chest tubes

[deadlydevil]

Hi can any one clear me if we can clamp the tubes or not what are the occassions we dont clamp it?

[Virgo_RN, BSN, RN]

Clamping a chest tube will never cause a tamponade, it's just impossible. The thoracic cavity can hold well over the amount of blood circulating in our bodies. Therefore, one could potentially hemorrhage out, but not tamponade.

What if it's a mediastinal CT?

[jbp0529]

Thats incorrect.

Tamponade is a real issue post-CABG...which is a primary reason why these patients have (usually) 2 mediastinal chest-tubes.

Clamping these tubes immediately post-op can quickly lead to tamponade...as these patients often have elevated PTT's, etc...and can dump a good amount of blood in the first few hours...and an could be an even more pressing issue should the patient have a bleeding/leaky graft..)

My goodness, if i ever clamped the mediastinal CTs on a fresh heart, the surgeon would clamp my @**

[nursecass]

Clamping a chest tube will never cause a tamponade, it's just impossible. The thoracic cavity can hold well over the amount of blood circulating in our bodies. Therefore, one could potentially hemorrhage out, but not tamponade.

I've actually seen it happen. We came onto shift with the patient going downhill quickly and within a few minutes the patient went into tamponade. Come to find out the CT's had not been connected to any kind of suction and apparently the day nurse didn't move the CT's to ensure patency/keep the drainage moving. That was a fun one...made me very glad I was not the primary nurse having to explain all this to the surgeon.

[missej2002]

I am a new nurse, and i have a question about collapsed lungs. What do you do when a chest tube does not work? What is the next step?

[BBFRN, BSN, PhD]

I am a new nurse, and i have a question about collapsed lungs. What do you do when a chest tube does not work? What is the next step?

http://www.teleflexmedical.com/ucd/nursing_considerations_troubleshooting.php

Here's a pretty good trouble-shooting guide.

[missej2002]

i guess that i should clarify the question, there is nothing wrong with the chest tube, it is the lung. The lung re-expand and then re-collapsed, and has not re-expand since then and the tube has been in placed for a week.

[UM Review RN, ASN, RN]

I think that falls into the realm of the doc's diagnosis and treatment, missej2002.

You might ask him what the next step in treatment would be if the CT is not working to expand the lung. Most docs are glad to teach.

[BBFRN, BSN, PhD]

Have they tried dry suction?

What is the cause of the pneumo? Was it tension, trauma, or fluid related?

[mtwedt]

When taking a CT patient off suction for transport, do you clamp the suction tubing? or do you leave it open to air. And why? I am not talking about the water seal tubing, I am talking about the tubing attached to the wall suction. Need to know asap as I am getting conflicting answers from very angry doctors...........

I think you are referring to the Argyle plastic tubing that connects the drain to the suction source, correct?. If you need to transport a patient, you have three options: Remove the suction tubing from the drain and transport the patient on water seal, something that may not be a good idea in a patient with large airleaks (ie.. lung reductions), transport with the suction tubing and connect to suction at your destination, or transport connected to portable suction (which I've never done). The determining factor is whether or not the patient can transport without unacceptable air accumulation off suction. Drainage of fluid from the thorax via chest tubes is first and foremost a gravity issue rather than one of suction.