Chest Drains - removing one at a time?

Editorial Team / Admin · Jul 17, 2015

Have you checked with your facility's policy/procedure on chest drain removal? Policies should include a list of references, which can guide you to what evidence was used in creating the policy.

hajordan · Jul 17, 2015

Hi Rose_Queen, thanks for the suggestion but our policies...If I can find it.....are usually fairly poor! I just can't find any literature to tell me one at a time or not. I'm also compiling a new education pack for new staff and this I think will be a bone of contention!

chare · Jul 18, 2015

I was working yesterday and was helping a collegue pull out 2 chest drains. He wanted to do both at once. I wanted to do one at a time. I would have assumed one at a time would reduce your risk of pneumothorax, but I can't find any literature on this.....or even on google!!

I'm not sure I follow your reasoning. When the chest tubes are removed, if the decision is based upon radiographic findings, chest tube output, absence of an air leak and/or other clinically findings, I don't see how removing two chest tubes is going to be problematic. However, if you are removing chest tubes based upon a clinically pathway, without regard for assessment findings I can see where this might be a problem. However, in this case I think it would most likely result from early removal more so than the fact that multiple chest tubes were removed.

â€¦I just can't find any literature to tell me one at a time or not.

I would be surprised if you did. However, if your facility has a library, or provides access to an online search service, you might try searching current surgical textbooks. If you do find anything supporting this, I would take a close look at what references they based this on.

ETA: I agree with Rose_Queen. You really need to review your facility's policies and procedures. If they don't have one, rather than creating a unit based educational offering, you might have better success writing a policy and submitting it to your facility's practice council for approval.

hajordan · Jul 19, 2015

There's my problem. We don't have a library, and any online access I'm using through my college. Our hospital is fairly new, so we're working through policies and procedures now. But does anyone have any ideas about whether it's one or two at a time?

MendedHeart · Jul 19, 2015

We have had MDS/PAs pull them out all at once. There should be no problem removing both at once .

I'm curious as to why you need a policy for an MD preference?

hajordan · Jul 19, 2015

It's a nurse-led procedure at my hospital, and on the rare occasion, the consultant may do it if he feels he put them in in such as way that may cause damage as they come out. So it falls to us to make sure we're doing it right. Maybe it's just my preference to do one at a time. I just would've thought there would be a bigger risk of pneumothorax if you are pulling them all at once. Maybe I'm worrying too much :)

MendedHeart · Jul 19, 2015

I'm floored that you, as a Nurse, can do this. this is something Nurses usually cannot do, not in scope in most states. You could do research on it and publish.

As far as policies, you need ONE approved reources for procedures like potter and perry. And record somewhere what it is.

chare · Jul 19, 2015

I'm floored that you, as a Nurse, can do this. this is something Nurses usually cannot do, not in scope in most states. You could do research on it and publish.

in North Carolina, both the placement and removal of chest tubes are within the RN scope of practice.

It is left to each facility to determine which RNs will be allowed to do this, and how continued competency will be demonstrate.

hajordan · Jul 19, 2015

Ah ha, see here's where it might differ for me then, MendedHeart; I am an Australian nurse, trained and registered in Australia and worked for a couple of years before moving to Ireland and working there now. We removed chest drains in both places. Unfortunately there is a lot of literature referring to the removal of A drain. But none of removing more than one. We also removed femoral sheaths post angio too back home. I never got around to up-skilling myself to that, maybe when I move back.....and getting published on something would be great....just need to find something unique. Maybe this IS it!

KAA1 · Jul 20, 2015

I work in CCU/ CVICU in Ga area, we have most of our chest tubes are combined tubes ( 2 tubes), combines with a Y adapter. The policy is 2 day post op from surgery as long as no air bubbles (lungs are intact), drainage less than 50- 100 cc in a 8 hr period. Prior to pulling the tubes make sure sutures are cut, clean area (bedadine tips)and place Vaseline gauze ( gives an occlusive dressing) around the tubes with 4/4 dressing and medaplex tape, have the patient take a breath and hold, remove tubes in one smooth motion. I recommend placing towel around tubes so not to make a mess on the patient.

hajordan · Jul 20, 2015

So you would pull both together, and not pull one, tie purse strings, then pull the other, tie those purse strings?