?? about Monitoring and removing IR-placed drains

[tinnnk]

Have a new issue to discuss about our IR, he places drainage tubes and now he has told us it is our responsibility to " check on the amt of drainage daily the pt. is putting out so we will know when to remove the drain." I have been working in this department for 2 yrs now and it has always been the floor nurses who do the I & O, and report to the ordering MD about the drainage tube and if he wants it to be removed they write an order......our IR will just tell us to go remove it but he won't write the order. If the pt's MD has written the order for removal is it ok for us to remove after checking with the radiologist who placed it or does he have to write an order also? He says we don't need an order, as a nurse, this just doesn't seem right ....... would the one order be sufficient? Please advise and if anyone knows where I can find written documentation on such an issued please let me know.

[dianah, ASN]

What has prompted this requested change (Rad. Nurses checking on the daily drainage rather than the floor RNs)? Why is the present system not good enough? (is it a billing issue? r/t turf?? i.e., IR wants to be the one to d/c the drain, doesn't want the ordering MD to assume that responsibility)

Perhaps if you knew his rationale you and the other nurse(s) could brainstorm another solution for the perceived problem.

You will need an order in order to remove the drain.

Don't know if you need BOTH to write an order, seems redundant.

If ordering MD writes order to d/c drain, you could just run it by IR: "Dr. T wrote for the drain on Mrs. N to be d/c'd, so I'll be going up to remove it later"

It would be more clear if only ONE MD were responsible for writing the order to d/c.

Seems if the floor RNs do the daily I/Os ANYWAY, why repeat the process by having the Rad. Nurses go up and do the same???

Not working in your facility, nor knowing how things are run/the lay of the land, it's a little difficult to offer much more. :)

[jer_sd]

When I am covering the hospital patients I round on all drain patients (including chest tubes). I believe that if we (IR) place the drain then we should follow it untill removed or patient is DCd and then arrange for adequate outpatient tube management. I can usually have drains out faster than the refering teams, or keep them in for fistulas when the refering team thinks no out put means removal.

If the IR doc wants an update that is appropriate, but are progress notes being written and is IR participating in the care and management of the patient?

Jeremy

[dianah, ASN]

If the IR doc wants an update that is appropriate, but are progress notes being written and is IR participating in the care and management of the patient?

:yeahthat: :)

[Radnurse54]

I am assuming that those that are participating in these patients with drains do not work in a large hospital. Frankly, working in a large teaching hospital with all the patients we put drains in, and all the procedures, we would have to have nurses doing only drain checks. Here the interventional MD's are responsible for the procedure, but the patient still remains under the care of their attendings and their residents. The attending and their staff are the ones that decide when the patient is ready to have their drains removed, after they are the ones who know most about the patient. Personally, making Radiology responsible doesnt seem logical since Radiology is not involved in the day to day care of the patient.

Just my opinion.

Thanks

[Lacourty]

I would have to agree that the attending physician should be making the decision when to remove the drains. At the facility I work at, I am only responsible for the patient during the procedure and during recovery. Once the patient is transferred to the floor, report is given to the floor nurses and they assume care. The rad does want updates but doesn't really care if they are good updates. It was my responsibility to report abnormal changes but it wasn't like the rad was going to do anything about it unless something was initiated by the attending physician.

[snicuradrn]

I work in a small community hospital, our responsibility with drainage tubes is after they are in they are the responsibility of the ordering MD. The only time we follow with aftercare is if they are nephrostomy tubes. We use percu-stay dressings and the floor RNs are not allowed to remove dressings due to many instances of dislodging the tubes. We recently had an experienced floor RN attempt to pull a drainage tube with a pigtail end. The patient experienced excrutiating pain and she finally stopped pulling. What a nightmare!!!! I know I am getting a little off topic but even in our institution that only holds 150 beds it would be almost impossible to follow drainage from tubes we place. Hopes this helps.