Our "heart team" nurses must be checked off in their yearly competencies for pulling chest tubes before they can d/c a chest tube on our OHS patients. I don't think I've heard of anyone having any complications or problems, but that doesn't mean there haven't been any.

Either the surgical interns or the NP's on the cardiothoracic service pull the chest tubes 12-24 hours s/p CABG in our unit.

Chest Tube Removal

Originally Posted by corkyrn

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 COMFORTABLE WITH THIS TASK. I AM NOT. I NEVER HAVE BEEN CHECKED OFF OR TAUGHT THIS PROCEDURE ON A FRESH HEART.

All 3 CT's are removed at once by the PA or MD. They are removed at the same time becuase the amount of pain is not associated with the # of tubes removed but the actual removal. So if they were removed separately the patient would have the same amt of pain 3 times. We give pain med immediately prior to removal. We have a couple of Dr's who in addition to pain med give 1-2mg of Versed. The patients that recieve the versed do not usually even remember having their tubes pulled.

trouble with antagonist Nubain

Patient files: Radiation treatment last year blood stream due cause anaerobe tumor; this year spur treatment. Does radiation affect the effectiveness of the medication indicated? How long does radiation last in the blood stream? What caused Nubain mixed with LR to be an antagonist?-CALAYCAY

trouble with antagonist Nubain

Patient file:

2 0 0 3
Diagnosis: anaerobic tumor, perforated appendix, inferior vena cava
tumor, ischemia, inflammed veins
Treatment: surgery with radiation - blood stream(2 half-liters bottle)
2 0 0 4
Diagnosis: spur formation
Treatment: surgery
Medication: Nubain, LR

Question:
What makes Nubain an antagonist?
Is it due to allergic reaction/adverse effects?
How long does radiation treatment last?

All RN's in our unit pull chest tubes, after the order has been written and the x-ray has been reviewed. No problems yet.

Just like CRNASoon, all RNs in the unit I used to work in also pulled chest tubes, rarely had a problem.

In our CVSICU RN's pulled chest tubes daily. We have such a busy heart center that it was necessary, it's in the policy and we were checked off on it. Sometimes we would pull all of them, or just one and y the others together, we also pulled blakes. In fact, we pulled all central lines, arterial lines, sheaths, femorals, and ET tubes.

Hello, I am a Special Procedures Nurse and I am currently developing policy and procedure for chest tube removal within my institution for the special procedures nurses. Also, I am looking to develope competencies for our Nurses to be evaluated in order to be signed off internally for chest tube removal with supervision and then on their own once competencies are meet. If you have any institutional guidelines, policies or competencies. Let me know, I would love to look over them in order to help advance nursing practice within our institution.
Thanks

Re: chest tube removal

Rn's in our unit must be checked off by a CV surgeon first, then a PA then a nurse educator. These are commonly the very experienced "heart" nurses. I have never had a complication. We do not pull epicardial pacing wires though. We also pull sheaths, ET tubes, a lines, swanns and introducers. If we pull htree at once We have two nurses doing it for patient comfort. It is not standard practice at my hospital to do a PCXR after CT removal unless you suspect problem. We usually put MCT PO Day #1. PCT a couple of days later (no air leaks or MD pulls .