Pain Med for Chest Tube Removal

Specialties MICU

Published

  1. Pain Meds given before pulling chest tubes?

    • 10
      Yes
    • 1
      Yes - Admin PO Drug
    • 22
      Yes - Admin IV Push Drug
    • 5
      No

38 members have participated

I recently read a journal article regarding the importance or pre-medicating pt's with pain meds before chest tube removal, but in my limited experience I've only seen this done a few times. I'm just wondering how often this does happen and what type of meds are typically used. Do you give medication prior to pulling chest tubes?

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Specializes in Nephrology, Cardiology, ER, ICU.

I work in the ER where we put chest tubes IN, not OUT but gee whiz - if I had a chest tube in - I'd sure want some IVP pain meds.

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I work in the ER where we put chest tubes IN, not OUT but gee whiz - if I had a chest tube in - I'd sure want some IVP pain meds.
TraumaRUs,

I'm in complete agreement with you, but many times I've been with nurses to pull CT's and they don't pre-medicate. As a new nurse, I'm still learning the ropes, so I always ask if they're going to give pain meds before. Usually they look at me like I'm an alien. Responses that I've gotten are ... "It only takes a minute to pull" or "I can have the CT out before I can even get into the Pyxis" but my favorite was "I've never given meds before pulling CT's. It'll hurt for a while but then he'll be fine".

I always play the NEW nurse card and explain that research indicates that this procedure is moderately painful/traumatic and pain medication is warranted. I also point out that it is hospital policy at our institution, but I have been unsuccessful many times. I'm hopeful that this is just my limited experience because I definitely would want pain meds before this procedure and I will be administering meds to my patients.

CRNAsoon

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Specializes in CCU (Coronary Care); Clinical Research.

Our standing orders state that we can give 1-2 mg IV versed and 1-2 mg IV MS prior to CT pull...We usually give the doses when we see the docs walk through the door in the morning...on average, usually 0.5-1 mg IV versed and 1-2 of MS works pretty well depending on the patient...our docs can get a little pissy if the patient is too snowed though so we try to find a good balance...

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Our standing orders state that we can give 1-2 mg IV versed and 1-2 mg IV MS prior to CT pull...We usually give the doses when we see the docs walk through the door in the morning...on average, usually 0.5-1 mg IV versed and 1-2 of MS works pretty well depending on the patient...our docs can get a little pissy if the patient is too snowed though so we try to find a good balance...

Thanks for sharing ... CRNAsoon

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When I worked on IMCU, the residents never gave pain meds for removal.

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Specializes in ER.

My husband, who is the most stoic man I know, had bypass surgery this year. He said the chest tube removal was the worst part (no premeds) and that if he had had a gun, he would have shot the doctor who took them out! He still talks about it and it has been 4 months. He was so angry, he wrote a letter to the surgeon about it. There is absolutely NO reason not to medicate a patient, except that cardiothorascic surgeons are usually pompous A$$es and do not want to wait the 2 minutes it takes for the nurse to get the meds. And for those nurses who actually pull chest tubes (and I didn't know nurses ever did), shame on you for not medicating your patient adequately. Why intentionally inflict pain on someone who has been through such a major surgery if you do not have to? Our job as nurses are to act on the patients behalf, not subject them to painful procedures if we do not have to. There is enough we do to patients that take away their dignity, autonomy and cause pain. Why not do what we CAN do, to make their hospital stay just a little less miserable.

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Dixielee,

Thank you for your response. I see that you feel exactly the way I do. Most facility's don't let nurses pull CT's but the CTICU where I work does allow it so it's always the RN. I'm still in orientation so I'm at the will of the preceptor for most of my actions, but I'm constantly questioning and pushing for pain meds. The other day, I saw a nurse with an orient pulling four chest tubes. After the first one came out, the pt screamed and begged for pain meds. I offered to get the meds and give but the nurse said it wasn't necessary and just had her orient keep pulling tubes. I thought I was going to cry for this gentlemen.

I am beginning to see how how stupidity and ignorance perpetuates itself throughout the nursing profession. At my institution, preceptors have no specific training. Whoever's available gets the new grad. The new grad is vulnerable and tries to emulate what they see without thinking for themselves ... and the cycle of inadequate care continues. I am trying really hard to be autonomous and perform tasks the way they were taught in school and in the policies/procedures manual, but I'm meeting a lot of resistance. I can easily see how many new grads just go with the flow because it's easier, but I don't intend to become a statistic.

I'm so sorry about the incident with your husband, but I'm so glad that you shared.

CRNAsoon

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Specializes in ER.

Dixielee's husband here. While I am a bit of a stoic, and have experienced pain before (I once pulled a inpacted wisdom tooth myself without any pain medication, when I was living out back in Alaska). Because of some oversite, and because I/we did not know the procedures, I went for the first 24 hours after my surgery without pain medication (came off the ventilator in 4 hours). A nurse would come in from time to time to enquire how was my pain. This was when I was laying perfectly still, and not taking too deep breaths. Almost everybody that I have ever talked to has told me how much whatever surgery they had hurt, so I thought the pain that I was having was about as good as it got. I was being given a handfull of pills twice a day and thought there was pain medication in them (they said there was, but it turned out to be toredol, good drug, but not enough). I had my first pain medication (Percocet) about 20 minutes before the doctor came in and yanked the chest tubes out. Until then the pulling my own tooth had been my "10" on the pain scale, but having the tubes pulled out is now my "10", and I hope to never feel that kind of pain again. Please do all that you can for the people under your care. Just because somebody is not screaming and begging for more pain medication all the time doesn't mean that they are not in pain. Trust me on this one.

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I work in a CTICU, and I usually offer it to my patients. Sometimes they take me up on it, sometimes they don't. Our standard postop pain meds are morphine, usually 1-10mg IV Q2 (depending on who wrote the orders). I usually don't give versed, because I need patients to hold their breath when their tubes come out - and patients who get benzos are sometimes not as cooperative as they could be:-) I have pulled CTs out with no pain meds before, and some people tolerated it every well. I encourage the patients to get pain meds before pulling the tubes if they are especially nervous about how painful it may be. I have found that adequate education beforehand usually helps reduce their perception of how bad the pain is - taking the time to explain why the tubes need to come out, and how much better they should feel afterwards (easier to breathe, etc).

In my opinion, pain meds should always be offered, or the tubes should be pulled to coincide with peak effect of pain medication that has already been administered.

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Specializes in NICU.

I work in the NICU, not adult ICU, but we always give our babies a 2 mcg/kg dose of Fentanyl a few minutes prior to inserting or removing chest tubes.

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... but having the tubes pulled out is now my "10", and I hope to never feel that kind of pain again. Please do all that you can for the people under your care. Just because somebody is not screaming and begging for more pain medication all the time doesn't mean that they are not in pain. Trust me on this one.

Dixielee's Husband,

Thanks so much for sharing your story. I'm so sorry that you experienced this during your hospital stay, but I am hopeful that this is a great teaching moment for all of us.

CRNAsoon

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