Chest tube, flush and aspirate?

[tojal1989]

Pt has a small-bore chest tube. Pt has empeyma and they had aspirated 30cc fluid when it was inserted. Doctor's notes says to flush 10cc normal saline and aspirate q shift. Has anyone done this? Giving report to another nurse when transferring the pt said never to flush a chest tube... I'm a new nurse and if I remember correctly I did this 2 months ago on another pt. Maybe this is new research. Idk I'm confused.

[brownbook]

Just want to put in my two cents. About 15 years ago I had a patient in ICU with a chest tube we would flush. I know it was not normal saline, and I don't think it was an antibiotic. I may be wrong but I think the purpose was to help the pleura adhere to the chest wall? (I know it wasn't super glue, ha ha.)

[wooh, BSN, RN]

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

Bahaha!! Yes, TPA, hehe!

[Horseshoe, BSN, RN]

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

LOL. You win the prize for this thread.

[RNperdiem, RN]

When we get those kind of pigtail chest tubes, the patient comes back from Vascular Radiology with doctor's orders for flushing with sterile saline twice daily.

Usually there is a stopcock on the chest tube for easy flushing.

[Esme12, ASN, BSN, RN]

I have seen this done rarely but it is done. Be sure your facility has set policies and procedure in place before you perform this task. Just because the Md said it's OK doesn't mean it is.........always follow hospital policy and procedure and if you are ever uncomfortable call the supervisor or the critical care units as they will be your best resource.

[Creamsoda, ASN, RN]

Its something the doc ordered on how he wants the CT managed. Im assuming the empyema is pretty nasty/purulent. Its probably just to keep the tube clear. just be gentle when you doing it

[Creamsoda, ASN, RN]

some kind of pleurodesis procedure? I thought that was usually done in the OR

[caroladybelle, BSN, RN]

Just want to put in my two cents. About 15 years ago I had a patient in ICU with a chest tube we would flush. I know it was not normal saline, and I don't think it was an antibiotic. I may be wrong but I think the purpose was to help the pleura adhere to the chest wall? (I know it wasn't super glue, ha ha.)

Frequently done on cancer PTs w/recurrent malignant pleural effusion. Usually involves a schelorosing agent such as sterile talc mixed in NS and lidocaine. The patient changes position every 30 minutes so that it gets to all areas of the pleural space.Again, many states strictly prohibit nurses from instilling ANYTHING via chest tube and the MDs are often not aware of that. If it is to be a nursing duty, there should be a written P&P for it.

[merlee]

I remember doing some instillations years ago. Gent or tobramycin I think. And, yes, it was as a sclerosing agent.

There is a very big difference between the types of tubes.

[psu_213, BSN, RN]

some kind of pleurodesis procedure? I thought that was usually done in the OR

We did it on our floor (no, not an ICU). It was only done by NPs/MDs. On the floor, it was done with (sterile) talc which caused a mechanical irritation, caused scar tissue to form, and causing the visceral pleura and parietal pleura to "fuse" together. After the talc was instilled, the pleuravac (sp?) had to be left above the level of the chest so that the talc did not just rush back out--yes, having it that high looked strange and "not right." I have seen it be successful.

[nurseprnRN, BSN, RN]

"empyema" is always purulent. it means "pus in the chest."

[london_lass]

Is it possible to put a sclerosing agent in the central line and if so, why would you do this?