Feeling like a dummy, re:chest tubes

  1. 0
    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.
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  4. 11 Comments so far...

  5. 0
    OOPS. Sorry about my atrocious spelling!
  6. 0
    If suction is set too high, water can evaporate quickly? Still a student, just going on theory, not experience.
  7. 0
    Good guess. I think that is true, however, the suction was set the same as before--20ccs suction. The problem had to do with some type of pressute change. Or not???
    Thanks. Hope there are some experienced nurses out there who have lots of CT exp and have an explanation?
  8. 0
    Been a while since I touched an "argyle" but it seems to me that I remember that if it got accidentally knocked over or tipped (even during ambulation) *all* of the fluids _could have (?)_ drained into one chamber and would show up as a net gain to the drainage column but might still be a relatively small volume of increase. This is something that can happen when family visits and you don't even get told.

    I really admire your determination to discuss this problem and see if there is something that you can do differently for the future. I hope you didn't get too reamed by the doc and PA. The PA is probably secretly thinking to himself, "Did I miss seeing (and hearing) the water in the chambers?" but he may never admit it. Go forward and learn and always forgive yourself for not knowing "everything" right away.
  9. 0
    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.
  10. 0
    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.
  11. 0
    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.
  12. 0
    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.
  13. 0
    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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