nursing care for chest tube of cabg patient

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CAN YOU TELL ME who are the best way nursing care for chest tube of cabg patient to prevent clottings inside of drenaige chest.

thanks

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Specializes in Surgery, Trauma, Medicine, Neuro ICU.

Strip them. Often.

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Specializes in Critical Care.
Strip them. Often.

Did you mean "milk them"? I haven't seen stripping of chest tubes still done anywhere for quite a while.

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In the PICU, we strip, milk, and tap chest tubes to maintain patency.

I know that many will advise against stripping a chest tube due to grossly decreased intrathoracic pressure. In six years in the PICU, I have never seen or heard of any problems related to chest tubes being stripped.

I have, however, participated in two procedures in which the CT surgeon was called to the bedside emergently, to open and washout the chest as a result of a clotted mediastinal chest tube.

Your facility should have a detailed policy on caring for patients with chest tubes.

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Specializes in ICU.

Yeah, I refrain from 'stripping' but will resort to that if it means getting a big honking clot out of there and preventing sending the guy back to surgery for tamponade! I remember one nurse that spent her whole 12 hour shift milking and stripping chest tubes with due diligence trying to keep them patient, grabbing anyone she could to help out. What a nightmare! OP: check them frequently looking to make sure they still draing 'something', if not, then 'milk' it to see if there's a clot that can be worked free and out.

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Specializes in critical care.

I have, however, participated in two procedures in which the CT surgeon was called to the bedside emergently, to open and washout the chest as a result of a clotted mediastinal chest tube.

I've been told never to strip an intrapleural chest tube, but it's ok to strip the smaller, mediastinal drains.

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Specializes in Emergency, Telemetry, Transplant.

My first RN job was on thoracic surgery step-down. Hospital policy there specifically did not allow nurses to strip CTs.

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I 'm not stating that aggressively stripping of chest tubes should be the first step in maintaining patency. However, if milking and tapping the chest tube don't maintain patency, stripping the chest can often dislodge the clot and restore patency. In the PICU, we frequently strip chest tubes when tapping and milking don't work. I have also done this in the adult CTICU as well. In both units, we regularly stripped chest tubes, and in both units this practice was both supported and endorsed by the CT surgeons.

I know that much has been written regarding stripping chest tubes, with emphasis on the gross increases in negative intrathoracic pressure. I know there is a nursing urban legend describing grafts being detached from the heart as a result of stripping chest tubes. In fact, it has been mentioned in at least one thread here on Allnurses, however no one has been able to cite the source for this other than a "conference" that they attended. I am not aware, however, of any documented injury as a result.

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Specializes in CVOR, CVICU/CTICU, CCRN.

All of the CT surgeons I work with in my CVICU strongly encourage stripping mediastinal tubes on a fairly frequent basis. One of them enjoys educating the rest of the staff - he pulled up several nasty post-op CXR's showing pulmonary effusions/edema and specifically linked the complications to failure to strip the tubing. Milking the tubes is good practice, but stripping them may better prevent clot formation. HOWEVER: definitely check your facility's policy on care of chest tubes before taking what we say on AllNurses into practice.

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Specializes in Critical Care.
All of the CT surgeons I work with in my CVICU strongly encourage stripping mediastinal tubes on a fairly frequent basis. One of them enjoys educating the rest of the staff - he pulled up several nasty post-op CXR's showing pulmonary effusions/edema and specifically linked the complications to failure to strip the tubing. Milking the tubes is good practice, but stripping them may better prevent clot formation. HOWEVER: definitely check your facility's policy on care of chest tubes before taking what we say on AllNurses into practice.

Stripping chest tubes is well established to be a bad practice, and while a CT surgeon's view on it is useful if you want to know what the views was on it 20 years ago, it's generally not a good source for current best practice.

After extensive studying stripping has never been shown to prevent or solve patency issues in a chest tube, it has been well established to cause additional bleeding. This can sometimes be misleading since there will often be a significant amount of CT drainage after stripping, but that's only because you caused the bleeding that is then draining.

I landed a fresh heart once that had a surgeon new to our facility. There was only about 20cc of drainage but no apparent blockage. The surgeon asked me to strip the tube, so I milked it, she said she wanted the tube stripped and I informed her that shouldn't be done. She then stripped the tube herself, stripping the full length of the tube (thats about -400 cmh20 suction at the end of the tube). Sure enough the tube started draining.... and draining, and draining, the patient ended up being an open chest code and was found to have a new arterial bleeder right at the tip of one of the tubes, she no longer asks us to strip the tubes.

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I don't have much experience with chest tubes but clicked on this thread to learn more (I always love to learn something new). I wonder if someone could explain "milking" and "stripping" to me? Many thanks.

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Specializes in Critical Care.
I don't have much experience with chest tubes but clicked on this thread to learn more (I always love to learn something new). I wonder if someone could explain "milking" and "stripping" to me? Many thanks.

"Milking" refers to repeatedly squeezing the tube to break up clots or other obstructions, or squeezing the tube and pulling down the length of the tube with the tubing is crimped or clamped on the patient side of the tube from where you are stripping to avoid causing severe suction at the patient end of the tube.

"Stripping" involves squeezing the tube near the patient end of the tube and pulling down the tube away from the patient in order to suck clots through the tube. This creates extremely high levels of suction at the end of the tube inside the patient which can easily cause erosions.

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