocate, How to Make the Transition from Pediatric to Adult Health Care. The importance of effective catheter securement. Retrieved from. Doctors are now able to drain up to 3 separate abscess/infection sites percutaneously (8). To flush the drain, find the flush port located on the stopcock. 2008 Jul 16-22;22(45):35-8. doi: 10.7748/ns2008.07.22.45.35.c6590. It is an example of a three-way stopcock. Does Blue Cross Blue Shield Cover Laser Hair Removal. Put the label from the dressing kit on the dressing. Get new journal Tables of Contents sent right to your email inbox, Caring for the patient with a PIGTAIL DRAINAGE CATHETER, Articles in PubMed by JANEY BURNS, RN, BSN, Articles in Google Scholar by JANEY BURNS, RN, BSN, Other articles in this journal by JANEY BURNS, RN, BSN, Privacy Policy (Updated December 15, 2022). Again, do not attempt to push the tubing back inside the patient. Principles for inserting and managing chest drains. smeltzer & bares text book of medical surgical nursing. Do not blow on it or fan it. Fluid or pus coming from around the drain. Caring for a pigtail drain. Open each package but leave the items inside until you are ready to use them. It usually forms one of two ways: during initial drain placement or as a result of continued catheter presence (9). This lets fluid drain from your childs body into the bag. The presence of the dye allows the area of concern can be seen with much greater clarity on medical imaging devices. This will close the flush port or turn it off so that drainage cannot leak out. Thanks to advances in modern medicine, suffering patients now stand a chance. Minimal amounts of leakage can be expected because the drain creates a track for small amounts of fluid to escape. your express consent. Read Course | Complete Survey | Claim Credit. The courses provided by NCC are based on industry knowledge and input from professional nurses, experts, practitioners, and other individuals and institutions. In order to get full access, you need to be on campus or log in through your institution (. is the best way to visualize how infections and abscesses change over time. Clinical skills: how to remove and change a suprapubic cathether. Surgery. tube; urine; drainage; nursing; continence; catheter; irrigation; 5-8 ml is usually plenty. Catheters help doctors monitor patient health. Deep pelvic abscesses respond well to percutaneous drainage, although these can be more challenging and require careful planning because of the presence of nearby organs (9). This article outlines the care of pigtail drains as adopted by nursing staff at the Western Hospital in Melbourne, Victoria. ; Contact Us Have a question, idea, or some feedback? Please enable scripts and reload this page. Patients at Western Hospital can safely be discharged home with a pigtail You have requested "on-the-fly" machine translation of selected content from our databases. The pigtail catheters themselves are single use, meaning they are disposed off immediately after use. 2015 Sep;45(9):59-61. doi: 10.1097/01.NURSE.0000470418.02063.ca. Hayes, Diana. You can take care of it by flushing it and changing the dressing. In the example provided, the switch is closed to the patient, meaning that fluid cannot pass into the bag. This technique is generally less invasive (6). PMID: 16502892 No abstract available MeSH terms Catheterization / instrumentation* Once the tube is in place, the wire is removed. Next, turn the off switch so it is pointing toward the flush port, if it isnt already. Hayes D. Pigtail drain tubes: a guide for nurses. You notice a lot of material in the fluid, or the fluid smells bad. A pigtail drain tube (pigtail) is a type of catheter that has the sole purpose of removing unwanted body fluids from an organ, duct or abscess. 2005, V12 (10), 19-20. EP - 20 For more information, please refer to our Privacy Policy. It comes as a long , sterile tube with a locking tip and several holes to aid with the drainage process. Pigtail Drain Tubes: A Guide For Nurses. w6/5WFJm3+JnFi7q8CW5ug==:NljoRY2Sh57DAW0lNFanbEBotOCXO0jq8G43Ewt8Ynuw+fIY+jjXSLm8syd+iFI1M8BF7BpIjmZcELEJ5IBfoU+DJ/rJKd9dB6CdEqAbh82YFeNMnISB4ZVIwzwR/sz/irE9U43ZrkwgHxXU7G3uTXHRCT2LDyHT0sq701nLShkI4a718Isb8sYHLUFul1ywZjvfhJRB++GjQGGd9N6+omE2erFZcYDezsyVpEoNmBSC9te4EeReq5bJJPAlY4IMoMH770KrfAbYl3+yFOp77207H67ZPqKpjgxNaFFgOBqZAtA0F+IOwtNV8iRCAHvLtuw9M8HK4eu/l6DxO9h6BFcqfpdNZCDW3KZCbxNYAYDJQNySqGBk9Qp39EnNG244tapzjPwk21TBb2HPPVbulw==. Drain management may also differ depending on what type of drain the patient has. Percutaneous abscess drains are more likely to require flushing because the purulent drainage can be thick and pose a risk for occluding the drain. The hallmark of a well-functioning drain is output. You can use them for a wide variety of types of treatments. EN. Disclaimer. 