Milking chest tubes - page 3

I just found out that the hospital I am currently working at, still has it in their policy for maintaining chest tubes to "milk" the chest tubes as needed. At my last hospital is was never allowed and it was a much more... Read More

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    "http://http://ajcc.aacnjournals.org/content/16/6/609.full.pdf+html"]http://http://ajcc.aacnjournals.org/content/16/6/609.full.pdf+html[/URL]


    http://ajcc.aacnjournals.org/content....full.pdf+html


    Hopefully the above links worked. From the study titled "To strip or not to strip: the physiologic effects of chest tube manipulation"

    Under the paragraph "adverse clinical consequences" they say the pressure created from striping 5 inches of chest tube has a median
    of -87 cm H20.
    Now you gotta think about how far you actually strip the tube. Most people I would say at least strip a foot. So that's over double that amount of pressure!

    If I find the picture of the autopsy from my class I will scan and post it here.

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    Quote from tahoe77
    Well yes obviously when faced with life threatening emergency such
    as tamponade in which case you have obviously contacted the surgeon and are simply
    trying to keep the pt alive sure. But surely you are not
    condoning striping as a regular practice as a whole.

    And if the surgeon wants to cut the chest tube and insert
    a yankie than that is their call during that emergency.

    Even still there is a difference between this one time emergency
    and the regular practice of striping the chest tube every shift
    repeatedly which I guess some nurses do.

    All I am saying is that I say the picture of the autopsy and
    the grafts were no longer attached. it was attributed to aggressive striping. (now theres a
    funny phrase "aggressive striping")

    I will continue to strip chest tubes as needed as I have been instructed by my surgeon and are written into our post op heart orders. I think if theres any question, ask the surgeon what he or she wants.
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    Addendum: In 6 plus years of taking care of heart patients I have never had or seen a negative outcome from keeping the tubes patent...only from letting them occlude by not being aggressive enough.
    KeepItRealRN likes this.
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    Quote from richard1980
    "A class at Stanford" eh? When did they become the authority on CT management...? Just kidding. :-P All sarcasm aside, the competent nurse should use his or her judgement on the selection of gentle "milking" or aggressive "stripping." There is a place for both practices in the care of post cardiothoracic surgical patients. I've seen a surgeon cut the CT and stick a sterile yaunker with full suction into someones chest to suck out clots. Thats a hell of a lot more negative pressure (considering he pinched the sides of the chest tube wall) than I could generate stripping a tube....
    I'm not encouraging reckless stripping of tubes but faced with the outcome of a tamponade you do what you have to do to generate the best end-outcome for the patient.

    Agree. I use ETT suction caths to evacuate CTs all the time.
    richard1980 likes this.
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    I agree with Richard. If you dont strip the tubes, or milk them, or do something, they clog off. Its unfortunate, but something has to be done. I wish there was a better way because it takes a lot of time and does not always work.
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    it has been a standard procedure in our unit to milk patient pleural and medi drain post opt...we do not need the surgeion approval...thanks for the above info.. i will be careful and think about the pressure it will caused while milking..
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    At our facility it depends on the surgeon -- some want you to strip, some don't. They will tell you what they want you to do. However, I have not seen even the ones who don't like it say not to strip in an event where tamponade is likely.

    I do think that stripping and milking are helpful in some situations. Like someone else said, best practice doesn't fit every patient every time -- I think the outcome of stripping vs. not stripping must be taken into consideration when deciding if this should be done or not.
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    Interesting discussion.... It never occurred to me to even see what the policy is at our facility, as it's assumed that you will milk a mediastinal CT on a fresh open heart if during your assessment you feel that it's not draining adequately, especially on a pt who has received blood products (namely FFP) and is now putting out "chunky" clotty drainage. In fact it's safe to bet that the surgeon would be pretty peeved if you called him to tell him the tube clotted off and that you haven't attempted to break the clot loose.

    I will also say that we don't routinely strip tubes. We rarely do, it's only if needed, but I've seen the surgeon give a tube a good few strips before going home for the night.

    Also the size of the tube makes a difference. The smaller silicone tubes they use with the noninvasive patients have a tendency to clot easier, you definitely have to watch those closer.
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    Quote from joeyzstj
    You DO NOT want to milk or strip a Pleural chest tube. You should only strip a pleural chest tube toward the patient as to blow the clot back into the body.
    I'm studying for boards and my review course says, "Gently milk in the direction of drainage, if needed." This was in regards to a pleural tube. Is anyone else familiar with the practice of milking a clot back in to the body? If so, what purpose does this serve?When I read this comment I thought it was a typo but then I thought I may not fully understand the negative pressure generate by stripping away from the patient towards the collection chamber. Would the result be comparable to jacking up the wall suction? Having personally had a spontaneous pneumo/hemo, chest tube, and pleurodesis, I'm not sure why I can't wrap my head around some of this stuff lol. All I know if my nurses let no one near my tube. If someone so much as repositioned it they flipped out lol.Thanks all!
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    I work at a very large hospital ranked in top #5 in country for CT surgery. We are instructed to strip chest tubes immediately after heart surgery. I agree with previous posts...I have never seen any harm come from stripping CT'S, only from them clotting off.


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