Chest tube, flush and aspirate?

wooh, BSN, RN · Mar 25, 2012

It's not something you do frequently, but if there's a lot of clots coming out, it's generally preferable to keep the tube patent and draining.

Wait til the day you're asked to instill TPN through a chest tube. That will really freak people out! (It sure did me the first time I saw it, was not sure I should be trusting that surgical resident. :))

Perpetual Student · Mar 25, 2012

It's not something you do frequently, but if there's a lot of clots coming out, it's generally preferable to keep the tube patent and draining.
Wait til the day you're asked to instill TPN through a chest tube. That will really freak people out! (It sure did me the first time I saw it, was not sure I should be trusting that surgical resident. :))

TPN or did you maybe mean TPA? I'm really struggling to figure out how TPN would do anything other than lead to one heckuvan infection

Cuddleswithpuddles · Mar 25, 2012

TPN or did you maybe mean TPA? I'm really struggling to figure out how TPN would do anything other than lead to one heckuvan infection

Now that's a meal that sticks to your ribs.

Perpetual Student · Mar 25, 2012

Oh, sorry OP, forgot to answer your question. I've never done it, but it is something that is safe and reasonable to do. Just be careful to maintain sterility.

caroladybelle, BSN, RN · Mar 25, 2012

Check your BON regs.In some states, nurses are not permitted to inject anything into a chest tube.And as with all new skills, if it is permissible to do, Check the P&P for your facility and/or have a nurse that has done the procedure, assist you the first time.

DookieMeisterRN · Mar 25, 2012

It's not something you do frequently, but if there's a lot of clots coming out, it's generally preferable to keep the tube patent and draining.Wait til the day you're asked to instill TPN through a chest tube. That will really freak people out! (It sure did me the first time I saw it, was not sure I should be trusting that surgical resident. :))

Please, please, please tell me you've never injected TPN into a chest tube.

I'm hoping this was a typo :-/

tcvnurse, BSN, RN · Mar 25, 2012

We have to do this sometimes. We use a lopez valve (or stop cock as you may know it) to do the flush aspirate thing. It's because the pigtails are so small that they get clogged up easily. We have also done insane things like blood patches to stop air leaks, instilling doxycycline through chest tubes and have the patient roll around a lot so hey get a pluerodesis effect. And we had a patient once who had a pneumonectomy, and we had to instill vancomycin into the lung cavity and then drain it through a lower chest tube.

Weird huh?

Altra, BSN, RN · Mar 25, 2012

We have to do this sometimes. We use a lopez valve (or stop cock as you may know it) to do the flush aspirate thing. It's because the pigtails are so small that they get clogged up easily. We have also done insane things like blood patches to stop air leaks, instilling doxycycline through chest tubes and have the patient roll around a lot so hey get a pluerodesis effect. And we had a patient once who had a pneumonectomy, and we had to instill vancomycin into the lung cavity and then drain it through a lower chest tube.
Weird huh?

I definitely learned something new there ... :)

NicuGal, MSN, RN · Mar 25, 2012

If you are permitted to do it at your hospital, there should be a policy/procedure in your manual/online. Check that before doing it!

psu_213, BSN, RN · Mar 25, 2012

I think they did mean TPA, not TPN.(?) Where I worked before it was done farily frequently, but always by an NP/physician.

I have flushed small bore chest tubes with a small amount of NS--always keep very close track of how much you instill vs. how much you aspirate. Oh, and make sure its sterile...no sink water! :uhoh21:

nurseprnRN, BSN, RN · Mar 25, 2012

there are chest tubes and there are chest tubes. if you know why it's in there, where, precisely, it is placed, and the precautions you need to take to prevent pneumothorax, it's sometimes ok to irrigate one.

empyema is a classic example-- sometimes these people even have open chest wounds that won't close due to the infection and poor nutritional status, and there is no pleural integrity. sometimes the infection is outside the pleura, and that may require different precautions.

instilling regular doses of antibiotics, with precise i&o, isn't that unusual. i've seen the pleurodesis thing work like a charm to create enough of an inflammatory effect that the parietal pleura adheres to the visceral pleura (sclerosis) and thus removes the space between them that can fill up with an effusion. no effusion collection = no space-occupying stuff to cause lung collapse.

you would not be disconnecting a chest tube on a recent postop thoracotomy/open heart/spontaneous pneumothorax, etc if you thought it was occluded. you would call for a stat physician eval and anticipate removal and changing, more than likely.