2 Clinical updates: Pigtail Drain tubes: A guide for Nurses Hayes. UR - https://www.unboundmedicine.com/medline/citation/16502892/Pigtail_drain_tubes:_a_guide_for_nurses_ However, head-to-head comparisons with a large-bore chest tube (LBCT) are lacking. It is important that the pigtail coil is released prior to removal to avoid trauma. Pigtail drains (see figure 4.7) are another type of passive drain. These tubes do not always have to be sutured in place, for they may contain a string that, when pulled, curls the distal end of the tube, making it a bit harder to pull out. A pigtail is a sterile, thin, long, universal catheter with a locking tip that (once inserted and adjusted by the radiologist) forms a pigtail shape, hence its name. Additionally, pyogenic and fungal abscesses in the lung parenchyma often resolve with more conservative management, namely through supportive care and antibiotics (9). As bedside ultrasound becomes synonymous with modern care of patients who are critically ill, pigtail catheters (PCs) have become increasingly common. D. Australian Nursing Journal. Turn the tap so the open side points to the flushing port. This is called a nephrostomy. If your child has these, take off the fastener that keeps the drain in place or the sponge with chlorhexidine in it. The area surrounding the opening is often lightly covered with gauze to collect fluid as it drains and must be changed when saturated (2). (Q51259970) From Wikidata. If the drain falls out please inform the specialist nurses urgently. Tube size can be found on hub of drainage tube. Infections may also form at the skin if a drain is present for a long time (9). The area around the drain can show signs of redness but if this begins to spread or you are getting pus from around the drain please contact your gp as you may have an infection of the drain site. The fitting of pigtail drains through the skin is usually performed by radiologists. Ensuring that the three-way stopcock (if present) is in the proper position is essential for proper function. Pancreatic abscesses remain at high risk of treatment failure with percutaneous drain placement, thus surgery is usually still the intervention of choice (9). A doctor called a radiologist puts in this drain if your child needs it. Unfortunately for these patients, this meant that a second surgery was required to heal them from complications of their first surgery. A pigtail drain, also known as a pigtail catheter, is a flexible tube that connects to the genitalia or skin of patients to aid with the draining of waste fluids. Rather than keep you waiting, we have only translated the first few paragraphs. Write your initials and the date and time you changed the dressing on the label. An 8.5 Fr pigtail catheter was inserted into the 1st intercostal space in the midclavicular line under fluoroscopic guidance using the Seldinger technique for the management of left pneumothorax. Nurses play a critical role in educating patients about . Repeat the process with the next 2 swabs. Try and log in through your institution to see if they have access to the full text. The saline that was just infused should now travel freely through the drainage tube and into the bag. When managing JP or hemovac drains, it is important to note the color of the drainage fluid. The drain should be emptied no later than when it becomes half full, as it will lose suction and become ineffective (2). Yet, when faced with a drain without drainage, It is important to use critical thinking and common sense. Always be aware of any written orders or policies that dictate drain management, as practices may vary from place to place. However, if there is any concern for the development of sepsis, further intervention is needed (6). A. (non-author abstract), We report a case of subclavian artery laceration caused by the removal of a pigtail pleural drainage catheter in a patient with a pneumothorax. D'agostino hb, vansonnenberg e, sanchez rb, goodacre bw, casola g. Facilities should ensure that information related to type of pigtail drain and locking mechanism in use is available for relevant clinicians. The advent of fluoroscopy, ultrasound, and especially CT provided