chest tube question-please help
- 0Nov 1, '05 by sashannSuppose you had a patient, and you walked into the room during your shift and they were standing about, brushing their teeth or something, with their chest tube still in their chest but totally disconnected from the pleurovac system? You just hook it back into the pleurovac (given that is was still sterile?) I would call the physician, but what would your immediate interventions be?
This was a critical thinking question in my textbook, but the teacher never goes over them and now I'm curious. Thanks so much everyone
- 0Nov 2, '05 by dianah, ADN Senior ModeratorToo bad the teacher doesn't go over the questions and answers AND rationale w/you. It strikes me that s/he is losing a valuable chance to teach. Please don't be afraid to ask, though!
Depends on how long it had been in, and what it's in for. I'd have to agree, assess the pt. and call the MD. I know chest tubes aren't clamped a lot these days, as opposed to practice years ago. I'd probably hesitate to clamp it. I might swab the end and change the PleurEvac set. The OP doesn't mention pt being SOB while up. Was this a multiple-choice or essay question?
- 0Quote from NurseyBaby'05You would NOT clamp it. Doing so might cause a pneumothorax.You mean after I did this: ? I would clamp it or put the end in sterile water, assess respiratory status and call the doc. It may no longer be sterile. The end is open for who knows what to crawl in the chest cavity. Did your textbook say to assume it is still sterile?
Putting the end in sterile water, to form a water seal, would be appropriate. Get a CXR, notify the doc, and let him take it from there.
- 0Quote from NurseyBaby'05I don't have time to search for an online source, but I can tell you what I have been instructed to do for at least the last nine years or so.Can you direct me to the info against clamping? I would be interested in bringing this up with our unit educator. I heard about not clamping the tube mentioned briefly, but not seen it in actual practice. Thanks so much!
Yes, years ago, we DID routinely clamp chest tubes, especially during transport and before removal. Not so today, IME.
I will clamp a chest tube to locate a possible leak in the tubing itself, but that's about the only time, and even then, very briefly. An old AACN procedure manual recommends clamping only for "less than a minute." I pinch off the tubing with my fingers when I change the collection unit. You can use the clamp on the tubing, but I have found that clamp clamped too many times----maybe the nurse was interrupted and forgot to unclamp it?
Quoted from the AACN manual regarding clamping chest tubes: "Once clamped, air and fluid will accumulate in the pleural space, and with no method to escape, a tension pneumothorax may result."
You might want to check if someone has an AACN manual around---maybe the ICU.
We just don't do it any more.
- 0Quote from SFCardiacRNYet you can still find conflicting info, especially on the internet. BTW, be careful with those internet sources. I came upon one where a bunch of "experts" (whose expertise could only be summed up, from the online evidence, as claiming to be registered nurses) recommended everything from never clamping chest tubes to clamping for four hours before removal and during transport of the patient.NEVER, NEVER, NEVER , NEVER clamp it. It is dangerous. We call them death clips. I can't tell you how many times a clamp has been left on by accident when a nurse got busy. I still see it being done and cringe every time.
That's why I referred the poster to another source, perhaps a current edition of the AACN Procedure Manual for Critical Care.
Even I could be wrong, ya know...:kiss