Help me out here....

[Aunt Slappy]

Inpatient admission from ER of 34 year old male born in Mexico, never smoker, c/o chronic nonproductive cough x3 years, chief complaint to ER is pain with breathing worsening over the course of the entire day since he woke up. CXR shows moderate right pneumothorax of unknown etiology. Chest tube is placed, patient is kept 3 to 4 days while pneumothorax resolves. You know from patient report that he has a recent positive TB skin test.

Would you test the fluid drained from the pneumothorax for TB? Why or why not?

[JKL33]

This not only shows the system in question, but how to avoid dilution.

What- are some of you guys using something else?

Nope, that's exactly what I would do.

[chare]

[...]

What- are some of you guys using something else?

I can't remember the last time I've seen anything other than a commercial, self-contained collection device being used.

If I was going to use the bottle system, if there was any possibility there would be any drainage I would set it up using two bottles minimally: collection chamber and water seal. And, in the setting of a pneumothorax would likely include the third, suction control bottle as well.

[Have Nurse, ADN, RN]

This not only shows the system in question, but how to avoid dilution.

What- are some of you guys using something else?

[ATTACH=CONFIG]27362[/ATTACH]

This equipment looks similar to what the military use to use during the Korean war. Atriums are what I am use to seeing nowadays.

[Have Nurse, ADN, RN]

It's not homework. I had to request records on this person for my workplace and I was hoping they had tested the fluid, because a doc has now ordered me to collect sputum. However the patient has been on LTBI medication for three weeks so I think collecting sputum is pretty futile at this point.

Well, most docs here just do a T.B. QuanteFeron Gold blood test and a chest X-ray to determine the course of action. (Whether or not to treat.) Is this fellow in a reverse air-flow room? If you aren't sure about him, he should be. And you should all be wearing PPE if you are caring for him until that is ruled out. And, if he is active, you will need to find all the staff and visitors to whom he has been exposed. You weren't clear on that in your original post. That's the only reason I toss it into the conversation, that's all.

[203bravo, MSN, APRN]

I'm curious, as I've not seen this, what type system you're using in which the water seal is between the patient and collection device.

Thanks.

ughhhh... thanks for the correction... between my work schedule and full time school I was thinking of the system backwards for some reason.... lesson learned don't try to respond to posts when you are just too tired :)

[Leader25, ASN, BSN, RN]

How old is that ? I have never seen that type in ages maybe never,we use only disposable pleur o vac.

[riverlands]

Isn't the fluid draining from the chest tube coming from the pleural space between the lung and the lung cavity lining? So it's not coming from inside the actual lung itself. Which is where the TB bacteria would live. So I would think pleural fluid would not be a reliable source of material to culture. Need to cough up a nice fresh sputum sample from down deep where the bugs are hiding right?

[Guest219794]

This equipment looks similar to what the military use to use during the Korean war. Atriums are what I am use to seeing nowadays.

Pretty sure no first world hospitals use this. I was just trying to find a drainage system in which the water seal and the effluent might mix.

[Aunt Slappy]

Isn't the fluid draining from the chest tube coming from the pleural space between the lung and the lung cavity lining? So it's not coming from inside the actual lung itself. Which is where the TB bacteria would live. So I would think pleural fluid would not be a reliable source of material to culture. Need to cough up a nice fresh sputum sample from down deep where the bugs are hiding right?

You can get TB in any body tissue, actually. But also, if the effusion is caused by TB, heck yes the fluid will contain TB bacteria. A colleague of mine who is a NP but worked as a RN at the hospital in question for many years told me that with the patient history given, she would've tested the fluid.

As it is, I got the records from the entire inpatient stay and no dice. Guess I'm calling him Monday to come in and collect sputum samples unless the provider doing his LTBI treatment tells me differently.

[Aunt Slappy]

Update: the NP doing the LTBI treatment consulted with the pulmonary specialist who consults for our clinic, and the decision was made not to collect sputum and to allow him to continue LTBI treatment. Most likely he'll have more follow up than a standard LTBI patient to make sure he doesn't develop active TB at some point in the future.

[LovingLife123]

I've never used a chest tube where any fluids go through the water seal. But, I've never collected sputum into a chest tube either. I've collected blood and the fluid that collects into the pleural space.

I thought TB dealt with the fluids inside the lungs. I don't work with TB very much at all, but that is my understanding. I thought latent TB was encapsulated as well.

Please correct me if I'm wrong.

I've never once collected any fluid for testing from a chest tube. There's no place on an atrium to do this, nor can you clamp off a test tube and pull apart the connections to get any fluid from there. A chest tube is not like a Foley where there's a lurlock to draw from. It's simply a tube. And you never, ever clamp them off unless directed to. You can make that pneumo much worse.

[nursej22, MSN, RN]

We would never treat a symptomatic person for LTBI without collecting sputum. He is from a country with high incidence TB, productive cough, and an abnormal X-ray. I hope they are not treating with rifampin alone; that is just asking for drug resistance.

TB can enter the pleural space and lymphatics. From there it can travel anywhere in the body, including CNS, kidneys, bone, and peritoneum.