Care of chest tube for paediatric cases - page 2
Hi everyone...i want to ask for help about the care of chest tube. I list the responsibilities of nurses for chest tube care. From your experiences, is there any info to add in the list below from... Read More
0Aug 4, '12 by NotReady4PrimeTime, RN Senior ModeratorWe almost never send a kid out to the floor with their chest tubes still in. JPs maybe, but not chest tubes. (There's a perception that chest tubes can't be managed on the wards. Neither do they administer antibiotics. Or oxygen, and any number of other things that can ONLY be provided in PICU... ) Any time there's significant and persistent post-op bleeding we give the surgeons the hairy eyeball... because it's almost always their fault. A few years ago we had a new surgeon whose patients always bled, and had other complications. Over time he got a lot better. We have 5 cardiac anaesthetists who do an excellent job of bringing the kids back in the best possible state.
Many of our kids are on heparin too; we don't start it until 4 hours after any post-operative bleeding has slowed right down, their INR is less than 1.5 and their PTT is less than 50. We target an unfractionated heparin level of 0.35 to 0.5, even on our ECMO kids. Our rapid deploy ECMO kids all need a ton of product in the first couple of days but eventually settle down to maybe 10 mL/kg/shift of platelets and packed cells.
Do your surgeons ever make use of a Fogarty catheter to restore patency to your chest tubes?