by DNPstudent Premium Member

After pulling epicardial pacemaker wires, the patient is always placed on tamponade precautions. I was recently told that they do not need tamponade precautions if they have chest tubes....this doesn't make sense to me. Tamponade is caused by an excess of fluid in the pericardial sac... since the CT are MS and/or plueral...any one else ever heard of this?

Re: Tampanode Precautions after pulling epicardial pacer wires

Can you tell me what "tamponade precautions" is, exactly? Not sure what you would do? Take BPs more often? Check on the patient Q15min to assess heart tones?

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by CVRN11

Can you tell me what "tamponade precautions" is, exactly? Not sure what you would do? Take BPs more often? Check on the patient Q15min to assess heart tones?

Basically, VS q 15 min, for 1 hour, then q 30 min for one hour, and auscultate heart tones on the hour...yeah, nothing too exciting...watch for hypotension, tachycardia, arrhythmias etc. Younasically stick by the of for an hour or two to make sure he's ok.....

Re: Tampanode Precautions after pulling epicardial pacer wires

Um, chest tubes go into the lung. Tamponade occurs around the heart. I don't see how a chest tube does a bit of good for tamponade. Unless it's a unique chest tube that somehow got put into the pleural sac. And I doubt that's ever happened.

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by ICUNurseCline

Um, chest tubes go into the lung. Tamponade occurs around the heart. I don't see how a chest tube does a bit of good for tamponade. Unless it's a unique chest tube that somehow got put into the pleural sac. And I doubt that's ever happened.

that was exactly what I said, but the nurse had 30 years experience compared to my 3 years...she said something about releiving the pressure in the chest (MS)...so I didn't want to tell her she was wrong, so I asked here!

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by ICUNurseCline

Um, chest tubes go into the lung. Tamponade occurs around the heart. I don't see how a chest tube does a bit of good for tamponade. Unless it's a unique chest tube that somehow got put into the pleural sac. And I doubt that's ever happened.

Well they do go into the plueral cavity, not the lung... Or the mediastinum...

Re: Tampanode Precautions after pulling epicardial pacer wires

Maybe she meant mediastinal tube? Although I'm not even sure a mediastinal tube would drain the fluid between the heart and the pericardial sac unless the little hole in the sac was big enough to drain the fluid. In that case it would help, but it still wouldn't hurt to have the pt on precautions.

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by carebearRN08

Maybe she meant mediastinal tube? Although I'm not even sure a mediastinal tube would drain the fluid between the heart and the pericardial sac unless the little hole in the sac was big enough to drain the fluid. In that case it would help, but it still wouldn't hurt to have the pt on precautions.

Yeah that was what I figured she meant the MS ones, but it still does Not make sence anatomically! Thanks for your responses! I am going to continue with my usual practice.

Re: Tampanode Precautions after pulling epicardial pacer wires

DNPStudent........the more experienced nurse was possible right or wrong depending on what she was referring to as the method of tamponade. There are different types of chest tubes and drains. Pleural chest tubes sit in between the pleural space, Mediastinal Chest tubes sit in the mediastinum. MS chest tubes prevent cardiac tamponade by releasing a buildup of blood volume in the mediastinum after cardiac surgery or in the even that you caused enough bleeding to somehow fill up the mediastinum upon pulling the epicardial wires. As far as causing a tamponade in the PERICARDIUM......thats a different story. You must be trained to remove them and know what to look for prior to pulling them. It only takes around 100 ml's of blood in the pericardium to cause problems. Checking to make sure your INR isnt 2-3 before pulling them, electrolytes, bed rest for an hour or so, ect.........are good things to practice. Pericardial Tamponade is rare. I have seen multiple Mediastinal tamponades from clotted off chest tubes several hours after surgery.

Re: Tampanode Precautions after pulling epicardial pacer wires

Originally Posted by DNPstudent-Michigan

Well they do go into the plueral cavity, not the lung... Or the mediastinum...

I stated myself incorrectly. CT's go into the pleural space, yes, but the pleural space is not the same thing as the pericardial sac. It would still be a different anatomical space.