Milking chest tubes

Specialties CCU

Published

I just found out that the hospital I am currently working at, still has it in their policy for maintaining chest tubes to "milk" the chest tubes as needed. At my last hospital is was never allowed and it was a much more progressive hospital. So! Does anyone have any information/studies that speak to this subject. Do you? don't you? I'm looking for some evidence to bring to my units educator who doesn't see a problem with the practice. I would appreciate any information! Thanks!

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Where I work they tell you not to strip the tubing. On the policy, it says this

  1. Do NOT strip the tubing. If there are areas that contain small clots, gently squeeze the tubing in these areas between your thumb and forefinger.

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Specializes in Home Health.

I am a traveler now and places I have been it is usually the MDs that make that choice. Fewer want it and will write an order to milk them I have had 2 who called me into the room and showed me how they want it done.

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Thanks for your replies! Its always interesting how different practice can be between facilities. Do either of you have a "why" to these policies?

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Specializes in Home Health.

The only reason I have been told my the MD is they think it will clog without milking it. with that said many are not milked and never clog.

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Specializes in CVICU, ICU, RRT, CVPACU.

First of all, Milking and Stripping a chest tube are really two totally different things. At my hospital we are allowed to do it, however I try to keep it to a minimum. You DO NOT want to milk or strip a Pleural chest tube. You should only strip a pleural chest tube toward the patient as to blow the clot back into the body. A mediastinal can be stripped either direction, and even this should be kept to a very minimum. Stripping a chest tube can cause a negative pressure in excess of 200 mmHg which can do some serious damage and potentiate bleeding. The reason for not stripping away from the patient with a pleural chest tube is to prevent causing a lung contusion which can easily happen with a suction pressure of greater than 200 mmHg being applied over and over. Lung contusions can very easily lead to some very serious complications. Bojar, in his book recommends against it as do several progressive hospitals. You have to find a fine line with mediastinals. They often need to be stripped a few times after surgery to preven a cardia tamponade from occuring.

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Specializes in CCU/CVU/ICU.
I just found out that the hospital I am currently working at, still has it in their policy for maintaining chest tubes to "milk" the chest tubes as needed. At my last hospital is was never allowed and it was a much more progressive hospital. So! Does anyone have any information/studies that speak to this subject. Do you? don't you? I'm looking for some evidence to bring to my units educator who doesn't see a problem with the practice. I would appreciate any information! Thanks!

Good question! I had a similar interest in this a year or so ago...

If you're looking for reputable 'evidence' one way or another, the Cochrane people conducted a literature review up through 2007. They concluded that there was insufficient evidence to prove that either aggresive(sp?) 'stripping' or gentle 'milking' was a better way of clearing clots from mediastinal chest-drains...OR (and this is the kicker) that either practice was necessary at all.:( So...the jury is still out i suppose, and probably a reason why you're finding this discrepency in hospitals' policies.

And...as far as your unit educator...he/she may be right in that there is no hard evidence that it is detrimental (speaking of 'milking') and may (or may not) be helpful. On the flip-side, you can show him/her that 'stripping' may (or may not) be helpful ...but is USUALLY very uncomfortable to the patient and can potentially (if rarely) cause complications...AND it's not clear if the practice helps!...so why encourage it?

To be safe your educator may want to re-evaluate this...or at least encourage a gentler approach to clearing clots. (which may or may not be helpful :) )

Clear as mud, eh?

http://www.cochrane.org/reviews/en/ab003042.html

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Ya'll Rock. Man I love finding the "why" behind nursing actions! I must be in the right profession... thanks for the article!

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Specializes in ICU.
First of all, Milking and Stripping a chest tube are really two totally different things. At my hospital we are allowed to do it, however I try to keep it to a minimum. You DO NOT want to milk or strip a Pleural chest tube. You should only strip a pleural chest tube toward the patient as to blow the clot back into the body. A mediastinal can be stripped either direction, and even this should be kept to a very minimum. Stripping a chest tube can cause a negative pressure in excess of 200 mmHg which can do some serious damage and potentiate bleeding. The reason for not stripping away from the patient with a pleural chest tube is to prevent causing a lung contusion which can easily happen with a suction pressure of greater than 200 mmHg being applied over and over. Lung contusions can very easily lead to some very serious complications. Bojar, in his book recommends against it as do several progressive hospitals. You have to find a fine line with mediastinals. They often need to be stripped a few times after surgery to preven a cardia tamponade from occuring.

Joey hit the nail on the head. Milking is very different from stripping a tube. We 'strip' JP drains and other negative pressure drains. Milking is simply allowing gravity to move the drainage from the patient to the drainage container, while ever so gently sqeezing the clots to get them to move.

I whole heartedly agree with the milking of the chest tube's being a bad thing.

Great thoughts.

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Specializes in CCU.

I agree with all the information provided and we like wise have some surgeons who write "milking prn". Have you checke the AACN procedure manual?

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Specializes in Paediatric Cardic critical care.

It's really important to keep the chest drains patent after cardiac surgery, we make sure they are draining and have to milk if clots are forming.

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There is a published study on attitudes about chest tube managment and stripping, milking, etc, for chest tube clogging. Its published in the Journal of Cardiac Surgery, 2009 Sep-Oct;24(5):503-9. The title is "Chest tube selection in cardiac and thoracic surgery: a survey of chest tube-related complications and their management." THis shows that chest tube clogging is common, and can lead to adverse outcomes. Lots of nurses and surgeons report frustration dealing with this problem. Many nurses report that chest tube stripping and milking doesnt always work. When they take patients back for bleeding, most of the time the chest tubes are totally clogged. Thus some are turning to active tube clearance devices, like the PleuraFlow.

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