chest tube and cvad

CCU BSN RN · Dec 14, 2016

1. 2 pairs of Kelley clamps and vaseline gauze should be at the bedside of every patient with a CT because: Vaseline gauze in case tube is accidentally dislodged, you can slap that on the site real quick, hopefully before they get a huge pneumo. The clamps are useful for a variety of reasons but the emergency that necessitates them being AT the bedside is if your CT became disconnected from the pleurevac/atrium, if there is a hole in the tubing of the chest tube, etc. You would need to clamp off the tube immediately while you work to remedy the cause. There are 2 clamps because you should always double-clamp in case one clamp fails.

2. When using clamping to evaluate for the location of an air leak, you have several options for where to clamp. Basically when you have an air leak, the question is- is the leak coming from the patient (i.e. pneumothorax, hole in lung itself, etc.) or is it coming from the system (issue with the atrium/pleurevac, tubing, dressing). I start this assessment by making sure that the chest tube dressing is occlusive and airtight. Then I examine the tubing for any holes, etc. The junction between the tube itself and the tubing is a weak point, I end up taping over this a lot. Essentially if you think the leak is somewhere in the tubing you would check by clamping the tube close to the patient with one kelley, and then clamp the other one distal by about a foot, see if you still have a leak, if not the leak is in between the clamps so search there, if the leak is still present move the clamp down the tubing and try again until you narrow down the area where the leak is, then go from there. Tape over the hole or replace the tubing/atrium. If the dressing and system are intact, the leak is coming from the patient and actually has clinical significance.

3. We wear masks when changing PICC dressings. It's less important than for a central line, IMO. While a PICC is a central line, it is very long. Bacteria entering at the site would need to travel a long way to reach the heart. A Cordis on the other hand is what? 4 or 6 inches long, tops, and terminates essentially in someone's heart. You should do it for both, prevent CLABSI.

You don't need a mask to change a peripheral IV dressing because it's in a small, distal vessel. Peripheral IVs are changed routinely every few days, so they're generally not in place long enough for the line itself to become colonized/infected. Your immune system should knock out any skin bacteria that enter through the site before it becomes an issue.

nfeese · Dec 23, 2016

Ok... love your detail. So, if I'm assessing for a leak 1. Clamp with 1 clamp closest to the patient, if there is still a leak then use the 2nd clamp to clamp a small ways down from the patient? If the leak has still not been found do i move both sets of clamps downward or just the one farthest from the patient?

Also, if cdu is full and needs changed where do i clamp tube at? I thought if tube was pulled out it should be placed in 2in of water.

nfeese · Dec 23, 2016

I meant if tube is disconnected from unit use 2in of sterile water to place it in...

chare · Dec 23, 2016

Ok... love your detail. So, if I'm assessing for a leak 1. Clamp with 1 clamp closest to the patient, if there is still a leak then use the 2nd clamp to clamp a small ways down from the patient? If the leak has still not been found do i move both sets of clamps downward or just the one farthest from the patient?
Also, if cdu is full and needs changed where do i clamp tube at? I thought if tube was pulled out it should be placed in 2in of water.

If you are using two clamps, and still have an air leak after placing the second clamp, move the clamp closest to the patient ~12 inches beyond the distal clamp.

I do something similar, but with one clamp. After ensuring that the dressing is intact and occlusive I clamp.the chest tube as close to the insertion site as possible. If the leak persists I replace.the clamp in the folloe I ng n sequence until I find the source: distal chest tube, just above the connection; proximal connecting tubing, just beyond the connection; distal connection tubing just above the connection; and the connection tubing on the collection device, just beyond the connection.