Care of chest tube for paediatric cases

[deepurple]

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 all of you. TQVM, You're most welcome.

1.Check dressing at the site of chest tube insertion

-Ensure the dressing or plaster is intact to avoid the chest tube is slip out.

2.Do dressing at the chest tube insertion site to avoid potential infection.

3.Check the patency of the chest tube

- Do milking or stripping along the chest tube to avoid blockage or obstruction of the drainage.

4. Observe the type of drainage and amount of drainage.

5. Check is there any bubble in the chest tube to to know whether there is pneumothorax

6. Change the drainage bottle when 2/3 full of drainage.

- if chylothorax - need to change the drainage bottle everyday to observe the progress of the drainage.

7. Clamp the chest tube when to move the patient or when to walk to avoid the back flow of the drainage into the lungs or cardial.

[umcRN, BSN, RN]

Chest tubes out POD 2? Ha, more and more our docs have been sending kiddos out to the floor still with their chest tubes (not always but I feel more so than when I started on the unit)

I would say that our biggest bleeding issues are with the single ventricle kids (regardless of the stage) and they are always on heparin drips post op. I have noticed that other kiddos bleed quite a bit too, even some who really shouldn't be bleeding that much (LPA sling?) as well as Tets and a rapid deploy ecmo kid I had once we were practically replacing his body volume continuously through the shift (and he was 3). Is it something the surgeons are doing? I don't know. We certainly use plenty of blood products. I get what you're saying about the blood filling the tube and possibly decreasing suction to the end of the tube so I'll keep that in mind.

[NotReady4PrimeTime, RN]

We 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?