LPN chest tube delegation

doomsayer · Sep 30, 2011

What about chest tubes?

I do not think an RN would be advised to delegate ANY invasive procedure or dressing/cleaning (high risk for infection) or even I&O of something like this to an LPN- like ever.

I am only a student too- but I am 99.9% sure- no, this is not a task an RN is supposed to delegate.

xtxrn, ASN, RN · Sep 30, 2011

I worked with nearly exclusively LVNs (LPN in the south). They took chest tube patients all the time. Why not? IV's are invasive, wound drains are invasive, as are wound care (deep), IMs, SQ injections, fresh trachs, fresh anything.....

You learn the proper way to deal with them, and do it. :) If I were the charge nurse, you would be assigned chest tube patients. I would do my shift assessment, and that would be that :) If you had problems, you'd come get me.

tyvin, BSN, RN · Sep 30, 2011

You need to know the steps and responsibilities of delegation. That also goes hand in hand with knowing the nurse practice act of the state. What sticks in my mind about an RN delegating tasks is that the one delegating must be certain beyond all doubt that the person they are delegating to is qualified and prepared to do the task without supervision. If there is a question of skill then supervision should be done to ensure it's being done right. Just because it's within someone's scope of practice doesn't necessarily mean they know how to do it.

What is the task?

Laurie52 · Sep 30, 2011

What about chest tubes are you delegating? Dressing changes, assessments, I&O, chest tube removal??

Zookeeper3 · Sep 30, 2011

I'm not accustomed to LPN's, however, you did not mention the state you will practice in, and many states vary on the laws governing skills.

Will you be required to provide conscious sedation?

Is the situation with the patient unstable and IVP meds given by an RN warranted, vasopressors and what not.

Are you simply handing off supplies to the surgeon in sterile technique which you are skilled to do?

What does your individual state BON allow you to do with IVP meds, conscious sedation and vasoactive drips?

Look up your BON guidelines and you'll never ever go wrong. This IS your responsibility to know just what you are asking, and it can not only vary state to state, but each hospital may place additional restrictions that you must follow as they are policy.

However, know this, anyone, anyone, following sterile technique, can hand off anything to a surgeon, follow directions to prep a chest tube collection device, it's simple. A chest tube insertion as an LPN on a med surg. floor is a common thing where I work and our aids can assist if I'm held up with something else.

xtxrn, ASN, RN · Sep 30, 2011

Chest tubes are on the regular M/S floors all the time...don't need conscious sedation to maintain someone with a chest tube.... and, like you said, different states also allow LVNs to give IVP meds... and even start IVs....

Sounded (to me anyway) that it was simple maintenance of the chest tube.....????

merlee · Sep 30, 2011

I am confused. Are you referring to the care of a pt with a chest tube? Placement of a chest tube? Marking the output?

Please clarify.

mLPN79 · Sep 30, 2011

Where I am from, LPN's take care of patient's with chest tubes and depending upon unit policy, can change the dressings, etc.. just not able to do insertion or removal. We do all kinds of wound care, from full thickness burns to Stage IV ulcers, etc.. You would need to check your unit policy.

Orange Tree · Sep 30, 2011

The "right" answer is that the patient with a chest tube should be assigned to the care of an RN. An LVN should be assigned uncomplicated patients who are unlikely to deteriorate (ex: a lap chole, one day post-op, with no complications who is expected to be discharged in the morning).

In real life, of course, you have very experienced LVNs and very inexperienced RNs.

xtxrn, ASN, RN · Sep 30, 2011

The "right" answer is that the patient with a chest tube should be assigned to the care of an RN. An LVN should be assigned uncomplicated patients who are unlikely to deteriorate (ex: a lap chole, one day post-op, with no complications who is expected to be discharged in the morning).
In real life, of course, you have very experienced LVNs and very inexperienced RNs.

Also, small town hospitals with primarily LVN staff, who take care of whatever shows up :) It was never an issue- if you were employed, to got the assignment (new nurses were a bit different; but a whole 'type' of nurse? Never a blanket "don't take chest tubes" :)). The nurses that made it through orientation were capable, and often very good :up:

The LVNs also got fresh surgical patients of all types (a LOT of new hips and knees- and did everything but initiate blood transfusions; they maintained them once hung). That was in TX.

In IL....LPNs are kept at a sickeningly 'dumbed down' level, when many knew more than the newer (and sometimes older) RNs. I was mortified. It was a total waste of a good nurse who wanted to do more- and didn't have the means (or sometimes desire) to go the RN route. It doesn't take a rocket scientist to take vitals and report problems with the initial post-op period. But a good LVN/LPN can tell when someone is going south when they walk in the room, if they've developed the "gut" of an experienced nurse. A VERY good PICU LPN was told her position no longer existed after 17 YEARS ....to put a new RN who would need another 15 years to get to be as good as the nurse they threw away. She knew those kids SO well, and had oriented a lot of the RNs.

JMO :)

Orange Tree · Sep 30, 2011

Also, small town hospitals with primarily LVN staff, who take care of whatever shows up :) It was never an issue- if you were employed, to got the assignment (new nurses were a bit different; but a whole 'type' of nurse? Never a blanket "don't take chest tubes" :)). The nurses that made it through orientation were capable, and often very good
The LVNs also got fresh surgical patients of all types (a LOT of new hips and knees- and did everything but initiate blood transfusions; they maintained them once hung). That was in TX.
In IL....LPNs are kept at a sickeningly 'dumbed down' level, when many knew more than the newer (and sometimes older) RNs. I was mortified. It was a total waste of a good nurse who wanted to do more- and didn't have the means (or sometimes desire) to go the RN route. It doesn't take a rocket scientist to take vitals and report problems with the initial post-op period. But a good LVN/LPN can tell when someone is going south when they walk in the room, if they've developed the "gut" of an experienced nurse. A VERY good PICU LPN was told her position no longer existed after 17 YEARS ....to put a new RN who would need another 15 years to get to be as good as the nurse they threw away. She knew those kids SO well, and had oriented a lot of the RNs.
JMO :)

The LVNs at my hospital do everything, too ...but the "textbook" answer is that an RN should be taking care of a patient with a chest tube, and the OP is describing herself as a second year student. :heartbeat