JP/ Chest Tubes

[greney80]

From my understanding current EBP shows that stripping of chest tubes is contraindicated due to increased negative pressure; however, literature also suggest that stripping of JP drains is recommended practice in order to clear the drain of clots and maintain suction.

As both are drains, I am confused on why you would strip one and not the other, as to me, both would lead to an increase in negative pressure.

Any clarification on this topic would be greatly appreciated

[HouTx, BSN, MSN, EdD]

CTs systems maintain a constant negative pressure when they're patent. In my organization, nurses do a 'fold and squeeze' to dislodge clots or occlusions rather than the old fashioned stripping technique. However, JPs are only under pressure if the bulb is compressed or not full and tubing is much smaller... so they can obstruct really easily. They are also not used to drain tissue that is super-delicate like lung tissue.

I'm going to follow this thread. Maybe someone has actually done some research on this topic. If so, I hope they'll share some info.

[Oh'Ello, BSN, RN]

i was always under the impression that it was a matter of maintaining the catheter. Some JP catheters are kinda teensie and can clog if you don't strip out the clots. I've never had to or even thought about stripping a chest tube... I just don't even know how that would work. The tubing (at least that we use) is fairly large bore and isn't really very flexible or strechy, so I don't even know what stripping would achieve.

[AJJKRN]

In my facility if you're in the ICU's then you have standing orders to strip both CT's & JP's, etc every four hours. You still need an order to irrigate though. Now when outside of the ICU environment, an order specific to the patient is needed to do any of it.

FWIW, we have different types of CT's depending on what they are placed for so we have the larger bore ones and we have ones that come out of the chest area the size of JP lumens that we call pigtails. Either way if we strip, we hold the line closest to the patient and "clamp" it (to both stabilize the line but also to help prevent the back pressure too) and move down the line towards the drainage container.

[BellsyNurse]

Stripping chest tubes isn't really best practice any more-it hasn't been shown to improve patentcy, and theoretically increases the pressure within the pleural space that you're trying to relieve (of fluid or air). Let your doc know if you're concerned about its drainage or lack thereof if you have concerns. Clamping off a chest tube is done briefly by nurses to usually change a collection set, or to troubleshoot a new air leak. Jp drains (typically) are placed in the abdominal cavity, which overall probably wouldn't be adversely affected by the momentary increase in pressure. They tend to clog too with exudate or clots.

Also depends on location of your drain-I've had patients needing pericardial windows, and thoracics will put Jp drains in the pericardial space...which need barely any bulb suction, and certainly no stripping, given the small sensitive place it's in. So a jp, but not your typical jp.