physicians with a tool to see inside the body without having to cut someone open. Knowlton, M. C. (2015). Nurses will also be responsible for emptying the drain, observing the site and documenting findings. It is also recommended for patients who have a good response to antibiotics and low risk of mortality. The act of placing a drain may cause bleeding from nearby small vessels (9). English Deutsch Franais Espaol Portugus Italiano Romn Nederlands Latina Dansk Svenska Norsk Magyar Bahasa Indonesia Trke Suomi Latvian Lithuanian esk . Knowlton MC 1. Keep in mind that percutaneous drains are often used for abscess or infection, meaning fluid will be purulent and/or bloody. (Mitomycin) for Pyelocalyceal Solution with a Nephrostomy Tube, Suprapubic Cystostomy and Nephrostomy Care This Brochure Will Help You Learn How to Care for Your Catheter, Percutaneous Nephrostomy and Antegrade Pyelography, Percutaneous Nephrostomy: Technical Aspects and Indications, Consent for Percutaneous Nephrostomy and Possible Stricture Dilation, Stent Placement, Tissue Sampling Or Stone Removal, Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: a Description of Three Novel Ultrasound-Guided Needle Techniques, Urine Leak Following Kidney Transplantation: an Evidence-Based Management Plan Shafiq a Chughtai1,2, Ajay Sharma2,3 and Ahmed Halawa2,4*, Criteria for Patient Selection for ESWL (Extracorporeal Shock Wave Lithotripsy), Early Continuous Renal Replacement Therapy and Antibiotic, A Comprehensive Review of Percutaneous Nephrostomy and Suprapubic Cystostomy, 2019 Stone Management Coding and Payment Guide, Managing Your Nephrostomy Tube and Drainage Bag, ICD-10-PCS Reference Manual 12/17/08 Preliminary, Stone Management Coding and Payment Guide, Nephrostomy Tube When You Have Kidney Stones, Temporary Ureteral Stent Placement Or Removal 2021, Quality Improvement Guidelines for Percutaneous Nephrostomy, Experience of a Tertiary-Level Urology Center in the Clinical Urological, Reference Manual for Procedure Documentation and Coding According to Icd-9-Cm, Nursing Management of Patients with Nephrostomy Tubes, Percutaneous Nephrolithotomy) Surgery How to Care for Yourself at Home. Medical Officer orders irrigation of the nephrostomy tube TYPES OF NEPHROSTOMY DRAINAGE TUBES Pigtail: The retaining mechanism is a coil which is retained within the renal pelvis (placed in Radiology). The records help the care team check how well the drain is working. Study design: A quasi-experimental design was used to . If there is a dead end cap, it will have to be removed, since saline cannot be flushed through. Gently flush the tube with 3 ml of saline. If the drain is occluded, fluid may begin to leak around the tube at the skin. The patient was successfully resuscitated through, By clicking accept or continuing to use the site, you agree to the terms outlined in our. If you are using povidone-iodine swabs, follow the steps below. You may have access to it for free by logging in through your library or institution. Assess the tubing for cracks or holes. A special doctor, called a radiologist or surgeon, will put a drain in if your child needs it. Knowlton MC. Some bleeding is normal. Clean for 30 seconds. If a clave is already present, wipe it thoroughly with an alcohol pad. All authors. Infection may form during initial placement if the needle punctures a non-target area (such as the colon) or from prolonged dilation, which is why the procedure should be completed in a timely manner (9). This keeps body fluid from leaking into the tube. Your child might need a pigtail drain to help remove unwanted fluid from the body. Follow any written instructions provided by the ordering physician. Again, it is important to note the color of the drain output. A pigtail is a sterile, thin, long, universal catheter with a lockingtip that forms a pigtail shape. An open system simply means that it is open to air. Assess the drain for kinks or obstructions. Chest tubes are silicone or pvc that have a radiopaque strip with a gap that serves to mark the post proximal drainage hole. All active drains should be monitored closely to ensure that the bulb or accordion is adequately compressed (2). Bookshelf It has three different ports and an off switch that swivels. Removal and/or replacement may be necessary. Other conditions requiring the insertion of a pigtail drain include a blocked bile duct that needs to be drained of bile, or a pusfilled abscess. Do not force the flush. scientific article published