Care of chest tube for paediatric cases
0Jul 28, '12 by deepurpleHi 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.
0Jul 28, '12 by NotReady4PrimeTime, RN Senior ModeratorStripping of chest tubes is no longer a standard of practice. This creates too much negative intrapleural pressure, pain and tissue trauma. Bottles are not used for drainage collection in most of the world now. Pleurevac or Atrium collection systems are the norm and do not need to be changed until nearly full.
0Jul 28, '12 by umcRNQuote from janfrnHi Jan,Stripping of chest tubes is no longer a standard of practice. This creates too much negative intrapleural pressure, pain and tissue trauma. Bottles are not used for drainage collection in most of the world now. Pleurevac or Atrium collection systems are the norm and do not need to be changed until nearly full.
It just so happens that I am currently in the process of reviewing our chest tube policies this year (we do this yearly and make revisions as EBP indicates)
We currently continue to strip our chest tubes, sometimes quite aggressively in our post op cardiac kiddos. Seeing that your unit doesn't how do you prevent clots? And potential tamponade in heavy bleeders? I have cared for quite a few kiddos who the attendings insisted that we strip the chest tubes even as much as every 30 minutes and there is one doc in particular who if she thinks your not doing a good enough job at it (depending on what the kiddo looks like) she'll stop by on the hour and get a little action of her own. Are you able to point me in any directions for recent research related to this? I am currently working on the lit search for the review and would love any other sources to look up.
0Jul 28, '12 by Sun0408The only time I have ever had to milk or strip a CT was for an open heart heavy bleeder. Other than that, we rarely need to strip or milk one...Depending on the system used; some will have a bubbling (normal) for that system or for others bubbling = leak. So I really can't answer without knowing the system. Dressings are changed q day and the CT is sewn in place to help avoid accidental removal. We also don't use bottles anymore.
0Jul 28, '12 by umcRNQuote from Sun0408Well I work in a cardiac ICU so they're all open hearts, and many are on heparin drips after surgery because of their anatomy, but I know that is the case in many pedi cardiac icu's so I would also be interested in how other units manage those pts chest tubes w/o stripping themThe only time I have ever had to milk or strip a CT was for an open heart heavy bleeder. Other than that, we rarely need to strip or milk one...Depending on the system used; some will have a bubbling (normal) for that system or for others bubbling = leak. So I really can't answer without knowing the system. Dressings are changed q day and the CT is sewn in place to help avoid accidental removal. We also don't use bottles anymore.
1Jul 28, '12 by NotReady4PrimeTime, RN Senior ModeratorumcRN, we've actually been issued a directive that we RNs are NOT to milk, strip, tap or otherwise encourage drainage through our chest tubes, and that if these are needed then a physician must do it. We have very few problems with clotting, even in our post-op CVs with bleeding. We use the Atrium dry drainage system with the suction set at -15 for mediastinal tubes and -20 for pleurals. We used to use a mediastinal sump tube on our CVs to minimize clotting until the bleeding decreased then switched to Pleurevacs but found that we had more mediastinitis. Once we started using the Atrium system we got rid of those sumps and have only had one clot. Without stripping, milking, flicking or tapping.
Here are some journal articles on the subject.
Medscape: Medscape Access
Is Milking and Stripping Chest Tubes Really Necessary? -- Lim-Levy et al. 42 (1): 77 -- The Annals of Thoracic Surgeryhttp://ajcc.aacnjournals.org/content/16/6/609.full.pdf
0Jul 29, '12 by deepurplethank you for those replying my question...
What i'd been practiced now in my ward which i handling post operative pediatric cardiac surgery.
Our surgeon was using the disposable bottle drainage which not connected with vacuum. The drainage will drain out follow the gravity. Under some circumstances, our surgeon will give order to connect CT to low suction but it's rarely.
I'd seen the ICU staff did stripping the CT on post op day. Which one is the good practice?
One more thing...what i had understand about the clamping of chest tube is to prevent back flow of drainage to pericardial or pleural and to avoid air from entering the chest tube if the connection is dislodged. Are these rationales incorrect?
0Aug 4, '12 by NotReady4PrimeTime, RN Senior ModeratorOne of those references indicates that dependent loops in the tubing are a cause of many drainage failures. I like to coil my tubing on the bed and whenever I notice fluid sitting in the coils I walk it down to the chamber. I also tend to disregard our directive to a certain degree. If I see fluid at the 5-in-1 I've been known to gently squeeze the tube just above that point to make sure it's not static. Then I walk it down. I do the same with my foley catheters but instead of coiling the tubing on the bed I run it down to the foot and hang the bag there so that there's a straight line for it to drain. Ditto for my PD collection set. Saves a lot of time and effort. I choose to work smart, not hard!