Chest Tubes and Clamping

susanmary · May 19, 2003

I've never done it. I won't even take a patient off of suction without an order, ex. "may be off suction for ambulation, for chest x-ray, etc. then placed back to suction." Don't want to cause a tension pneumo, crepidous, etc. And I don't take patients with air leaks off suction -- the chest x-ray will be done at the bedside. You can always get extension tubing, tape all chest tube connections, etc. so that the patient can ambulate in the room, get out of bed, etc. You really need to check your facility's policies and procedures. Forget the "scolding" and turn this into a learning experience.

meownsmile, BSN, RN · May 19, 2003

NO,, a chest tube shouldnt be clamped without an order from the Dr. Clamps should be at bedside for emergency situations only.

altomga, ADN, BSN, MSN, DNP, RN, APRN · May 19, 2003

No....we never clamp a chest tube!! For transport purposes and depending on what type and how bad the "pneumo" was we may ask the MD if we can transport with it on water seal

RNforLongTime · May 19, 2003

Ditto to the above responses!

Home Health Columnist / Guide · May 19, 2003

Tube Clamping

The chest tube should never be clamped. Doing so in a patient with a residual pleural leak, even if small, can lead to a tension pneumothorax and resultant cardiac arrest.

http://www.nursewise.com/courses/chestubes_hour.htm

Clamping, stripping, and irrigating:

Clamping the chest tube is not done except briefly to change the chest drainage container and to check for air leaks. The clamp needs to have rubber sleeves over its jaws so as not to damage the chest tube.

NEVER CLAMP THE CHEST TUBE IF THERE IS AN AIR LEAK FROM THE PATIENT.

Stripping the tubes(with mechanical strippers) to promote drainage through them is not favored anymore as it causes high negativity within the chest cavity which may damage the tissue.

Irrigation is usually only done by the surgeon.

http://faculty.valencia.cc.fl.us/mludy/review.htm

American College of Chest Physicians:

Only 41% physicicans will clamp chest tube once lung inflated prior to removal...

http://www.chestnet.org/education/physician/statements/pneumothorax/interactive/ssp/page09.php

***Chest Tube Care and Monitoring

http://www.medtrng.com/blackboard/chest_tube_care_and_monitoring.htm

UK--PORTEX waterseal setup:

http://www.frca.co.uk/portex/chest-drain.htm

***Nursing Management of Chest Tubes Who gets a chest tube?http://academic.cuesta.org/mscott/chstube.PDF

nightingale, RN · May 19, 2003

Thank you for all the valuable info. I knew I could count on you for positive feedback.

I am sure I will hear more about this when I go back on Tuesday but I will have these copies to bring to report.

I know I have clamped before but will never do again without an order (and may refeuse to do so).

Thank you all! (Especially Karen for the references).

NurseBoricua · May 19, 2003

1. Do not clamp chest tube

2. make sure there is order to allow off suction, for ambulation and xray.

3. Can order portable suction device, or get portable xray ( I usually do the second).

4. And don't let a doctor do it, even after injecting tubes.

P_RN, ADN, RN · May 19, 2003

All that.....

We got a bunch of residents who enjoyed ordering negative pressure...(suction) but couldn't have set up a pleurevac if their life depended on it. I like the newer ones with the dial thingy.

P

lee1 · May 19, 2003

Originally posted by nightngale1998
Okay.. I feel REALLY stupid (after I was "scolded" in report) but.. is it okay to clamp a chest tube temporarily to allow the patient to walk or sit away from the wall suction?

NO, you only clamp if you are changing the pleurevac or you have an emergency----somthing became disconnected.

Otherwise you just UNDO the suction to water seal so at least it is still draining by gravity

If you clamp you run the risk of clotting off the tubing and tamponade

nightingale, RN · May 20, 2003

Lots of great info. Thanks friends. P_RN, I like the dial thingy too!

susanmary · May 21, 2003

Never have seen a "dial" on a chest tube -- any info -- name of the pleurovac? I'm very interested. Good thread.