in May 2005. The use of chest tubes was described as long ago as the time of hippocrates (c. Drains may also be placed to help remove fluid or air from body cavities. Caring for the patient with a pigtail drainage catheter Nursing. The area around the drain can show signs of redness but if this begins to spread or you are getting pus from around the drain please contact your gp as you may have an infection of the drain site. Drain output may cease for two reasons: there is no more fluid or the fluid cant get out. This means the off switch needs to be turned toward the bag. Hide full disclaimer, Select results items first to use the cite, email, save, and export options. All rights reserved. SP - 19 The Student understands and agrees that NCC shall not be held liable for any acts, errors, advice or omissions provided by the Student based on knowledge or advice acquired by NCC. JO - Aust Nurs J A drain is a small tube that lets unwanted fluid out of the body. Please enable it to take advantage of the complete set of features! It is important that the pigtail coil is released prior to removal to avoid trauma. A package of povidone-iodine swabs If your child is allergic to the ingredients in ChloraPrep or younger than 2 months old. If a clave is present, the saline syringe can be screwed in directly. Often, they are placed at the end of a surgery or percutaneously to help eliminate any fluid that may accumulate within the wound. An unusual local complication of endoscopic nasobiliary drain catheter placement. Drains may also be placed percutaneously: Percutaneous: (adjective) effected or performed through the skin (4). The off switch will have to be turned before flushing is possible. Significant advances in technology have allowed interventional radiologists to specialize in using medical imaging (CT, ultrasound, X-ray, and MRI) to place drains without making an incision. The information is designed to assist healthcare professionals, including nurses, in addressing issues associated with healthcare. If so, it is often easily replaced. Again, never flush a drain without orders from the physician. Passive drainage allows for gravity to help remove excess fluid, without the use of pressure (2). A drain may be superficial to the skin or deep in an organ, duct, or a cavity such as a hematoma. Next, a drainage catheter is threaded across the wire to its final resting place. However, it is costly and unnecessary to expose patients to extra radiation as a matter of curiosity. However, patient selection is still very important, and physicians must know which patients are good candidates for percutaneous drain placement and which are better off heading to the OR. The site of insertion is usually sterilized to ensure no bacteria outside the body attach to the catheter and infect the body. The drain is used to remove unwanted body fluids from an organ, duct or abscess and is inserted under strict radiological guidance to ensure correct positioning. Pediatr Neonatol. Youll also learn the basics of types of drains and drain management. The improper removal of these medical devises will create a medical emergency. These drains may also be sutured in place. The string is then wrapped around the end of the catheter and kept in place by a rubber stopper. Use a wipe to take off any more adhesive. If the ordering physician wrote specific instructions on how much saline to infuse, follow the directions closely. (Retrospective study; 43 patients) Lin CH, Lin WC, Chang JS. Small-bore chest tubes - also referred to as pigtail catheters - are being used to relieve both spontaneous and in some cases, traumatic pneumothorax. National Institutes of Health. Unable to load your collection due to an error, Unable to load your delegates due to an error. Sometimes the contents of the abscess can be thick or contain particles that can clog the tube leading to the bag. The off switch should be pointing to the flush port at all times, unless the nurse is preparing to flush the drain. The Together Blog is a resource that delivers timely topics on childhood cancer from providers, families, patients. 