Chest Tubes and Clamping

HoJo · May 21, 2003

from myownsmile

no,, a chest tube shouldnt be clamped without an order from the dr. clamps should be at bedside for emergency situations only.

ok what i want to know is how did you convince dr. clamps to show up for emergency situations? :roll

SharkLPN · May 21, 2003

>>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.

So, this makes me ask a question - If a pt is on either suction or water seal, is it OK to lift up the tubing (*not* the pleurovac - I know that's bad ju-ju!) to allow what drainage has collected in the tubing to drain into the pleurovac for measuring purposes? That's not considered manual stripping, is it?

HoJo · May 21, 2003

That's perfectly legit thing to do. Manual stripping is much much more agressive.

However I know I shouldn't do it but I did do it one time when the pt was ordering to be on LIS and the previous nurse had it to only a WATER SEAL. I noticed that there was no output from the tube over the last 6hrs when the previous night the pt had tremendous amts of output. I also noticed a nice clot that had formed occluding the tube. So I stripped it conservatively and got the clot out.

I didn't need to call the surgeon to replace a CT that another nurse forgot to hook to LIS, saved her butt, my butt, the patients butt and my managers butt. So I'll be the 1st to admit that I have stripped a CT once, literature or not.

gwenith, BSN, RN · May 21, 2003

One stripping of a chest tube is OK but a "few" years ago it breifly became "fashionable" for nurses to uses metal roller clamps to run up and down the chest tubing once and hour - My Clinical consultant at the time tried to convince me to introduce this into my practice but - I, well, let us just say that my response was reasoned. Time as proven me correct (that one consolation from being a nurse for so darn long.)

I note that many of the responses state that the outcome of clamping a chest tube is a tension pneumothorax. Althoough this can occur it is far more common on a ventilated patient and rare with a non-ventilated spontaneously breathing patient - the rationale for this has to do with the interpleural pressures themselves. Do not assume all clamped tubes will lead to a tension pneumothorax as this will alter your assessment criteria and the more common pneumothorax will be missed.

JohnnyGage · May 21, 2003

OK...

Yes, I've clamped chest tubes for a couple of hours -- in a patient with a previous pneumo. We do it occasionally for a couple of hours and then get an x-ray to see if the pneumo will return once the tube has been removed, as has happened occasionally.

Yes, we strip chest tubes. Not purely pleural ones, but mediasteinal ones sometimes after cardiac surgery. Many times we have to in order to prevent the tubes from clotting with blood. We "milk" them when possible... but sometimes it's not adequate. Our other option is to allow clots to form in the mediasteinum that might progress to cardiac tamponade.

Now neither one of these practices is routine -- only under special circumstances. But don't get yourself into the habit of thinking that nursing doesn't have any shades of grey -- no matter what the litterature says.

Chttynurs · May 21, 2003

Like JohnnyGage, we clamp (with an order) for 4-6 hours, or overnight, so as to get an x-ray to see if the a pneumo returns (or pleural effusion or whatever...), then tubes are pulled if the x-ray is okay. Of course I unclamp if the patient becomes SOB. Otherwise I NEVER clamp unless changing the pleurovac. I walk off suction if there's no airleak, I just let 'em drain to gravity. I haven't been a nurse long and had been taught never to strip, I believe I was told it could do damage to the tissues. I work with some older nurses that still strip, but they've been doing this a lot longer than I have and I'm assuming they know what they're doing. :)

JohnnyGage · May 21, 2003

Originally posted by Chttynurs
I haven't been a nurse long and had been taught never to strip, I believe I was told it could do damage to the tissues. I work with some older nurses that still strip, but they've been doing this a lot longer than I have and I'm assuming they know what they're doing. :)

Never strip pleural tubes. As I mentioned before, we strip mediasteinal tubes to prevent clotting and tamponade. Yes, it can bruise the heart, but what's your other option -- death?

P_RN, ADN, RN · May 21, 2003

http://monsite.ifrance.com/drainage/P0000731.jpg

is the Pleurevac with the dial. It has negative pressure numbers and also a floating orange thingy that will show in a window when the pressure is met.

We strip (milk gently actually) only with a doctor's order.