Chest tube came out!

[julieK]

On my unit the other night (during report, of course), a patient's chest tube came out. I wasn't involved in the crisis because enough nurses were tending to it, but I was thinking about what to do. In nursing school, we learned - monitor vitals and put a petroleum gauze over the site. But what kind? Is a xeroform dressing appropriate to keep at the bedside?

-Julie

[pers]

I was taught in nursing school to use the vaseline gauze, but to only tape three sides of the dressing; reason being that you don't want to let air in, but you still want to let air escape in the meantime. Is this not done anymore?

I learned the same thing and just double checked in my med-surg book (1996) to confirm.

[rnffemtguy, BSN, RN]

I was taught in nursing school to use the vaseline gauze, but to only tape three sides of the dressing; reason being that you don't want to let air in, but you still want to let air escape in the meantime. Is this not done anymore?

I'm also interested to see if this is still recomended..... I know in prehospital care we're taught to tape the sides of the occlusive dressing & leave a corner loose to allow air to escape, and my med-surg text also says to leave a side untaped to prevent a tension pnumo.....

[nerdtonurse?, BSN, RN]

Don't forget you want the patient to perform the valsalva maneuver when you apply the petroleum gauze to try to "burp" any trapped air out of the chest thru the chest tube opening.

[kadell]

I was just taught to tape 3 sides.

[pagandeva2000, LPN]

I was taught that if it came out of the chest, to use xeroform, and if it disconnects from the actual drainage system, to place in sterile water, get help.

[jbp0529]

Thank you guys. I'm really shocked. We don't do this at all on my unit, meaning the petroleum at the bedside. Yikes! The simplest safety measures can really come in handy when push comes to shove.

-Julie

Julie, funny story:

I had a similar thing happen to me several weeks ago. I work in ICU and its still a big headache and kinda stressful for a few minutes.

My pt (who truly was AOx3 and appropriate), intentionally pulled all 3 of his chest tubes out!! Yes, he knew what he was doing!! He didnt want them anymore, said they were bothering him, and "oh...well i was told they were coming out in the morning." I knew he was kind of a butt and self centered before it happened, but never imagined he would do THAT. LOL. Guess he had no idea that he could have made himself worse. Maybe he didnt care. idk

The worst part was...I was at lunch when this went down. A fellow nurse saw it happen after-the-fact, came into the breakroom holding my "presents" for me, and smiled :wink2: I knew right away what happened.

I ran out to my pt's room, assessed him (he was fine and the sites were already covered w/ an occlusive drsng). I then proceeded to scold the heck out of him (actually got him to apologize)!

But what are you gonna do? What's done is done. Wasn't like he had an indication to be in restraints and wasnt. And the tubes really were gonna be d/c'd in the AM.

But I still had to notify the doc at 2 AM and have some humble pie for dessert

...uh, I could have slapped that patient. So angry.