Chest tube care
- 0Jul 31, '12 by deepurplehi 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.
2.do 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.
- 0Jul 31, '12 by deepurplethank 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?
- 0Jul 31, '12 by tcvnurse, BSN, RNAgree 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.
- 0Jul 31, '12 by umcRNQuote from SCnurse2010We 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 policyMake sure you have really thick skin for the verbal beating you'll get from the MD for milking or clamping a chest tube!
- 0Forgot 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.
- 1umcRN: 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.