Question about Jackson Pratt Drains & retention sutures

Nurses General Nursing

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How many of you have ever removed Jackson Pratt drains? If you have never removed them yourself, but have watched them be removed, you would feel comfortable doing it on your own?

I would esp like to hear from any home health nurses who have done this. But I think all nursing input is important here.

I have been a nurse for 20+ years, and today I was made to feel like an a$$ because I questioned whether this is within the scope of nursing. The order was to "D/C JP Drain when drainage is les than 30 cc per day", which to date, the pt has not met the criteria, so it has not become an issue. But, being the girlscout I am, I figured we should address it before it is an issue, so we can have it clarified for the pt and for ourselves. The supervisors were particularly PO'd that I told the pt I would have to see if the nurses could do this b/c to my knowledge we do not ordinarily remove JP drains. The pt said to me, Yeah, that's what the other nurse said too, so I apparently wasn't the first one to think this was out of the ordinary.

Just to clarify, I don't think it would be incredibly difficult to remove a JP, no harder than removing a G-Tube or SP tube, just wanted to clarify if this was a nursing function. It just seems to me it falls under the surgeon's realm, or maybe a RNFA. (???)

If you have removed them please indicate under what circumstances, ie, what is your nursing background, how were you educated to do this, and if you have a policy.

I did say to the supervisor, well, I looked for a policy, and there was no policy for removal of a JP drain, so how was I supposed to know?? And apparently the other nurses don't know this either. Her main goal was to embarrass me for telling the pt this info and making her afraid to have a nurse do this. I think she wanted to put me down, because I had asked her to mentor me in a program, and she then admited she did not meet the criteria, which I had assumed she did (I would have taken that as a compliment myself, AND I did not ask her in front of a room full of people either.)

Anyway, doesn't the pt have a right to have a person who has done this procedure before, or at least been watched by someone doing the procedure at least once before?? We don't put in NG's on our own or start IV's on our own, or even apply sterile gloves for the first time without being checked for our compentency.

And, what about retention sutures? I am comfortable if the rest of the wound looks good and is approximated etc, even though I have never removed retention sutures before, but figured, while we are on the subject, I would ask, and again, under what circumstances and how were you evaluated?

Thanks for your help.

Specializes in Home Health.

Thanks to everyone for their input. Very interesting reading.

Just thought I would share this. I was searching thru our purchased version of P&P for Visiting Nurses Assoc of America last night, and found a policy on retention sutures. The page simply said "Removal of retention sutures is inappropriate in the Home setting." Nothing about JP's, but I came home and e-mailed them that question. If they get back to me, I'll let you know.

Thanks

I have removed JP drains too.. What states do you all practice in that you remove JP drains????::D

Specializes in CCU (Coronary Care); Clinical Research.

Same as code blue chic at my hospital.

Never removed one yet; am a new nurse. But ten years ago I had major surgery; I had 3 JP drains and if I correctly recall i believe it was either the ICU nurse that removed it or the PNP( don't quite remember, was only 13, and just remember it hurt like hell). It was definitely not the surgeon or any resident/med student.

Specializes in MS Home Health.

Yes I have done it in the hospital and in home health. However, I had a surgeon teach me when he asked me to do and I told him I never had before. He was great. Took me back in and told me what to do while I did it.

renerian

I have removed JPs and sutures.

HOWEVER, you are well within your "rights" so to speak to request training and/or supervision and a policy on this. As far as retention sutures, why doesnt the MD do that on the check-up visit? It would be a fine pickle to do it and have "parts" spilling out all over and the doc hadnt even assessed the wound. (are surgeons getting lazier or is it because the surgical fee payment is global and they dont get any more money to do it....hmmmmm)

I remove JP's all the time! We get a LOT of breast cancer surgeries, and they always have a JP or Hemovac. Quite often, the MD gives orders for the nurse to remove them. Even our RPN's (LPN's) are able to do this...one suture to snip, then a steady, gentle pull and it's out.

Have removed lots of sutures and staples, but never retention sutures. Mabye that's because I've never even SEEN retention sutures in the community!

We get a fair number of coronary bypass patients, and if you ever want to practise your staple-removing skills, I'll invite you to come along on the day when I remove the staples from their ankle-to-groin incision....the patients often ask me to count as I take them out, so they can brag to their friends! :D:D

Specializes in Telemetry, Case Management.

I am an LPN and have removed both the sutures and the JP drains. As recently as last month.

I've never d/c'd a JP drain, the residents do that in my academic hospital. I did work in a community hosp where nurses d/c'd JP's, pulled sutures, even obtained consents, but I was fortunate to avoid that. MMB

Specializes in ER/PDN.
Originally posted by codebluechic

At my hospital I d/c JP's, hemovacs, chest tubes, pacer wires,a-lines,swans, introducers. Used to d/c epidurals at another hospital but the CRNA's do it here.

HI ya'll!

I work at a very small-47-bed-hospital and we do TKR, THR and numerous surgeries (no heart) We dc the drains on orthos(hemovac) and abdominal and whatever else come through. WE even dc art lines like codebluechic said. This is a skill I actually got to do in nursing school. I dc'd a JP from a Thyroid surgery. Now that was cool. I think we have a procedure manual on this procedure.

Our surgeons don't use retention sutures on many people so I have only seen those one time and he went home with them in so we didn't actually take them out but I think that is something we can do here in MO.

Hope this helps!

MJ

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

Boy Deja vu all over again. This was from 2001. Anyway I've been doing it forever. Im in SC

Here's a great policy from the cleveland clinic.

http://www.clevelandclinic.org/health/health-info/docs/2200/2205.asp?index=8667

I have never taken one out, but a patient of mine has....she was sitting up in bed after ambulating back from the bathroom...and said...oh by the way...this came out......surprise, surprise!

I have always been under the impression that is was the surgeon's job to remove drains........but who knows these days! I graduated from school in 1959...and things have changed since then.:eek:

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