I've been a nurse for about 1 1/2 years working on a busy med/surg floor. A question arose the other day however, I noticed a the drainage in the JP drain tubing was looking rather thick, I asked another nurse about it and she told me to "milk" it.
Now my question is can you do this without a doctors order? I you are pinching it off above where you are milking it at, so as not to create more suction (and of course not pull the darn thing out).
I asked my Nurse Manager about it the following morning and she really didn't have an answer for me (go figure)
I know in nursing school they teach you to never milk anything....but what are you thoughts and opinions?
Jul 24, '08
Although we rarely use JPs we use Blake drains which are similar. If we didn't milk them they would clot off making them ineffective. As far as I am concerned it is a nursing judgement as to when and how forcefully to milk the drainage from these tubes. The doctor placed the drain for a reason and it is my rsponsibility to see that it continues to function properly. As to technique: First you pinch off and secure the tube as close to thier body as is convenient. With the other hands' thumb and first finger you strip down the drainage into the pleurevac or grenade drain. Let go with the srtipping hand frist to relieve some of the excess vacuume, then release the securing pinch. If the tube still isn't patent you can gently MILK down the drain without securing the tube alowing a slight intermittant incerease in suction and hopefully work any clot down and out of the tube into the drain container. Our docs will throw a tantrum if you let a drain clot off.
Jul 25, '08
We always milk JP's - otherwise they would clot off...seen it happen - not pretty!
Jul 25, '08
I don't routinely milk JP's, but if it seems sluggish in the tubing, I will. No big deal, just make sure you have a good grip above where you're milking so it doesn't pull at the sutures!
Jul 26, '08
I've used a little lotion on my gloves while milking it. Helps a little.
Aug 24, '08
Take an alcohol prep and put it in front of you fingers with your fingers proximal to the insertion site. Run the prep pad along the tubing in front of your fingers, while your non-dominant hand stabilises the tube to prevent pulling against the stiches. The alcohol lubricates the tube and allows your fingers to strip the tubing. common practice on our floor.
Sep 10, '08
I work on a med/surg floor where we frequently have JP drains. Our protocol is to "strip" (or milk) the tubing every 4 hours. I use an alcohol pad as well, makes it easier. This prevents the tubing from clogging.
Sep 15, '08
I will milk JP's only if they are sluggish. Using the alcohol prep works well. I don't believe you need an order for that.
Sep 18, '08
I understood you needed an order. If the manager didn't have an answer then its her job to find you one. If in question, ask the doc. Whatever the floor protocol, if he/she doesn't want it done they need verbalize it
Sep 18, '08
It was part of my duties when I was a CNA. I can't see that it would need to be ordered, I bet it's part of a protocol. The alcohol square helps a lot.
As a nurse, when the patients were up to caring for themselves, I taught them how to do it since most went home with the drains.
Always something new, isn't there
Sep 19, '08
Does the facility have a P & P on milking drains? If not then get one. We do not routinely milk the JP drain tubes until we notice a decrease in output, then we do it about q 4-6 hours depending on how the drainage looks in the tube and how much we get when we milk it. If there is no significant increase or the drainage seems to have decreased drastically, we generally mention it to the doc, he will decide to pull it or put it to suction for 5 minutes every 6 hrs x 2. If the drainage continues to be low, he generally pulls the drain. Just how we do it here, I am sure things are a little different everywhere.
Sep 19, '08
Having had my fair share of the things lately (ummmm, 5 at last count), I had orders to strip the tubing prn. If you've ever had one yourself, you find out real fast to hold that proximal end so you don't pull at the stitch!! OUCH!!
Sep 21, '08
Our hospital P&P states to strip JP q shift. I always do it during my initial assessment. Alcohol wipes are great and remember to hold the tube at the insertion site!