RN role in Chest Tube insertion in the ER?

[x28y31]

Hi everyone! I am on my second week on the floor in the ER. Brand new in the ER and I'm loving it! We have carts for central line insertions and chest tube insertions for any emergent needs. I have never seen what any of these insertions look like or what the RN is supposed to do while the MD puts the catheter in. So any guidance on this topic?

Idk what the kits look like on the inside...dunno what the procedure is (apart from all of it being aseptic, I believe)...any of it Any advice is appreciated! If you have a nice article or video link handy, I'd love that too. Thanks so much!

[sommer0515]

I've assisted another RN who made sure appropriate meds (lidocaine, etc.) was drawn up and available. My job was to hold pt arm up and support durning insertion... Probably one of the most painful procedures performed, no doubt....

[AJJKRN]

Painful indeed! That's when being moderate sedation certified comes in handy if there's enough time to premedicate the Pt prior to any insertion, cardioversion, or whatever is about to be done that's really painful. This is generally the RNs role at my hospital when on the Med-Surg floor (but only if the RN is certified in Moderate Sedation!).

[brownbook]

You Tube has wonderful educational videos of medical/nursing procedures, including chest tube insertions and central line placement.

[dah doh, BSN, RN]

RN: get supplies ready. Our carts don't always have everything in them.

Make sure the patient is pre-medicated with pain meds and/or sedatives! Lidocaine...available and placed where doctor wants it.

Position patient! Pad them with towels if you have time...some doctors are messier than others.

Help doctor donning sterile gown.

Open and hand to doctor the sterile towels, chest tube, clamps, trochar, needles, syringes, etc.

Hand doctor the pleur-evac or container that you already prepared.

Hand doctor suture and needle driver.

Help dress the site and tape or zip tie the connectors.

Get chest X-ray.

Clean up.

Some doctors are more independent than others and will do most of this stuff on their own.

Hope this helps.

[Bobjohnny]

Open and hand to doctor the sterile towels, chest tube, clamps, trochar, needles, syringes, etc.

Hand doctor suture and needle driver.

This isn't all in your chest tube kits? I think the only thing not in ours are the gloves & the pleur-evac. Also, y'all still use trochars routinely?

In reply to OP, I typically just pull up a chair and plug my computer in to the wall. Sit down and proceed to document. When the doc needs something they'll let you know. Typically it's when they need to put the site dressing on or when the chest tube is ready to be hooked up to suction.

[dah doh, BSN, RN]

This isn't all in your chest tube kits? I think the only thing not in ours are the gloves & the pleur-evac. Also, y'all still use trochars routinely?

In reply to OP, I typically just pull up a chair and plug my computer in to the wall. Sit down and proceed to document. When the doc needs something they'll let you know. Typically it's when they need to put the site dressing on or when the chest tube is ready to be hooked up to suction.

To the PP: Our chest tube cart has it's supplies separate, not as a handy little kit. Yes the trochar is there in the cart for the doctor's use if needed.

As for pulling up a chair to chart while a procedure is going on in my room...that is horrible advice to a newbie in my opinion and besides which it wouldn't go over well where I work as the carts don't always have everything and some doctors need more help than others.

[Bobjohnny]

As for pulling up a chair to chart while a procedure is going on in my room...that is horrible advice to a newbie in my opinion and besides which it wouldn't go over well where I work as the carts don't always have everything and some doctors need more help than others.

Sorry, I'm used to having an attending, 1-2 residents, and a med student all around the patient putting in the chest tube. That is why I just pull up a chair and chart. Most of the time the only other hing I do is hook up the chest tube to the pleur-evac. Unless it's a trauma, then it is a little more involved.

[AnnieOaklyRN, BSN, RN, EMT-P]

Chest tube: Setting up drain and having it ready to go and of course, conscious sedation! I agree with everyone else, seems to be extremely painful!! If I ever need a chest tube I am getting lots of Propofol or I am running out of there!

Central line: More task oriented as far as just handing the physician stuff. Also monitoring VS.

Annie

[emtb2rn, BSN, RN, EMT-B]

Annie, conscious sedation for chest tube insertion? Wow, seems like overkill, we just use some lido & in it goes.

[Lev, MSN, RN, NP]

Yeah...we just put the tube in. No conscious sedation for us.

[AnnieOaklyRN, BSN, RN, EMT-P]

Annie, conscious sedation for chest tube insertion? Wow, seems like overkill, we just use some lido & in it goes.

If it is someone with a spontaneous pneumothorax (no trauma) we do use conscious sedation. If done in an emergency situation for a trauma patient they get some narcotics and in it goes. I should have been more clear.

Annie