Chest tube care

  1. hi everyone...i want to ask for help about the care of chest tube. i list the responsibilities of nurses for chest tube care. from your experiences, is there any info to add in the list below from all of you. tqvm, you're most welcome.

    1.check dressing at the site of chest tube insertion
    -ensure the dressing or plaster is intact to avoid the chest tube is slip out. dressing at the chest tube insertion site to avoid potential infection.

    3.check the patency of the chest tube
    - do milking or stripping along the chest tube to avoid blockage or obstruction of the drainage.

    4. observe the type of drainage and amount of drainage.

    5. check is there any bubble in the chest tube to to know whether there is pneumothorax

    6. change the drainage bottle when 2/3 full of drainage.
    - if chylothorax - need to change the drainage bottle everyday to observe the progress of the drainage.

    7. clamp the chest tube when to move the patient or when to walk to avoid the back flow of the drainage into the lungs or cardial.
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  3. by   RedXIII_
    Keep a bottle of sterile water nearby just incase....
  4. by   SCnurse2010
    Make sure you have really thick skin for the verbal beating you'll get from the MD for milking or clamping a chest tube!
  5. by   deepurple
    thank you for those replying my question...
    what i'd been practiced now in my ward which i handling post operative pediatric cardiac surgery.
    our surgeon was using the disposable bottle drainage which not connected with vacuum. the drainage will drain out follow the gravity. under some circumstances, our surgeon will give order to connect ct to low suction but it's rarely.
    i'd seen the icu staff did stripping the ct on post op day. which one is the good practice?

    one more thing...what i had understand about the clamping of chest tube is to prevent back flow of drainage to pericardial or pleural and to avoid air from entering the chest tube if the connection is dislodged. are these rationales incorrect?
  6. by   tcvnurse
    Agree that clamping a chest tube is a good way to get reamed, especially if done without an order.

    Keep the pleurevac BELOW the level of the insertion site and you wont have a problem with backflow.

    Only milk or strip with order as it creates much more pressure .

    Keep vaseline gauze at bedside.
  7. by   classicdame
    I did not read all that but do recommend you get some free information from the website I am scribing. Your equipment may be from a different manufacturer, but the info is still good.
  8. by   umcRN
    Quote from SCnurse2010
    Make sure you have really thick skin for the verbal beating you'll get from the MD for milking or clamping a chest tube!
    We still aggressively strip tubes in my pediatric icu, sometimes the MD's get in on the action too. We are now though in the process of reviewing this policy
  9. by   classicdame
    Forgot something: We are transitioning to "push to set" wall suction. On the traditional type, many nurses were not aware they must pinch the tubing BEFORE setting the level of suction on the wall. Therefore, the suction was actually whatever the chest tube vaccutainer was set for (-20 usually) PLUS whatever the nurse set on the wall (-80 usually). The result? Suction was actually -100!!!. This can damage mucosa and has been indicated as a precursor to hospital acquired pneumonia.

    If your suction device is "push to set", the device is pinching the tubing for you. If it is not, then you need to pinch the tubing close to the wall while you are dialing in the amount of negative pressure that is ordered. Hope this helps.
  10. by   classicdame
    umcRN: please check with the chest tube manufacturer, pediatric pulmonology, pertient associations for standards of care. Stripping creates lots of POSITIVE pressure and can cause tamponade or other problems, not to mention pain. I do not think it is recommended any longer.
  11. by   picurn10
    our picu also routinely writes orders to strip chest tubes. Its part of the order set to strip every hour for the first 24hrs.
  12. by   turnforthenurse
    We never strip or milk a chest tube without an MD order. And never clamp them, either, unless you're trying to locate an air leak. Keep a pair of hemostats and if you have to clamp, make sure either the hemostats are padded or you provide padding (wash cloths can work).
    Keep vaseline gauze at the bedside.
    Make sure connections are secure.
    Keep the drainage unit BELOW the patient and try to avoid any dependent loops in the tubing.
    Observe insertion site and note if any eyelets are visible; could be a sign that the tube has slipped out
    Monitor water seal and suction control chambers to make sure they are at the prescribed level. Water also evaporates so make sure to look for that too and add more (sterile) water if necessary.
    Look for tidaling, which is normal. Absence of tidaling can indicate a blockage (such as a clamp or kinked tube) or could indicate lung reinflation.
    Keep a bottle of sterile water at the bedside just in case.
    Observe for bubbling. Intermittent bubbling indicates air is leaving the pleural space which means the pneumothorax is resolving. Continuous, rigorous bubbling indicates an air leak. Check along the tubing and if the air leak cannot be found, you might need to replace the CDU.
    Monitor drainage. Typically drainage should not exceed >150-200cc/2 hours but it depends on hospital policy and on the surgeon. The amount of drainage should gradually decline. Monitor your vital signs!
    Finally, don't accidentally knock it over