Forgot to unclamp chest tube?

[DH1234]

My pt is getting a medication through his chest tube which requires the nurses to clamp the tube for two hours after the MD administers the drug. Day shift said they unclamped it before they left. And I assessed the chest tube which has a pigtail attached to it with a stopcock and when I looked at it I thought it was unclamped until the doctor came to the bedside at 0400am to basically realize I had the stopcock facing in the wrong direction. So it was clamped basically most of my shift. I feel so bad because I made a huge mistake and I didn’t even realize it. I’m scared I could have completely messed up the pts treatment. I don’t know what to do. I know I’m going to get yelled at most likely from the MDs. Can I get fired for this? 

[JBMmom, MSN, NP]

You made a mistake, it happens and you will mostly not get fired (not knowing your particular situation I could be wrong but I think it's unlikely). Was the medication being administered per tube supposed to dwell for the treatment to be effective? Or was the chest tube draining fluid and the medication was to maintain patency? I'm not exactly sure of the scenario. But, now you've learned an important lesson about the set up and use of chest tubes. About all you can do now is learn from it. Always clarify new procedures or situations you come across, even if it's just looking up a Mosby's or Youtube video on chest tubes, you may have quickly come across your issue on your own.  

[JadedCPN, BSN, RN]

In theory you can get fired for just about anything. However like JBMmom stated, you mostly will not get fired just on this (without knowing any previous work issues or details about the situation). The positive side is that this is one of those tough lessons learned and I bet you will never make the same mistake again. Also know that it is not okay for you to genuinely be actually yelled at in a professional setting, even if you made a mistake.

[MunoRN, RN]

It's possible that you missed the 3-way was closed when you first assessed it, although it's not all that unusual for the 3-way to change position due to patient movement, particularly when it's placed more proximal to the patient on their flank.

[Been there,done that, ASN, RN]

Can't see you getting fired. Can see you getting written up. 

Stopcocks are confusing and chest tubes are confusing. Add the two together.. and it's a recipe for disaster. I have never seen that.. in my 30 years at the bedside. In the future, if you have a treatment that is that complicated, do a bedside check with the off going nurse.  

[violet87, BSN, RN]

Something to also take out of this is the importance of monitoring chest tube output. 

I always check charting and notes to see how much has been normal in terms of drainage amount, and make sure that I'm getting relatively similar amounts throughout my shift.

I check the drainage at least every 4 hours, and seeing no drainage at all would be cause for alarm, as it could be clogged, dislodged, or clamped. And it's really only up to us to monitor for these complications.

I actually did make a mistake once and left a chest tube clamped. There were 2 clamps on the tubing in different places, and the MD told me to unclamp the chest tube now and he will come to the bedside in 2 hours to reasses him. I took off one clamp and didn't see the other one. Until I went back into the room an hour later and noticed there was no drainage in the collection chamber and he was known to drain large amounts. After trouble shooting, I found the pesky second clamp. I called back the MD and told him NOWW we're unclamped. He laughed and rescheduled his assessment.

Moral of the story, checking drainage frequently can save your butt.

I hope you don't get in any trouble. I think every mistake is an unforgettable learning opportunity.