Feeling like a dummy, re:chest tubes

Nurses General Nursing

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I graduated in May 2000 and have been working as as staff RN for 5 months, the last month in a new unit (Card/Tele).I feel like I am really "getting it" now. All those things I learned in scholl are finally being "appied". Then....yesturday, I had a sweet old guy w/ 2 chest tubes to suction and everything was running smoothly.I only had 4 patients that day and was o.k(still out of breath and needing to pee badly of course!).The PA came and "stripped" the tubes and then left.About an hr later the Doc and PA come back and I hear from the room "tell her to come in here". I thought my heart was going to stop! I went in and they say there's no H2O in the system.Well, there was an hour before, I swear! I looked at them and heard the bubbling.BOTH Pleurovacs were filled to the correct line. So can anyone tell me if stripping the tubes messed w/the pressure or what? I owned up and said frankly "I'm very sorry.I'm new here and I'm still learning.Can you tell me what happened?". The Doc just filled them and the PA fixed it and that was that.They didn't rant or yell but I feel really bad! The PA said no harm done but I want to know what happened.I dont't want to harm my patients.

Any advice would be appreciated. Thanks.

Originally posted by cmggriff:

sharann,

Stripping the tube transiently increases the pressure at the end of the tube. I am not aware of any problems with any system r/t stripping and the water seal. I think the problem must have been as suggested above. If the suction set up gets tilted or turned over, the water in the chamber can run into another. No way 20 cm of H2O evaporates in 1 hour.

We all make mistakes. After working with chest tubes infrequently for 2 or 3 years, I set up an Argyle wrong. I had no suction at all. One of my fellow nurses had to straighten it out. Keep on keeping on.

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Originally posted by cmggriff:

sharann,

Stripping the tube transiently increases the pressure at the end of the tube. I am not aware of any problems with any system r/t stripping and the water seal. I think the problem must have been as suggested above. If the suction set up gets tilted or turned over, the water in the chamber can run into another. No way 20 cm of H2O evaporates in 1 hour.

We all make mistakes. After working with chest tubes infrequently for 2 or 3 years, I set up an Argyle wrong. I had no suction at all. One of my fellow nurses had to straighten it out. Keep on keeping on.

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Originally posted by cmggriff:

sharann,

Stripping the tube transiently increases the pressure at the end of the tube. I am not aware of any problems with any system r/t stripping and the water seal. I think the problem must have been as suggested above. If the suction set up gets tilted or turned over, the water in the chamber can run into another. No way 20 cm of H2O evaporates in 1 hour.

We all make mistakes. After working with chest tubes infrequently for 2 or 3 years, I set up an Argyle wrong. I had no suction at all. One of my fellow nurses had to straighten it out. Keep on keeping on.

I have been working with pluerovac for a couple of years now and stripping a tub is contraindicated because the trancient increase in pressure can so great that in could damage the plural lining. It is also unlikely that you had too much negative flow because the pluralvac should have a dial to regulate the flow to what you set it at i.e. 20 cm/H2O. One thing that I have noticed with working with residence and PA at my teaching Hospital is that this individual sometime accidentlly knock the pluralvac over causing the H2O level to drop into the other chambers and think there is nothing wrong.

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Originally posted by cmggriff:

sharann,

Stripping the tube transiently increases the pressure at the end of the tube. I am not aware of any problems with any system r/t stripping and the water seal. I think the problem must have been as suggested above. If the suction set up gets tilted or turned over, the water in the chamber can run into another. No way 20 cm of H2O evaporates in 1 hour.

We all make mistakes. After working with chest tubes infrequently for 2 or 3 years, I set up an Argyle wrong. I had no suction at all. One of my fellow nurses had to straighten it out. Keep on keeping on.

I have been working with pluerovac for a couple of years now and stripping a tub is contraindicated because the trancient increase in pressure can so great that in could damage the plural lining. It is also unlikely that you had too much negative flow because the pluralvac should have a dial to regulate the flow to what you set it at i.e. 20 cm/H2O. One thing that I have noticed with working with residence and PA at my teaching Hospital is that this individual sometime accidentlly knock the pluralvac over causing the H2O level to drop into the other chambers and think there is nothing wrong.

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Thanks so much everyone! I was really feeling bad, but now I see that I am not alone.I have to remember I'm not perfect,I'm just expected(by all)to be. Nope, I didn't get reamed by the Doc or the PA, in part I think to the fact that I didn't get defensive. I just said "I'm sorry I am new and learning.I'll pay attention to this in the future now that I know." This WAS the truth.I got lucky.

Thanks again, I much appreciate everyones input.

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Thanks so much everyone! I was really feeling bad, but now I see that I am not alone.I have to remember I'm not perfect,I'm just expected(by all)to be. Nope, I didn't get reamed by the Doc or the PA, in part I think to the fact that I didn't get defensive. I just said "I'm sorry I am new and learning.I'll pay attention to this in the future now that I know." This WAS the truth.I got lucky.

Thanks again, I much appreciate everyones input.

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SRIGGS,

I was aware, although I didn't make it clear,

that stripping of chest tubes is containdicated in the new (I'm old) systems. Frankly, I wondered why a PA would be doing this any way?! I thought the whole thing smelled. But I don't have enough info to judge.

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SRIGGS,

I was aware, although I didn't make it clear,

that stripping of chest tubes is containdicated in the new (I'm old) systems. Frankly, I wondered why a PA would be doing this any way?! I thought the whole thing smelled. But I don't have enough info to judge.

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Hey Nittlebug,

That idea of watching a video of the system is really good! Thanks. These tubes are tricky. I think the PA knew better but knew it too late.

Thanks for the info!

Sharon

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Hey Nittlebug,

That idea of watching a video of the system is really good! Thanks. These tubes are tricky. I think the PA knew better but knew it too late.

Thanks for the info!

Sharon

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Hi Sharon ! I haven't had to use a chest tube in awhile, but we just had a inservice on the new Pleurevac CT system. Stripping is generally contraindicated due to the excessive negative pressure that builds up, and I wouldn't do it without a doctors order. But no matter what the new standard is, you will always get an old school doc who has been doing things his way for years.

My point is on the new Pleurevacs, ( and the Thoraklex System as well ) they have relief valves you push down on to releive the excessive negative pressure if the tubes need to be stripped.

They also have separate air leak indicator chambers so you can tip the thing over and still have accurrate measurements. Nothing gets mixed together, and no damage is done.

Your unit should have a video from the product rep somewhere. I recommend you take the time to review it. I had to watch ours 3 times before I really understood how it worked. They always tell you a bunch of crap you don't need to know and it gets confusing.

[This message has been edited by Nittlebug (edited March 04, 2001).]

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Hi Sharon ! I haven't had to use a chest tube in awhile, but we just had a inservice on the new Pleurevac CT system. Stripping is generally contraindicated due to the excessive negative pressure that builds up, and I wouldn't do it without a doctors order. But no matter what the new standard is, you will always get an old school doc who has been doing things his way for years.

My point is on the new Pleurevacs, ( and the Thoraklex System as well ) they have relief valves you push down on to releive the excessive negative pressure if the tubes need to be stripped.

They also have separate air leak indicator chambers so you can tip the thing over and still have accurrate measurements. Nothing gets mixed together, and no damage is done.

Your unit should have a video from the product rep somewhere. I recommend you take the time to review it. I had to watch ours 3 times before I really understood how it worked. They always tell you a bunch of crap you don't need to know and it gets confusing.

[This message has been edited by Nittlebug (edited March 04, 2001).]

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