I have recently started a new senior clinical post on a multi-discplinary acute care ward in Singapore (my past nursing experiences are in UK and Australia). It seems that they are obsessed with compulsory 'anchoring' of all drips and drains which I am having difficulty rationalising.
Left to my own discretion(as i am used to) I would anchor a drip/drain depending on the location, purpose, situation and patient rather than a rule.
I have observed that the anchoring can contribute to the kinking and twisting of chest tubes(scary) compromising patient safety rather than enhancing it...
I have looked for some evidence/recommendations to support this anchoring practice but cannot find any.Sometimes anchoring is mentioned with regard to Indwelling urine catheters but otherwise, nothing!
Oct 16, '09
I worked on an open heart floor and usually the Chest tubes were secured in place with sutures by the MDs during Surgery and are usually covered with medi-pore tape. They usually require no 'anchoring' or anything we just usually let them be for the most part.
However, Jackson-Pratt Drains (JP drains, the ones that look like grenades kinda) I have always secured them to a patients gown but made sure that they are in an area where they wont sit on them/ its out of the way kinda thing.
Foley Catheters I always use a 'cath secure' device to anchor them to the patients leg to minimize pulling on them because it's uncomfortable and it good practice, end of story.
hope that helps.
Oct 17, '09
Routine anchoring of any devices/tubes that enter and exit a patient's body is a tricky business that should be addressed using critical thought. I am in favor of policy which provides guidelines but, ultimately, our practice must reflect the individual patient's needs. Experienced nurses have thousands of hours of case experience which enriches their practice in that bedside model. Procedures are necessary for development and maintenance of safe practice. But, they are rather like recipes...if you do something less you can have disaster, but a chef can certainly improve upon it.
This is part of what makes nursing a profession and an art.
Oct 17, '09
Thanks for the responses.I certainly value the importance of guidelines but it would seem as though this 'guideline' is considered a rule in my work place. Enforced by the powers above. Compromising patient safety when adhered to by nurses forced to abandoned critical thinking to comply with the rule.
Modern nursing is attempting to move away from rules and rituals, replacing them with an emphasis on critical thinking that values patient safety and the individual as opposed to promoting the aesthetics of the ward.
Not really sure how anchoring reduces nosocomial infections, except for, if you have tubing in contact with the floor or other contaminated sources. Perhaps i need enlightenment there.
Finally-has anyone seen any evidence from research to support this practice?
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