Milking chest tubes

[CleioRN]

I just found out that the hospital I am currently working at, still has it in their policy for maintaining chest tubes to "milk" the chest tubes as needed. At my last hospital is was never allowed and it was a much more progressive hospital. So! Does anyone have any information/studies that speak to this subject. Do you? don't you? I'm looking for some evidence to bring to my units educator who doesn't see a problem with the practice. I would appreciate any information! Thanks!

[Post Oper]

I agree with Richard. If you dont strip the tubes, or milk them, or do something, they clog off. Its unfortunate, but something has to be done. I wish there was a better way because it takes a lot of time and does not always work.

[michellehoong]

it has been a standard procedure in our unit to milk patient pleural and medi drain post opt...we do not need the surgeion approval...thanks for the above info.. i will be careful and think about the pressure it will caused while milking..

[Zombi RN]

At our facility it depends on the surgeon -- some want you to strip, some don't. They will tell you what they want you to do. However, I have not seen even the ones who don't like it say not to strip in an event where tamponade is likely.

I do think that stripping and milking are helpful in some situations. Like someone else said, best practice doesn't fit every patient every time -- I think the outcome of stripping vs. not stripping must be taken into consideration when deciding if this should be done or not.

[CABG patch kid, BSN, RN]

Interesting discussion.... It never occurred to me to even see what the policy is at our facility, as it's assumed that you will milk a mediastinal CT on a fresh open heart if during your assessment you feel that it's not draining adequately, especially on a pt who has received blood products (namely FFP) and is now putting out "chunky" clotty drainage. In fact it's safe to bet that the surgeon would be pretty peeved if you called him to tell him the tube clotted off and that you haven't attempted to break the clot loose.

I will also say that we don't routinely strip tubes. We rarely do, it's only if needed, but I've seen the surgeon give a tube a good few strips before going home for the night.

Also the size of the tube makes a difference. The smaller silicone tubes they use with the noninvasive patients have a tendency to clot easier, you definitely have to watch those closer.

[Matt799]

You DO NOT want to milk or strip a Pleural chest tube. You should only strip a pleural chest tube toward the patient as to blow the clot back into the body.

I'm studying for boards and my review course says, "Gently milk in the direction of drainage, if needed." This was in regards to a pleural tube. Is anyone else familiar with the practice of milking a clot back in to the body? If so, what purpose does this serve?When I read this comment I thought it was a typo but then I thought I may not fully understand the negative pressure generate by stripping away from the patient towards the collection chamber. Would the result be comparable to jacking up the wall suction? Having personally had a spontaneous pneumo/hemo, chest tube, and pleurodesis, I'm not sure why I can't wrap my head around some of this stuff lol. All I know if my nurses let no one near my tube. If someone so much as repositioned it they flipped out lol.Thanks all!

[jezlynh]

I work at a very large hospital ranked in top #5 in country for CT surgery. We are instructed to strip chest tubes immediately after heart surgery. I agree with previous posts...I have never seen any harm come from stripping CT'S, only from them clotting off.