Chest tubes

[Lisa CCU RN]

I have a question I cannot find the answer to.

When sending a patient to X-ray with a chest tube, which of the following is true?

A. Disconnect the suction and maintain the pleural -vac

B.Pt. must have a portable X ray as he/she can't go to the X Ray Dept.

C.Clamp the chest tube and remove the plueral-vac

D. Attach the collection chamber to portable suction for transport

and what is the rationale?

[WOLFE, BSN, RN]

Answer A...where I work with chest tubes...post open heart and other procedures...chest tubes are disconnected for the xray and then reconnected to suction when they return.

[burn out]

Take off the suction and reconnect when the patient returns is how we do it where I work IF it is not portable. In most cases though the xray is done portable just to keep from pulling the darn thing out. By the time you have portable suction and oxygen and iv poles and monitor if the patient is in ICU you have a circus on wheels going down the hall just for a chest xray and the chances of pulling that tube out are great. eb

[weirdRN, RN]

I know a nurse who said the best way to get rid of a chest tube was to let it go to X-Ray.

[gauge14iv, MSN, APRN, NP]

What the question doesn't tell you is what test is being done.

If it's a CT or angiogram, the patient will just have to suck it up (somewhat literally LOL) and be taken to the department.

If it's a chest X-ray, or some other more common thing that can be done by portable - then in most cases it would be done portable.

[Lisa CCU RN, RN]

Thanks you guys.

I just asked the woman who would be grading the test and she said the answer was A.

[TopherSRN]

We always put them to H2O seal and a nurse accompanied the patient down and back. I know they don't like PCXRs because of the quality.

[Tweety, BSN, RN]

Thanks you guys.

I just ask the woman who would be grading the test and she said the answer was A.

Thanks for sharing the answer. It actually seems the real world and the textbook match in this situation.

[tdg_rn]

Ahh...the complexity of the nursing school type question!! I'll stick to my answer based on (1) the question never said what kind of xray is needed. A portable may not be an option and the time the patient would be off of suction could vary greatly (2) all of the answers could work but ultimately if the pt is being treated with a chest tube for ??? priority would be placed on maintaining therapy without compromising the diagnostic purpose of the xray

Perhaps in the real world it is different d/t hospital policy or something. I work in a pulmonary unit and we regularly have these type patients. It's just an unwritten rule with our pulmonologist to always maintain suction unless ordered otherwise. I've had to go down to radiology with 4 chest tube patients during the last week. Three had to be on portable suction, one had an order stating it was okay to d/c suction for the pt to ambulate or leave for various procedures. All of them had to be escorted by licensed personnel (equipped w/ vasoline gauze).

Good question...I'd be interested in which answer your facility says is "right".

[NRSKarenRN, BSN, RN]

icu faqs has great info : chest tubes

[Tweety, BSN, RN]

Thanks Karen, that's an excellent resource. I printed it out, not only for myself but my preceptees and students.

[neumann]

With a new chest tube insertion, we always do portable CXRs

but if I am taking my patient to CAT or other testing that I need to

leave the unit with my patient

The chest tube pleura vac is disconnected from suction

I try to make sure that during travel that pleura vac doesn't tip over also

We don't ever clamp chest tubes any more

nor do we milk our chest tubes,

when I return I hook the suction back up

no harm is ever done