Question about Jackson Pratt Drains & retention sutures

[hoolahan, ASN, RN]

How many of you have ever removed Jackson Pratt drains? If you have never removed them yourself, but have watched them be removed, you would feel comfortable doing it on your own?

I would esp like to hear from any home health nurses who have done this. But I think all nursing input is important here.

I have been a nurse for 20+ years, and today I was made to feel like an a$$ because I questioned whether this is within the scope of nursing. The order was to "D/C JP Drain when drainage is les than 30 cc per day", which to date, the pt has not met the criteria, so it has not become an issue. But, being the girlscout I am, I figured we should address it before it is an issue, so we can have it clarified for the pt and for ourselves. The supervisors were particularly PO'd that I told the pt I would have to see if the nurses could do this b/c to my knowledge we do not ordinarily remove JP drains. The pt said to me, Yeah, that's what the other nurse said too, so I apparently wasn't the first one to think this was out of the ordinary.

Just to clarify, I don't think it would be incredibly difficult to remove a JP, no harder than removing a G-Tube or SP tube, just wanted to clarify if this was a nursing function. It just seems to me it falls under the surgeon's realm, or maybe a RNFA. (???)

If you have removed them please indicate under what circumstances, ie, what is your nursing background, how were you educated to do this, and if you have a policy.

I did say to the supervisor, well, I looked for a policy, and there was no policy for removal of a JP drain, so how was I supposed to know?? And apparently the other nurses don't know this either. Her main goal was to embarrass me for telling the pt this info and making her afraid to have a nurse do this. I think she wanted to put me down, because I had asked her to mentor me in a program, and she then admited she did not meet the criteria, which I had assumed she did (I would have taken that as a compliment myself, AND I did not ask her in front of a room full of people either.)

Anyway, doesn't the pt have a right to have a person who has done this procedure before, or at least been watched by someone doing the procedure at least once before?? We don't put in NG's on our own or start IV's on our own, or even apply sterile gloves for the first time without being checked for our compentency.

And, what about retention sutures? I am comfortable if the rest of the wound looks good and is approximated etc, even though I have never removed retention sutures before, but figured, while we are on the subject, I would ask, and again, under what circumstances and how were you evaluated?

Thanks for your help.

[NRSKarenRN, BSN, RN]

NEVER removed either JP drain nor retention surtures (due to chance dehisence, type of running stitch) in 24 years of nursing! Surgeons job...no policy in my HH agency manual for removal either.

Have removed sutures from total knees, CVP sites, single remaining suture left behind etc in my days with VO.

Also have agency policy on staple removal.

ALL REQUIRE OBSERVATION/SUPERVISION of first performance.

[scottyroo]

Well, believe it or not, I did in fact remove a JP drain when I was an LPN student. An RN and my supervisor was there, I had previously wittnessed removal 2 times before. Before we went into the room, I was given last minute instructions. YES, my hands were shaking! The RN snipped the sutures (abd drain) and I told the pt to take a long deep breath and blow out, as I removed the drain. (I just puleed steadily and counted 1,2,3 & it was out.) I then applied a loose dsg, checked it 1/2 hour later, and the RN instructed me to leave the dsg off. Honest, that's all threr was to it. As a student, I also assisted in para & thoracentesis, inserted NG's, and numerous suture & staple removals. Our school was very good, and I had clinics at 5 different facilities. I consider myself lucky to have gotten so much experience.

I wish everyone well & God Bless.:)

[janine3&5]

I also had the chance to remove one as a nursing student. I was in clinicals on a surgical floor, the nurse I was working with talked me through it. I was under the impression that this is a nursing skill.

[P_RN, ADN, RN]

Hey finally something I am good at!!! I even wrote both policies for our rules and procedure manual.

Ortho uses a LOT of both of these!

JP: The JP is a bulb with a length of perforated tubing. The "holes" are all beneath the surface in order to remove the drainage and maintain suction. We emptied the JP 3x day (usually no more than a few cc so we used a med cup to measure).

