chest tube removal - page 5
I WORK IN A BUSY CCU/ICU DEPT. I HAVE A QUESTION ABOUT THE REMOVAL OF CHEST TUBES. DO RN'S IN YOUR HOSPITAL REMOVE CHEST TUBES S/P CABG 12-24 HOUR POST-OP? WE HAVE A COUPLE OF RN'S WHO FEEL... Read More
Jan 27, '09In the unit where I used to work RN's were allowed to remove chest tubes, provided that you have been found competent in the procedure.
Jan 27, '09RN's who have been signed off on a competency pull medistinal and pleural chest tubes at the hospital I work at. I would never do it without proper training or being signed off though!
Feb 9, '09This is a very old thread, but considering the new replies, here goes...
My state (AZ) says it's a no no for RN's to pull pleural tubes. We can pull MS tubes, however. Having said that, my doc pulled all the tubes, and the epi wires, too.
Feb 9, '09I work in AZ too and we have been signed off by doctors to pull PT. I looked at the AZ Board of Nursing site, but cannot find information about what is in the scope of practice. They only have the meetings listed. How do you know nurses are not supposed to pull pleural tubes and can you tell me where to find that information? Thanks. I I do know that doctors have to pull epicardial wires.
Feb 9, '09Not going to say where I work, but our RN's pull them in the CVICU. Our "policy" is a see one, do one, teach one, kind of deal.....not so safe, but we actually haven't ever had any problems.
Feb 22, '09It's common practice in my unit for RN's to pull chest drains. The protocol says to remove the drains after at least 3 hours of no drainage or bubbling.
Feb 28, '09RN's in my unit remove ct's. once taught and you understand the complications following inappropriate removal, you'll be fine, just remember breath sounds before and after
Aug 21, '09Quote from grano5Some pts have a purse string to close the wound.Can anyone tell me the proper procedure for closure of the chest tube wound once the tube has been successfully removed. Patient after 3 mos. still has open incision. Is this normal practice? Is it supposed to close on its own. Patient is 78 yr. old and diabetic. What sort of complications can result from the open incision. Should we contact a surgeon to close it? Patient is in SNF.
Those without should heal in a week or two.
An open wound is set up for infection. The presence of infectious signs- rubor (erythema), tumor (swelling), calor (warmth), and dolor (pain) needs an eval. Also look for drainage.
The pt could have a simple sinus tract into the incision, which can be probed with a long qtip to assess for depth. If the incision is subxiphoid you are about 6-8 cm from the medastinum most likely. Diabetics are more prone to these problems due to relative immune compromise.
The extent of the tract and signs of infection will determine the need for ABX. Otherwise it's local wound care, good nutrition and time.
A wound this old should not be closed but allowed to heal inside-out by secondary intention.
Oct 11, '09My colleague accidentally cut off the purse string stitches on the mediastinal chest drain before removing it. We continue to remove the drain but close the wound with steril-strip. However, she was very upset but I reassured her that patient is fine and no risk of pneumothorax. Could someone help me better explain this in terms of anatomy and physiology.
Oct 12, '09Quote from JoelocatoMediastinal tubes are generally inserted subxiphoid, and there is a soft tissue tract of 3-5 cm between the skin and the mediastinum. This tract will collapse down on itself after the tube is out. For this reason some folks don't even put in purse strings at this site. It is nearly impossible to entrain air in, even w/ deep inspiration; additionally if the pleural spaces were not entered, the tract communicates only w/ the mediastinum so no PTX.My colleague accidentally cut off the purse string stitches on the mediastinal chest drain before removing it. We continue to remove the drain but close the wound with steril-strip. However, she was very upset but I reassured her that patient is fine and no risk of pneumothorax. Could someone help me better explain this in terms of anatomy and physiology.
Intercostal tubes have a higher risk of PTX, especially if the skin insertion site is at the same level as the pleural entry site (instead of cutting skin one level lower). If you lose a purse string here you can place vaseline gauze over the site to create an air seal.
I have had plenty of times when I pull a tube and the pt breathes in at the wrong time, sucking some air in. This is OK and can be monitored conservatively. The only real risky situation is a pt w/ a known air leak, eg post pulmonary resection, emphysematous bleb rupture etc. Those pts need to be followed more diligently.