Advice on Chest Tube & mistakes by colleague

[Magsulfate]

I have been searching the web and this site for about an hour trying to get confirmation that we still use petroleum gauze around a chest tube site... .. Is this true?

I was always taught to dress the site with petroleum gauze, 4x4's and medipore or a very good surgical tape and then ancher the tube to the patient with two more pieces of tape.

Most posts on this topic at AN are several years old and I need a current answer/opinion/knowledge base a little more specific to my issue. I had a patient the other night, upon assessment I found that the dressing was intact,, HOWEVER-- it was below the chest tube site and the insertion point was open to air. I also found the pleurevac must have been turned over at some point because each chamber had an inch or two of drainage in it. The previous nurse had timed, dated and initialed each chamber. (I found this quite interesting). Also the drainage system was not set up correctly to the 20cm wall suction.. wall suction was turned off . The patient was stable with no signs of distress and a normal respiration rate and pattern.

The patient had been in our facility for a little more than a day, had been seen by our nursing wound care team ( initial wound care assessment done on sacrum stage 2 wound) and had care from at least two different nurses before I took over care.... once again...HOWEVER---the tape used for this dressing was not tape that we have at our facility. It was surgical foam tape. I know for a fact we do not keep this tape there.

This dressing didn't even look like it had slid down. It just looked like there was a big part of it missing. It was intact,, but completely NOT ON THE SITE. The chest tube was inserted about two weeks before this, and it was not a dressing that I can imagine was put on by the physician or during surgery.

Anyway, I cleaned the site with choraprep, dressed it with petroleum gauze, 4x4's and an abd pad, topped off with 3inch wide medipore tape to cover and anchored it with silk tape. I also had to replace the pleurevac.

Can someone please give me their educated opinion regarding how I should deal with this?? Am I over reacting? I have already written two other incident reports on the nurse that I recieved this patient from. That's two incident reports out of three that I have written in my almost 8 year nursing career. These are major life ending mistakes. Granted, this OTA chest tube probably wouldn't have killed my patient, but there are some nasty bugs in our facility including multiple drug resistant bacteria, VRE, Acinetobactor and other bacteria that should NEVER be near a chest tube insertion site.

I don't want to make this post about this other nurse, but I have a gut feeling that he will continue to make mistakes. I have already talked with management (and typed incident reports twice regarding nurse not acting on order to help correct a critical blood lab value and titrating an anticoagulant drug grossly incorrect) in educating or reorienting him to practice. However, he has the "I KNOW EVERYTHING AND I'M THE SMARTEST NURSE EVER" attitude and management is focused on other issues not pertaining to our unit or nursing at our facility in general. He would be an outstanding nurse, I am sure of it, but he needs to quit believing that he already knows everything and maybe just once try to listen to his peers. He show's great focus on certain nursing aspects, but great ignorance on other very important aspects.

I realize that this incident has several broken processes. But the only common denominator is this one nurse. I just seemed to have gotten more upset than usual because I am now thinking that it is only a matter of time before he really messes something/someone up. Then I will be left feeling guitly, or worse, have my license in jeopardy because I didn't pursue the issues. As a witness to these mistakes, it leaves me feeling like I have an obligation to report. Like the Nurse Practice Act tells us, we are just as much at fault if we do not report.

But then again, I resent our management for not taking my reports seriously, and it leaves me to not even want to report this to them. However, I did document everything in the chart. Very factual and professional, just like I would any other nursing note.

Thanks in advance :)

Magsulfate

[zacarias, ASN, RN]

I vaguely remember something about not using vaseline gauze for chest tube dressings. I wish I knew an article or something.

I remember in nursing school that you always needed to have clamps in the pt's room with a chest tube in case the tubing dislodges from chest tube drain. Then I learned early on from a PA that you never clamp a chest tube like that or you can cause a tension hemothorax which makes sense. I guess the only reason you would ever use the clamp would be to assess where a leak is coming from, but you would leave it clamped for only a SHORT period of time to prevent positive pressure buildup.

[ohgoodnessgracious]

I've had chest tube patients and can't recall seeing vaseline gauze dressing for them. I know some places don't do it because it can cause an increase in infections around the site.

[KaroSnowQueen, RN]

Now, I will start off by saying I have been off the floor for nearly three years, but I have been a nurse 26 years. And when I left the floor, we were still doing the vaseline gauze dressings. And I was taught to always replace an overturned pleurovac, as the drainages would be out of sequence and the docs would have a fit.

[XingtheBBB, BSN, RN]

my apologies. at my nursing school and where I precepted and now work it was a big no-no. I really dont remember the reasoning behind it though. can anyone enlighten me? It does make financial sense but there must be a reason (Im thinking it breaks the water seal or affects the accuracy of the suction) that other hospitals mandate it to be changed.

In the older systems that I learned on it made a huge difference. It did affect the waterseal and patients' lungs could redrop when the units were knocked over. As far as I know in most current systems (at least the atrium systems we use) it only affects water level, we mark it and move on. All new drainage wll collect in order. Just make sure that info is passed on- and physically pointed out- in report.

[fiveofpeep]

In the older systems that I learned on it made a huge difference. It did affect the waterseal and patients' lungs could redrop when the units were knocked over. As far as I know in most current systems (at least the atrium systems we use) it only affects water level, we mark it and move on. All new drainage wll collect in order. Just make sure that info is passed on- and physically pointed out- in report.

Thanks. Good to know. Im going to ask about the reasoning on my unit and see what they say :)