chest tube question-please help

jmgrn65, RN · Nov 2, 2005

put it back together check lung sounds and call physcian probably would get cxr

NurseyBaby'05, BSN, RN · Nov 2, 2005

You mean after I did this: :eek: ? I would clamp it or put the end in sterile water, assess respiratory status and call the doc. It may no longer be sterile. The end is open for who knows what to crawl in the chest cavity. Did your textbook say to assume it is still sterile?

Editorial Team / Admin · Nov 2, 2005

Too bad the teacher doesn't go over the questions and answers AND rationale w/you. It strikes me that s/he is losing a valuable chance to teach. Please don't be afraid to ask, though!

Depends on how long it had been in, and what it's in for. I'd have to agree, assess the pt. and call the MD. I know chest tubes aren't clamped a lot these days, as opposed to practice years ago. I'd probably hesitate to clamp it. I might swab the end and change the PleurEvac set. The OP doesn't mention pt being SOB while up. Was this a multiple-choice or essay question?

WindwardOahuRN, RN · Nov 2, 2005

You mean after I did this: ? I would clamp it or put the end in sterile water, assess respiratory status and call the doc. It may no longer be sterile. The end is open for who knows what to crawl in the chest cavity. Did your textbook say to assume it is still sterile?

You would NOT clamp it. Doing so might cause a pneumothorax.

Putting the end in sterile water, to form a water seal, would be appropriate. Get a CXR, notify the doc, and let him take it from there.

NurseyBaby'05, BSN, RN · Nov 2, 2005

Can you direct me to the info against clamping? I would be interested in bringing this up with our unit educator. I heard about not clamping the tube mentioned briefly, but not seen it in actual practice. Thanks so much!

WindwardOahuRN, RN · Nov 3, 2005

Can you direct me to the info against clamping? I would be interested in bringing this up with our unit educator. I heard about not clamping the tube mentioned briefly, but not seen it in actual practice. Thanks so much!

I don't have time to search for an online source, but I can tell you what I have been instructed to do for at least the last nine years or so.

Yes, years ago, we DID routinely clamp chest tubes, especially during transport and before removal. Not so today, IME.

I will clamp a chest tube to locate a possible leak in the tubing itself, but that's about the only time, and even then, very briefly. An old AACN procedure manual recommends clamping only for "less than a minute." I pinch off the tubing with my fingers when I change the collection unit. You can use the clamp on the tubing, but I have found that clamp clamped too many times----maybe the nurse was interrupted and forgot to unclamp it?

Quoted from the AACN manual regarding clamping chest tubes: "Once clamped, air and fluid will accumulate in the pleural space, and with no method to escape, a tension pneumothorax may result."

You might want to check if someone has an AACN manual around---maybe the ICU.

We just don't do it any more.

SFCardiacRN · Nov 3, 2005

NEVER, NEVER, NEVER , NEVER clamp it. It is dangerous. We call them death clips. I can't tell you how many times a clamp has been left on by accident when a nurse got busy. I still see it being done and cringe every time.

WindwardOahuRN, RN · Nov 3, 2005

NEVER, NEVER, NEVER , NEVER clamp it. It is dangerous. We call them death clips. I can't tell you how many times a clamp has been left on by accident when a nurse got busy. I still see it being done and cringe every time.

Yet you can still find conflicting info, especially on the internet. BTW, be careful with those internet sources. I came upon one where a bunch of "experts" (whose expertise could only be summed up, from the online evidence, as claiming to be registered nurses) recommended everything from never clamping chest tubes to clamping for four hours before removal and during transport of the patient.

That's why I referred the poster to another source, perhaps a current edition of the AACN Procedure Manual for Critical Care.

Even I could be wrong, ya know...:kiss

laRN1 · Mar 18, 2006

Hi there.

I'm a relatively new grad nurse and I have a question. When changing the Pleurovac system, do we disconnect and connect the new tubing at any time or do we do it with inspiration/expiration?

Thanks!

epiphany · Mar 18, 2006

I visualize the mechanics of the chest tube/pleuravac system. If you clamp it, the lungs will have to push again the closed system on expansion. Depending on the type of injury, and the amount of air remaining the in the pleural space, the damage could range from shifting, to nothing at all in the short term. That's the rationale for putting the tube sterile water, so that air can bubble out if enough pressure builds up.

Daytonite, BSN, RN · Mar 18, 2006

We had a chest surgeon who used to intimidate any new nurses he spotted working on our unit by asking them questions like this. You get the end of the tube immersed in water immediately (water seal) or pinch it off and get it hooked back up to it's water seal fast. Get them back to bed. Swab the drainage port with alcohol or betadine and get the tube hooked back up to the water seal drainage system.

For laRN1. . .ideally, you connect the chest tube to a new drainage set up on an inspiration. It is safer, however, to clamp the tube very briefly while you make the change over despite what others have said in this thread. It's true that you need to make sure you remove the clamp. It is always a good idea that you assess the patency of a chest tube before leaving the patient's bedside by physically running your fingers along the tubing checking for kinks, checking the connections and noting the tidaling of water in the water seal compartment of the pleur-evac (if that is the drainage system you are using). You also don't want the tubing hanging down in loops over the side of the bed. You want it neatly coiled on the bed.

FYI. . .there is a CE article on chest tubes in the current March issue of Nursing 2006. You can read the article on line for free at this website http://www.nursingcenter.com/prodev/ce_article.asp?tid=633945