Chest Tube Care and Pacer Wires

allele, LPN · Nov 25, 2004

1) I was all ways taught that plueral CT dressing were to have petrolatum gauze applied to the insertion site to ensure a seal and the dressing was to be tight to prevent air leaks. To achevie this we use cloth tape to cover the 4X4s. The reason I asK is that I recevied a PT from a OHR unit and the site was exposed open to air, no petrolatum gauze to be found and the dressing was losely applied with plastic tape coming off. Please inform me hoe it is done on other units and if possible a rersouce for your standard.
2) Same patient. What is your policy on wraping and grounding External pacer wires status post Open Heart Surgery and a Resouce place. This PT had both Atrial wires inserted in to a cut off finger of a glove and the same for the Ventrical wires I was taught that all four wires had to be wrapped seperately.
Reason I ask that my supervisor has ask me to file a incident report on it. I want to know what is the current Standard so I can learn from it to.
Thanks

Hi! I work on a cardiac surgical unit........if our CT's are mediastinal, even if one is going into the pleural space, we don't put Vaseline gauze on them. Not even after I d/c them, I just put a dressing over them. Pleural tubes that are inserted through the ribs (lateral tubes, etc.) such as after a thoracotomy usually have Vaseline gauze or xeroform gauze, but not always. I just ask the surgeon or PA-C if I'm questioning it. Once one of these pleural tubes is discontinued, we only bother with Vaseline or xeroform gauze if there's no suture left to close the site.

As far as AV wires, we just make sure to wear gloves before touching the non-insulated part of the wires. We're supposed to place both A wires and both V wires into the finger of a glove and tape them to the patient if they're not in use, but it's rarely done. Once I did it in front of the PA-C and he thought it was a silly protocol. I have to agree, really. We definitely don't have to 'insulate' each wire individually. Besides, I'd rather have them un-''insulated'' than wrapped in gauze, which is what some people do. Sometimes the gauze gets drainage on it from the chest tubes, sternum or where ever--it seeps into the tape holding the gauze on the wires-- and keeping the wires in a moist environment is just a bad idea. Bacteria would have a straight shot to the heart.

After all that nonsense I just wrote, in the end, if your institution has specific protocols in your nursing P & P on how to dress CT's and insulate wires, then those protocols have to be followed, and if someone didn't follow them they are technically putting the patient at risk and it should be written up. Good luck with this!!

zambezi, BSN, RN · Nov 25, 2004

Our CT sites don't come up from the OR with vaseline gauze...when we pull the tubes, we do put vaseline gaue over the insertion site. Our pacer wires come up from the OR in clean/dry (but small) lab tubes (the kind without any additives, etc in them). Our A and V wires are, of course, seperated but if there are are total of four wires, the V wires are tubed together and the A wires are tubed together.

ICUnowOHN · Dec 3, 2004

Way back when, when I worked ICU, and/or Tele floor, our policy was to roll them up A and V separately, and tape them on the pt's chest. We only used plain old 4x4's and whatever tape worked best for each pt. That was back in '97. I'm sure there are facilties that use vaseline gauze, or dsd(4x4's), etc... I typically had 3 fresh post open heart every night. I worked 5 12's in a row, and took 4 off, and the benefit of being there that much was that I got see them go from the entire process, from postop- Day 1, thru Day 5 which most were discharged. I learned a great deal that way. The PA and surgeons wanted the wires secured and protected, but easy to get to if they were needed. The tube sites after the tubes got pulled, we put 4x4's and then elastoplast for pressure. That came of on D 3 and they were up and into the shower. I hear it's much faster now, only 3 days in and out. I guess they don't care if they go into A-fib at home.