The length of the incision will closely approximate the length of the tubing under the surface. Release the suction by opening the drain plug. Then in one smooth movement after VISUALLY identifying the insertion site, pull the JP tubing out.

It SHOULD slip out about as easily as a foley or an NG tube. If the skin dimples or you have difficulty STOP! There is a problem, either a stitch or a clot is holding it in. CALLTHE DOC. They CAN and DO break off!

There's a technique in the Blue Ortho journal that addresses this in case the DOC doesn't know how either.

http://www.orthobluejournal.com/0600/6tips.asp

Retention sutures: They can be wire with rubber tubing to keep from cutting into the skin...I leave those to the doctor.

If they are polymer or plain old silk, it is just like removing regular sutures. Clip close to the skin and pull out from the other insertion point.

If they are the John Charnely "marshmallow pillow" sutures, you clip close to the skin near one pillow and pull the other one out.

And YES a patient should have the right to refuse treatment, and to have someone who has experience. Your agency could probably get a surgeon to stitch a piece of chamois or leather to illustrate. Nothing to it once you know how.

________________

Look at this site. I found this after I wrote this. Theirs is better.

Mine's from memory :)

http://www.harcourthealth.com/MERLIN/Elkin/Skills/

[hoolahan, ASN, RN]

Thanks for the replies. A good mix so far. We seem to be in the minority Karen! It certainly seems easy enough, just want to be sure, so at least we know nurses have done it, maybe it is institution's policy, key word being POLICY! Maybe why I have never done it is 1. I have been in ICU or recovery most of my experience and we send pt's out with those, or 2. I worked mostly nights, and maybe this gets done on days. I can tell you one thing though, our surgeons (cardiac) would do this themselves, they are way too anal (in a good way) to have the nurses do this, unless it's one of their RNFA's. And everyone was watched/shown at least once before solo as well. I would do it, just for the first time want someone there just in case, someone who has done it, though I'm sure they will never send me to see that pt again, LOL! Robotics seems to be encouraged and thinking is not an option, esp if God forbid, you question any supervisor's judgement.

And P_RN, you are good at way more than this!! Thanks for he link.

Still want to hear from more people, please jump in.

[nurs4kids]

Have had several JP's and Hvac's fall out or pulled out by pt, but NEVER removed one intentionally. Always removed by the surgeon. Same for the retention sutures.

[Ellen in Ont]

In our hospital all RN's remove JP's, hemovac's, sump drains and penrose's as well as all types of sutures, central lines, arterial lines and epidurals. We do have policies for all of these and are watched for the first one. I thought this was standard nursing procedures everywhere? One thing to watch for when removing retention sutures, if it looks like there is a lot of tension on them, I start by removing every second one. If the wound looks like it might open I stop and report this to the doctor. I also sometimes use steristrips in place of the ones I removed if it looks like there is still tension on the wound edges.

[willie2001]

:) I have removed JP drains on several occasions and have never had a problem. However, on one occasion, upon inspecting the tube after removal,it did not look as long as it should and the end of the tube didn't look right to me. I did not let on to the patient the panic I was feeling. I called the surgeon and he informed me that he had shortened the drain himself prior to placing it in the operative site. I wished he had told me that before I removed the drain!

[pts1st]

I agree with nurse4kids. Have seen jp's fall out, but never removed one myself. Don't think it's in our nursing policies/procedures, but certainly sounds easy enough, listening to others. We don't remove sutures, either.

[codebluechic, ASN, RN]

At my hospital I d/c JP's, hemovacs, chest tubes, pacer wires,a-lines,swans, introducers. Used to d/c epidurals at another hospital but the CRNA's do it here.

[Cdn student]

Here in Canada, it's an R.N.'s job to take out the Jackson Pratt, with the Dr.'s d/c order first of course. I'm a nursing student in the 3 year Diploma program, and I've removed 3 J.P.'s, twice with my clinical instructor watching, and the last one on my own.:)