Chest tube came out!

[julieK]

On my unit the other night (during report, of course), a patient's chest tube came out. I wasn't involved in the crisis because enough nurses were tending to it, but I was thinking about what to do. In nursing school, we learned - monitor vitals and put a petroleum gauze over the site. But what kind? Is a xeroform dressing appropriate to keep at the bedside?

-Julie

[leslie :-D]

xeroform would be fine. but still try and tape the edges, no matter how greasy. you want it totally occluded.

[lsyorke, RN]

In pinch you can tape an unopened 4x4 (in the package)over the site since they are impermeable. Vaseline gauze is best and should be at the bedside of anyone with a chest tube.

[julieK]

Thank you guys. I'm really shocked. We don't do this at all on my unit, meaning the petroleum at the bedside. Yikes! The simplest safety measures can really come in handy when push comes to shove.

-Julie

[CHATSDALE]

this is one of the scariest things that can happen unexpectedly---you get use to take these things in stride...once i walked into a oom and an aide had taken a cabg pt in for his first shower...she is that suppose to look like that..the surgical wound had opened and stapled sternum was staring back at me....put him back in bed and pulled call light out of the wall....his poor wife said i never saw so many people materalize so quickly

[Gompers, BSN, RN]

We always keep a few packets of vaseline gauze taped to the bed of any patient with a chest tube. When a tube falls out or we pull one, we slap on a piece of the vaseline gauze, then cover with a large piece of tegaderm to keep the site occlusive. This is in neonatal, though, but I don't see why it can't work with adults as well...

[leslie :-D]

gompers, tagaderm is a wonderful idea, or any transparent adhesive dsg....

[Jolie, BSN]

Vaseline gauze and padded hemostats should be kept at the bedside of any patient with a chest tube. The Vaseline gauze is used as described, and the hemostats are needed in the event that the chest tube inadvertently becomes separated from the drainage system.

[neneRN, BSN, RN]

I was taught in nursing school to use the vaseline gauze, but to only tape three sides of the dressing; reason being that you don't want to let air in, but you still want to let air escape in the meantime. Is this not done anymore?

[Dinith88]

Vaseline gauze and padded hemostats should be kept at the bedside of any patient with a chest tube. The Vaseline gauze is used as described, and the hemostats are needed in the event that the chest tube inadvertently becomes separated from the drainage system.

Actually...don't clamp an open/disconnedted chest-tube!

What you should do is stick the end of the tube in a cup of water (sterile) or saline. It creates a one-way valve for the air to exit but not re-enter.

If you clamp the tube you can create a tension-pneumo and may inadvertently kill someone. Obviously, the pt's not going to keel over dead when you clamp the tube, but if the plera arent sufficiently 'healed and sealed' a tension pneumothorax will occur.

Obviously, if a tube comes all the way out, you have no choice but vasoline-gauze...Although a tension pneumo can develope by doing this, it's probably a better option than letting more air into the pleral space.

In either case, you're in for a bad day.

[Dinith88]

I was taught in nursing school to use the vaseline gauze, but to only tape three sides of the dressing; reason being that you don't want to let air in, but you still want to let air escape in the meantime. Is this not done anymore?

..........

[Hkmh81]

this is what we are currently learning!

Final year, Flinders Uni, Australia