I work on the CV-surgical step down unit....nurses who have been checked off on the competancy and supervised pulling three sets of tubes (this must include pulling Argyles or Atriums, converting a blake to JP and pulling the JP when appropriate) do all D/Cing of chest tubes. Nurses who are not comfortable do not have to do it, but it really is nice not to have to wait for the surgeons to FINALLY have time to do it!! In our hospital surgeons do not have to be in the building for us to perform this procedure. RN's also pull epicardial wires where I work, for this the surgeons do need to be in-house in case of tamponade. I can safely say that there has never been a problem with RN's doing these things...we all know when NOT to pull and there has never been a complication.

Surgeons or a PA removes the chest tubes, even in Or the PA removes the chest tube, I havent known of a case where the Rn was covered to do such a procedure unless they worked for the surgeon and even then the PA did it, and the Nurse assisted.
Zoe

The fact is if you pull enough chest tubes you will experience a complication. After witnessing a couple of major bleeds over the course of my career I would have to say that this is one task I will cheerfully leave for the docs and midlevels.

At the hospital where I work only the Surgeons and Pa's pull chest tubes. We do however have one Surgeon who wants to
train the RN's to take over this task . To date no RN's have volunteered.

No thank-you... I have enough to do without expanding my job description anymore...with 5-6 tele patients on our super busy and super sick floor of 53 patients with all going for cardiac caths..stress tests and post cabg patients of 24 hours...I don't need to add that task..we do prepare; assist and dress the site and of course continue with the respiratory aspect of it...pulse ox/incentive spiro etc... enough already....

None of our staff nurses do it on our own. We set up and assist with the procedure, but the surgeon or cardiac care clinition (advanced practice nurses who work directly with the suirgeons) pull the tubes.

On my unit (CV surg) RN"S can pull chest tubes... there has to be order of course ..
The nurse has to be competent.. only the nurses who have been on the unit for years usually do it.. (and thats pretty much only the nurses on day shift) I think they have to take a course or prove competency... They can only pull mediastinal chest tubes though.. the PA's pull the pleural tubes.
The RN's can also pull epicardial pacing wires... the PA's have to be on the unit though..

In our CVICU,the resident on call for that day pulls the cts early on dayshift, or occasionally, the more energetic ones pull them before am rounds, as they're finishing their nightshift. Very occasionally, the surgeon might. Everyone has them pulled before they're transferred to the IMCU- usually on their first post-op am. When I worked in the west,9 yrs ago,everyone was sent to the step-down unit with cts in place. Don't think they do it that way any longer though. I'm quite sure most nurses in the unit would not be interested in taking on this procedure,thank you very much! We've enough 'Delegated Medical Acts' on our plates right now, plus more being added - like doing our own dialysis- oh,joy!!

Nurses are playing increasingly important roles in the ICU/CCU. It is not uncommon to see nurses remove central lines or arterial lines or endotracheal/ trach tubes. Therefore I see no reason why they cannot remove Intercostal tubes. Like any procedure, it is important that the RN are properly oriented to the relevant issues and initially supervised by previously trained RNs.

Don't readily take it on as a routine duty. It is just ONE MORE UNCOMPENSATED TASK!!!!! Plus, when you have to wait for the doc or the PA to pull it, you can buy some more time to get your work done, before you toss, oh I mean transfer, the pt out of the unit.