Chest Tube Question

Nurses General Nursing

Published

We use LPNs on my floor. They cannot do IV pushes. So an LPN asked me give solumedrol and ativan to her patient. So I agree and head down to the room. When I get in the room the patient seems to be in quite a bit of respiratory distress. I don't know much about the patient so i question her if she has been SOB for long. She tells me she just returned from xray and she has been short of breath throughout her hospital stay but not this bad. I also hear a terrible sucking, burping type noise. I remember hearing something about a chest tube removal earlier in the shift. I ask her if she had a chest tube removed today and she said she did. I grab a set of vitals and an O2 sat. Her O2 sat was 82% on 2L and I bumped her up to 5L where she came up to 92%.

Remember I know nothing about this pt. I call for her primary nurse to come to the room. I see her outside the room and she says she just picked up the pt at 1500 and she hasn't seen her yet b/c she'd been in xray.....

Anyways she reinforces the dressing and we get a stat portable CXR. She calls the physician and i go back to my patients...

My questions is.. why was it making that terrible sucking noise?? I know that can't be good and it has something to do with the air passing through the old chest tube site, but i don't quite understand why it would do that. And I hate to sound like an idiot. But the other nurses just told me it shouldn't be doing that.. But I was wanting a better explanation. If y'all could help that'd be great.

Thanks

Tiger

Specializes in vascular, med surg, home health , rehab,.
the pleurovac on our unit has a shut off valve on the short suction tubing that connects it to the longer tubing to wall suction. If this short suction tubing is supposed to be left open to air when the system is to gravity, why is there a shut off valve there? The doc on our unit went ballistic when he saw it open to air -- don't understand his thinking.

I think I know what you mean, the same question came up last week so we asked the surgeon; He said it doesn't matter, the valve is just to turn off suction while you top off the fluids when in use. When wall suction is off and its to water seal it doesn't matter, the water seal will prevent air from reentering the lung. Most of out CT pts go to radiology off suction, because they get a better film. Not sure why you doc was freaking out? Hope that helps.

The chest tubes I mentioned were not "open to air", there was a doctors order to disconnect the CT from suction for transport,-- I feel very comfortable taking care of these patients. I was merely questioning why a doctor would get upset because the suction tubing was not clamped after it was taken off suction

Specializes in vascular, med surg, home health , rehab,.

I found this on Atriums website, these are the drains we use.

1. Should the suction control stopcock be turned off for gravity drainage or for patient transport?

No. The suction control stopcock should always remain in the on position when connected to the patient. If the stopcock is turned off though, the patient is still protected two ways; first by the one-way valve created by the water seal, and second, by the integral positive pressure valve. Both the water seal and the positive pressure valve provide maximum patient protection when either the suction line or stopcock remain open or closed. It is not necessary to turn off the stopcock, clamp, or cap the suction line during gravity drainage or patient transport

Specializes in ACNP-BC, Adult Critical Care, Cardiology.

I guess my post was not clear...I meant the tubing that connects to the wall suction tubing, the one with a valve that clamps the tube...that should never be clamped even when the patient is in transport.

Specializes in ACNP-BC, Adult Critical Care, Cardiology.
The chest tubes I mentioned were not "open to air", there was a doctors order to disconnect the CT from suction for transport,-- I feel very comfortable taking care of these patients. I was merely questioning why a doctor would get upset because the suction tubing was not clamped after it was taken off suction

I would clarify this and ask that physician for his rationale. The suction tubing you are referring to should not be on the clamp position when taken off suction. Again, that closes the whole pleur-evac unit and prevents air from being evacuated - not something typically done unless there is a good reason to.

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
The doc on our unit went ballistic when he saw it open to air -- don't understand his thinking.

He wasn't thinking and that's the problem. If he's going to order a piece of equipment to be used on a patient the least he could do was understand how it works. :banghead:

Agreed, provided the under water seal is functional, you have a one way valve. One think I like to do is place a heimlich valve between the patient and the pleurevac that can act as a backup.

My flight service started using newer "dry" evacs that maintain a seal without water. This is quite nice in the transport environment.

we currently use a heimlich valve at the end of our chest tubes for transport, we have a new md that thinks it is ok to connect a chest tube directly to wall (or aircraft/ambulance) suction canister without a water seal drainage device in line. i have read there are dry devices you can use in line, i don't know much about them. my question is has anyone ever connected a chest tube to suction tubing that goes straight to the suction canister connected to the suction head???

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