Recently I was given an order to TPA and the later to Talc (pleuradese) a double chest tube. I declined as this falls outside my experience. While I have assisted with the procedure and taken care of the patient following the procedure, I had never physically injected the meds.
Is this something that falls inside of a staff nurse's scope of care?
Mar 10, '05
We strip mediastinal CT's all the time to hopefully prevent clots, but I've never done what you're talking about and actually never even seen that done.
Mar 10, '05
not within the scope of practice in pa to instill anything into chest tubes. assisted the docs many times when worked pulmonary unit. talc worked well >95 %, better than antibiotic. turning side to side every 15 min, even to prone if can tolerate helps to distribute talc and promte internal scaring to seal lung.
chemical pleurodesis links:
Last edit by NRSKarenRN on Mar 10, '05
Mar 11, '05
Our Interventional Radiologists did this, or instructed the Residents how to do it (although some of them I'd not trust with stopcocks, if you KWIM). I would NOT do it. Check w/your state BON.
Mar 25, '05
Quote from NRSKarenRN
Not within the scope of practice in PA to instill ANYTHING into chest tubes. Assisted the docs many times when worked pulmonary unit. Talc worked well >95 %, better than antibiotic. Turning side to side every 15 min, even to prone if can tolerate helps to distribute talc and promte internal scaring to seal lung.
Well, I am on assignment in Florida, but I refused as I am not comfortable with doing this procedure.
As I work oncology and most of my pleural effusion pts are malignant in origin or ca related, the success rate on pleuradesing is not nearly so good.
I was just amazed that this facility will not permit cardiac gtt on the onco unit and are very fussy on KCL boluses/cardiac pushes on the onco unit, but would ask us to TPN/talc a chest tube.
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