chest tubes

[eheh]

i was told the canister was changed on day shift. i assessed lung sounds, looked at the site, monitored o2, saw the suction was on, pt said he felt fine, i had rapid response double check to set up. well, it turned out that the day shift forgot to unclamp the chest tube after replacing the canister. can air get back inside while the tube is clamped? plus the md ordered the chest tube to be clamped in am, i guess to see if it's time to pull it out. does the md mean to actually clamp it or to take it off suction...i've been getting conflicting answers.also, what can happen if the pt is clamped for too long?

[jmgrn65, RN]

Our policy is to never clamp the chest tube, except when changing the canister. And then that should only be seconds. Lung can and will collapse. If MD ordered to clamp and you weren't sure which he meant I would get clarification. Our docs would never order a chest tube clamped.

[eheh]

that's what i thought was that chest tubes were to never be clamped, but i found some literature that says it is ok to wean them off. the pt i took care of was clamped for about 5 hours on the day shift before i arrived-he had a cxr the next am and was totally fine, chest tube was removed and pt sent home. so i guess it is ok to clamp a chest tube.

[Tweety, BSN, RN]

I would say that "clamp in AM" means just that. You clamp it. It's a good way to test the lung to see if it can stay expanded on it's own. Sometimes with complicated pneumothoraxes a doc may take a couple of days. One day the suction is merely turned off, but the tube is not clamped. If the x-ray looks good the MD may clamp it for another 24 hours. It's all MD preference.

[Boston-RN, RN]

Depending on the reason for the chest tube, yes it's OK for "clamping" trials as long as there's a MD order