Discussion

Chest Tubes---Help!

Jul 31, 200421 yr

Guides

Because I developed a raging case of verbal incontinence during my recent performance review---admitting that I needed more education about chest tubes---guess what topic I've been assigned to do an inservice on next month??

It's embarrassing, but I've NEVER really understood how the equipment really works, let alone how to fix it when something goes wrong. Of course, I know what to do when a patient steps on the damned tube and inadvertently dislodges it (you should've seen the look on one patient's face when I literally tackled him and applied pressure to the site in one fluid motion :eek: ), and I know how to measure the output in the collection chamber. But other than that, I'm pretty much at a loss, and since I don't deal with them all that often I've gotten lucky so far.

You know the problem with luck, though: sooner or later, it always runs out, and I don't want to stand there not knowing what to do when the fecal matter collides with the oscillating ventilatory system. We use the Atrium chest drainage system where I work; is anyone here familiar with it, and if so, PLEASE explain it to me?? I hate not understanding things........For example, what are the implications of suction vs. water seal? How do you know if the system's been breached, and what does it mean when the water is bubbling? How does it feel to the patient when there's an air leak, and how do you help them? I know what crepitus feels like to the touch; how does it develop, and what do you DO about it?

Any help you all can give me would be very much appreciated.....I don't mind doing my own research, but I learn more stuff from you guys than I do from dry instruction manuals or texts. Thanx!

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Jul 31, 200421 yr

I hate chest tubes.

Jul 31, 200421 yr

I did a Google search on "Atrium Chest Drainage System" and got a CEU article as the first listing. It was pretty thorough.

Jul 31, 200421 yr

Author
Guides

Cool! I'll check it out.......thanks Jolie. :)

Jul 31, 200421 yr

While I am quite comfortable with chest tubes and the questions you've raised, I don't think I could adequately answer the questions in a forum like this... I'm much more of a hands-on teacher and for something like CTs, even more so.

However...

Have you thought about contacting the company to see if they could arrange for one of their education reps to do a hospital inservice? Most are very willing to arrange for this type of education seeing it as a cheap and easy way to keep customers.

Jul 31, 200421 yr

We have an inservice on things rarely used, like chest tubes, once a year.

What good does it do?, on something rarely used you don't remember it if you finally get one anyway.

It covers their ***, they can say you attended an inservice on one.

Jul 31, 200421 yr

I don't appreciate censorship, that was A S S, in case anyone didn't know.

Jul 31, 200421 yr

Expert

gathered all the websites re chest tube care and management from posts i scattered on bb:

great info on chest tubes here: from www.icufaqs.org

http://www.icufaqs.org/chesttubes.doc

understanding chest drainage - nurse ceus... unit will be used. the atrium express is similar to other chest drainage systems in its principle function. the unit has three chambers ...

www.nursingceu.com/nceu/courses/chestdrainagekm/

rn web: listing of manufactueres and types of chest drainage systems

http://www.rnweb.com/.../issue/internallinks.jsp?filename=/be_core/content/journals/r/data/2000/1000/mc1000.html

atrium website

chest tubes and clamping

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

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

american college of chest physicians:

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

http://www.chestnet.org/education/p.../ssp/page09.php

***chest tube care and monitoring

http://www.medtrng.com/blackboard/c..._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

chemical pleurodesis for malignant pleural effusion

carolyn clary-macy, rn, ocn, ucsf thoracic surgery

http://www.cancersupportivecare.com/pleural.html