Chest Tubes "Help"

beachmom · May 27, 2009

If the chest tube wasn't in the correct spot, then yes, the lung could collapse.

For example, if the chest tube migrated a bit and was sucking on tissue rather than the space between the lung and the chest wall. Or if the chest tube was up high and the lung was leaking down low.

I'm not that experienced with them. I've only seen one where the lung was collapsing, and it was pretty obvious. The chest was larger on one side than the other, and the pt. was having a hard time breathing.

Daytonite, BSN, RN · May 27, 2009

as patient advocates our duty is to report our patient's symptoms and complaints, not our conclusions and opinions unless the doctor (or the doctor's assistant) seems open to that. if they are not, then you get what you get, such as "a demeaning scene at the nurses station". it sounds like you were looking for a fight and got one. you won't get me to stand on your side defending you. i would never start suggesting what i think might be going on about a patient to a doctor or doctor's assistant because they have more power than me and any argument is only going to end with me feeling exactly like you do right now. i report to them and then watch that patient like a hawk.

RNperdiem, RN · May 27, 2009

How did the patient look?

Was there a change in his breathing, color, lung sounds, or mental state?

How did a report about change in patient status turn into something so personal as a demeaning scene at the nurses station?

Something is missing.

diane227, LPN, RN · May 27, 2009

I would imagine that when the patient was on water seal his lung went down again. Placing him back to suction should re expand his lung so my question would be has the tube migrated to another spot and the first thing I would check is the insertion site. The first few inches of the chest tube has small holes that allow drainage to occur. If you check the insertion site and you see any of these little holes, the tube has migrated or been pulled out to far. It would have to be replaced. Forget this doctor. He is just an ass.

classicdame, MSN, EdD · May 27, 2009

You are obligated to protect the patient. The learning can take place later. Google for chest tubes and you will get all kinds of stuff.

twinklebelle · May 29, 2009

hi everyone!

thanks for your insight! i did not go into the details of the demeaning part because it didn't have anything to do with pt problem. i had called one of the dr.'s on call that should have been called after the assisstant was contacted. i stated to him i had made a mistake and your assisstant is here now do you want me to talk to him or since i have you on the phone tell you about the situation. in the mean time the pt is waiting for assistance. prior to the call; the placement was checked, hemodynamically he was stable at the time, pain meds & anxiety meds were already implemented prior to the call to the contact made to dr. after the dr. on the phone was done yelling about who was contacted, the pa decided he would have the same converstaion of who should have been called first. as i stated to the dr. on the phone i made a mistake. neither one after 5 minutes had past ask why or would give me the opportunity as to why i was calling. i finally blurted out "as he was going on about the call list system & how it worked" that a pt was in need of his assistance"he states it feels like his r lung is collapsing like my left last night. during the phone call and conversation of how the call list works i waved to my charge nurse to check on my pt. by then the pt was in distress and the pa ran down the hallway and yelled "a lung can't collapse on suction!" that statement did not make sense to me because we all know lungs can always collapse for numerous reasons. i was hoping to hear or get some feedback why or scientifically why he may have said this? i went to talk to a dr. here in town i know and he explained the small aspect as to what he may have meant by what he stated.

it was just bad communication starting with the wrong person being contacted first. dr. & pa have to understand when the nurses are calling them it is for the pt. yes, i called in the wrong order, yes i made that mistake but in hindsight neither was concerned about why i was contacting them until i blurted out my need. "yes" they had the right to be upset who was called first! in the end, the first contact i made had to be contacted in hindsight. thanks everyone else for your insight to the question being asked, i appreciate. this all happened at the end of my shift, the next day i found the pt went into distress shortly after i left. the pt did fine after surgery. thanks twinklebelle

Dinith88 · May 29, 2009

. I would never start suggesting what I think might be going on about a patient to a doctor or doctor's assistant because they have more power than me and any argument is only going to end with me feeling exactly like you do right now. .

This is one of the most pathetic statements i've ever heard (seen typed) come from a nurses mouth. Maybe a new-grad or inexperienced (or just bad) nurse can get away with this foolishness...

A good nurse should ALWAYS discuss 'what might be going on'. Not all doctors are created equal...(nurses either...unfortunately) ...and some can actually use guidance from a solid nurse's judgement...

Fearful of PAs? Ahh..come on!

So...you have a hunch about (or know exactly) what is going on with your patient but wont say so because the Dr (and freakin PA!?!) "...have more power than me...". I'm (nearly) speechless...

...and dumbfounded(sp?).

Nursing cowardice (and a few other choice terms) shouldn't be advocated on these message boards.