8600 Rockville Pike They may be equipped with a three-way stopcock to allow for easy flushing. For most patients drainage will stop or significantly slow before this. Start cleaning at the spot where the drain goes into the body. Content may be. An educational slideshow about the pigtail drainage catheters Pigtail drain tubes are widely used in Australian hospitals to facilitate the drainage of body fluids such as urine, blood and bile. (2008). Before the advent of antibiotics, the development of an abscess or postoperative infection was often a death sentence (7). For example, percutaneous drainage is sometimes avoided in patients with chest infections, such as empyema, abscess, and pleural effusion because of the risk of pneumothorax (9). If there are no orders it is reasonable to contact the physician who placed the drain for clarification. A patient may require drain placement for various reasons. The purpose of a drain is to get fluid out of the body. Dressing change required every 7 days and PRN with Mepilex foam dressing or q48h and PRN with gauze dressing. The following image is an example of a penrose drain (3). This site needs JavaScript to work properly. Rather, the draining fluid is contained within the system, and the collection bulb or bag is simply emptied from time to time, as needed. Nursing Management of Patients with Nephrostomy Tubes . An abrupt cessation of fluid could indicate a problem. Want to earn credit for this course? Your use of the translations is subject to all use restrictions contained in your Electronic Products License Agreement and by using the translation functionality you agree to forgo any and all claims against ProQuest or its licensors for your use of the translation functionality and any output derived there from. Technique for Noninvasive Replacement of a Damaged PleurX Drainage Valve. VL - 12 A JP drain is an example of a closed drain. Do not attempt to put the tube back in, as it is no longer sterile. By clicking complete you are agreeing to these terms of use. To compress a JP, use the "side-in method" where the nurse compresses the JP bulb at its largest diameter (in the middle) with fingers and thumb to compress the bulb (14). Finally, if a patient develops an abscess, a drain is often required to help remove the infected fluid more quickly. Be careful not to touch the area where the drain goes into the body. Carefully document drain output as dictated by the physician or facility protocol. Emedicine: Instant access to the minds of medicine; 2001.December 3; [cited 2002 Oct 10]. Turn the tap so the word OFF points to your child. Copyright Australian Nursing Federation May 2005. Careers. Use an up and down, then side to side motion. ER -. To compress a JP, use the "side-in method" where the nurse compresses the JP bulb at its largest diameter (in the middle) with fingers and thumb to compress the bulb (14). eHow may earn compensation through affiliate links in this story. Drain Management Drains systems are a common feature of post-operative surgical management and are used to remove drainage from a wound bed to prevent infection and the delay of wound healing. Type your tag names separated by a space and hit enter, 20002023 Unbound Medicine, Inc. All rights reserved, TY - JOUR Information for patients and nurses rocket medical. 2005 May;12(10):19-20. If a dead end cap is present, remove it. Unfortunately, drains can develop complications. Your message has been successfully sent to your colleague. Remove the syringe. Pigtail drains are inserted under strict radiological guidance to ensure correct positioning. You may be required to have a provider order in order to flush a drain. Active drains use actual pressure, typically negative pressure, to help remove excess fluid from the body. (2015). Signs of infection include: If the drain comes out, cover the area with sterile gauze. D. Australian Nursing Journal. 1. It is essential that providers choose patients carefully, as ineffective or incomplete drainage of the infection can lead to significant morbidity and mortality (8). Pigtail drain tubes: a guide for nurses. These drain tubes are a great way to help nurses with their jobs and keep nurses hands free. Throw all the parts of the old dressing into the trash. In the old days, surgery and antibiotics were the only way to treat intra-abdominal infections. This course is also designed to provide a basic understanding of drain management and troubleshooting. PY - 2006/3/1/entrez They can also be used to introduce fluid, usually a dye, into the body to help monitor activity in a specific organ or body area. Once the bag is flushed, return the off switch to face the flush port.
Austin Turk Theory Of Criminalization,
Is John Copeland Still Married To Marty Copeland,
Baby Angel In Heaven Message,
The Catch Pilot Grey's Anatomy,
What Do You Mix Dole Boosted Blends With,
Articles P