chest tube orders

[morningstar5]

I work on a med surg floor. I have a question about chest tube orders. The pt got a CT for a pnuemothorax and when he came back with it the order read: "chest tube to 20cm of H2O pressure. No more than 20cm of water." The first nurse that had the pt put in the 20 cm of water and hooked up to the wall, which by the way I thought was what 20 cm of water pressure meant. The following nurse said that it should not be hooked up to the wall suction because it did not say to. She took it off the wall suction and left it to water seal only with 20cm of water in the chamber and every other nuse after left it like that. When I got the pt it was still like that. I asked my charge nurse and she said it should not be hooked to the wall suction. If any of you frequently work with chest tubes frequently I would appreciate your input. Thank you.

[classicdame, MSN, EdD]

they are right. Water seal at 20 cm may be all the patient requires. Is the tube high or low? If high, they are dealing with air. If low, you are dealing with fluids, like blood. Chest tubes on wall suction are more aggressive.

I recommend this website for free tutorial (good even if your hospital uses another type of equipment)

http://www.atriummed.com/EN/chest_drainage/ocean.asp

You might also search for the website for your particular vendor. Most have CE for nurses because if we have negative outcomes we tend to blame them, not ourselves, and their goal is to sell as many as possible.

[morningstar5]

Thanks for the reply. The tube was low. I just wondered how other nurses interperet the order- "chest tube to 20cm of H2O pressure." Does that mean just to water seal only, not to wall suction?

[Miss Kitty00]

We had a debate on my floor about a similiar order. My order said 20cm water suction. Is that water seal or or suction? I mean technically whether it's suction or seal, shouldnt it have water in it anyway?

[nyrn5125]

Ideally the order is supposed to read CT to -20 Low Cont Wall Suction. Or CT water seal. The tube is always at 20cm of water in the chamber. I think the MD needs to write it clearer.

[morningstar5]

Yeah, he should have wrote a more precise order, and I guess if I was the original nurse I could have clarified the order. It was the interventional radiologist who wrote the order, and he was not there when I took over 3 or 4 days later.

[CrabbyPatty]

Ideally the order is supposed to read CT to -20 Low Cont Wall Suction. Or CT water seal. The tube is always at 20cm of water in the chamber. I think the MD needs to write it clearer.

I agree with Angelfish. Order should have been clearer; and if the MD is not there to clarify, someone should be covering for them who can clarify what the order should be.

Here's the site for Pleur-Evac CDU info:

http://www.teleflexmedical.com/ucd/index.php