chest tube removal

[corkyrn]

I WORK IN A BUSY CCU/ICU DEPT. I HAVE A QUESTION ABOUT THE REMOVAL OF CHEST TUBES. DO RN'S IN YOUR HOSPITAL REMOVE CHEST TUBES S/P CABG 12-24 HOUR POST-OP? WE HAVE A COUPLE OF RN'S WHO FEEL COMFORTABLE WITH THIS TASK. I AM NOT. I NEVER HAVE BEEN CHECKED OFF OR TAUGHT THIS PROCEDURE ON A FRESH HEART.

[CALAYCAY]

Patient files: Radiation treatment last year blood stream due cause anaerobe tumor; this year spur treatment. Does radiation affect the effectiveness of the medication indicated? How long does radiation last in the blood stream? What caused Nubain mixed with LR to be an antagonist?-CALAYCAY

[CALAYCAY]

Patient file:

2 0 0 3

Diagnosis: anaerobic tumor, perforated appendix, inferior vena cava

tumor, ischemia, inflammed veins

Treatment: surgery with radiation - blood stream(2 half-liters bottle)

2 0 0 4

Diagnosis: spur formation

Treatment: surgery

Medication: Nubain, LR

Question:

What makes Nubain an antagonist?

Is it due to allergic reaction/adverse effects?

How long does radiation treatment last?

[CRNAsoon]

All RN's in our unit pull chest tubes, after the order has been written and the x-ray has been reviewed. No problems yet.

[heartICU]

Just like CRNASoon, all RNs in the unit I used to work in also pulled chest tubes, rarely had a problem.

[jewelcutt]

In our CVSICU RN's pulled chest tubes daily. We have such a busy heart center that it was necessary, it's in the policy and we were checked off on it. Sometimes we would pull all of them, or just one and y the others together, we also pulled blakes. In fact, we pulled all central lines, arterial lines, sheaths, femorals, and ET tubes.

[Specials Nurse]

Hello, I am a Special Procedures Nurse and I am currently developing policy and procedure for chest tube removal within my institution for the special procedures nurses. Also, I am looking to develope competencies for our Nurses to be evaluated in order to be signed off internally for chest tube removal with supervision and then on their own once competencies are meet. If you have any institutional guidelines, policies or competencies. Let me know, I would love to look over them in order to help advance nursing practice within our institution.

Thanks

[CVICURN2003]

Rn's in our unit must be checked off by a CV surgeon first, then a PA then a nurse educator. These are commonly the very experienced "heart" nurses. I have never had a complication. We do not pull epicardial pacing wires though. We also pull sheaths, ET tubes, a lines, swanns and introducers. If we pull htree at once We have two nurses doing it for patient comfort. It is not standard practice at my hospital to do a PCXR after CT removal unless you suspect problem. We usually put MCT PO Day #1. PCT a couple of days later (no air leaks or MD pulls :).

[APNgonnabe]

In my facility we as RN's pull drains that are in the mediastinal space and not the pleura. Obviously if you did not feel right about something then don't do it. Typically these are pulled during the day (after CV surgeon orders it) so they are around God forbid.

[Specials Nurse]

thanks for your feedback. Currently the data I have found indicates, the chest tubes that are removed by nurses, seem to be placed by surgery and are a larger french then the ones used in specials. The Size ranges for us, are 8FR-14FR. THese are the same type tubes that we use for nephrostomies, abcess drains and chest tube drains. We have always removed abcess drains and nephrostomy drains in our department. The next step is to removel chest tubes, since they are the same tube, but of course with the supporting protocols.

Thanks

[Specials Nurse]

Is it possible to get hold of those competencies for the policy.

Thanks,

SPecials Nurse

[Specials Nurse]

Is it possible to get hold of your institutions policies, standards of care, and competencies for this practice.

Thanks,

Specials Nurse

[BBFRN, BSN, PhD]

Is it possible to get hold of your institutions policies, standards of care, and competencies for this practice.

Thanks,

Specials Nurse

Have you considered bringing some of your cardiac surgeons on board with helping to develop your facility's P&P on this? That's probably going to be your best bet in getting this done.