Chest tube flush

MunoRN, RN · Apr 20, 2014

Does your facility subscribe to any online references; Mosby, Lipincott?

lmccrn62, MSN, RN · Apr 20, 2014

Nurses should not be irrigating a chest tube. This is a MD role. Probably why you don't see it anywhere. It's very risky.

ausrnurse · Apr 23, 2014

I've only seen this once. I believe nurses are allowed to do it (I imagine this would depend on your facility) but we all decided that it would be best for the cardiothoracic surgeons to do it themselves.

MunoRN, RN · Apr 23, 2014

According to other threads here it sounds like are limitation in some states, although in my state the only thing nurses can't instill in chest tubes are sclerosing agents. Fibrinololytics and mucolytics are occasionally instilled into chest tubes and I've never seen that done by a Physician, only nurses.

lote.luvuiviria · May 20, 2014

May 20, I have nursed patients on chest drains, but have never seen it being flushed. The only thing we do is milking the tube to prevent blocking.

Biffbradford · May 21, 2014

Have never seen any chest tubes flushed. I've seen surgeons and advance practice nurses aspirate them with a sterile Salem Sump NG. I don't recall, but they may have irrigated a bit with a normal saline bullet, then sucked it back out again, but now we don't even use N/S bullets for ET tube irrigation either. If I recall, those patients were sicker than sick, open chest (do NOT turn), and there wasn't much choice.

CCRNCMC11 · May 24, 2014

In the CVICU I work in, we (RN's) routinely (almost hourly immediately post op) suction mediastinal chest tubes with an 18 fr suction catheter and only pleural chest tubes while the patient is still intubated. On occasion we leave the meds hooked up straight to wall suction to prevent tamponade. Surgeons orders. But no instilling of ns flushes

ausrnurse · May 25, 2014

In the CVICU I work in, we (RN's) routinely (almost hourly immediately post op) suction mediastinal chest tubes with an 18 fr suction catheter and only pleural chest tubes while the patient is still intubated. On occasion we leave the meds hooked up straight to wall suction to prevent tamponade. Surgeons orders. But no instilling of ns flushes

Interesting! Our post-ops have their mediastinal drains connected to an underwater seal drain on suction. The only time I've ever seen a mediastinal drain disconnected and suctioned was in a tamponade situation to keep the pt stable enough to get back to the operating theatre without having to reopen in the ICU.

Christy1019, ASN, RN · May 26, 2014

May 20, I have nursed patients on chest drains, but have never seen it being flushed. The only thing we do is milking the tube to prevent blocking.

I'm not an ICU nurse but I thought we weren't supposed to milk chest tubes anymore? Or did they change it again?

MunoRN, RN · May 26, 2014

I'm not an ICU nurse but I thought we weren't supposed to milk chest tubes anymore? Or did they change it again?

The definitions used aren't totally consistent, but typically it's stripping chest tubes that should not be done, milking is acceptable.

What shouldn't be done is to run your hand down the length of tube while pinching it, which is often was "stripping" a chest tube refers to. The problem being that this produces severe negative pressure (-300 cm/H2o) which poses a high risk of causing injury to the patient, typically a bleeding event.

Milking often refers to squeezing the chest tube and not running your hand down the tube while squeezing, and sometimes also stripping the tube but with the tube pinched or clamped between the patient and where it is being stripped to avoid the negative pressure created by stripping from reaching the patient.

Christy1019, ASN, RN · May 27, 2014

Thank you Muno!