Question about Jackson Pratt Drains & retention sutures

[hoolahan]

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.

[jax]

We remove our drains with suction still intact. I work Ortho and it's the surgeons preference. Anyone else do this? Not comfortable for the pt. but over very quickly. Our surgeons also like the dressing left intact when we remove the drains, sometimes this is just not possible - especially when the drain site is wrapped under a dressing , sheet wool and bandages.

Jax

[jax]

P RN thanks for the sites. They're great. jax

[Burnie]

Hi! I am new to this site and have been reading some interesting comments, stories. I have removed jp drains by order of the physician on several occasions during my career. However, on a personal note - let me warn you to be very careful and examine the tube before you attempt to remove it. I underwent surgery last March and when the DR went to remove my jp drain, the drain broke into two pieces and recoiled back into my wound. I had to have surgery, again, to remove the tube and of course, I'm a nurse, so I have had multiple complications and infections due to it.

Be very careful. I will never again remove one. I had not heard of a tube breaking before it happened to me and since then, I have heard a few stories. Your best bet is to NOT remove it. The dr. placed it, let him remove it.

[orrnlori, RN]

I work in surgery. Just to let you all know, retention sutures are never part of the wound suture. They are placed separately, usually with silk or nylon suture. Also, most doctors cut the JP between the holes, not through the holes, sort of a way to make sure the drain doesn't break at the holes and accidently leave the tail of the drain in the wound, if you look at the end of the drain, you should see a clean cut. Hope this helps.

[RNinRubySlippers, BSN, RN]

I have pulled a JP drain and I am a nursing student. It is a skill we learn at the beginning of 3rd semester. The suture was the haredest part as it is very tight and hard to pull up so you can cut it. The drain is very long and that was surprising, even tho i knew it was. Doing it is completely different! I think it hurt the pt. more than me tho...but I felt terrible doing it...I am sure you know what I mean!

[fiestynurse]

JP drain always removed by doctor. I was never asked to remove one.

[mackrn]

I have removed JP, hemovacs and just about every type of drain that you can think of patients having inserted. Of course have been a trauma/ortho nurse off and on for over 25 years and have been in hyperbarics and wound care for the last 15 years. Piece of cake actually and sometimes a lot easier than waiting around for physican to show up.

Have removed some retention sutures, but usually when placing a negative pressure dressing on the wound and they are in the way of getting a good seal over the dressing.

[wessie17]

can i ask something?

For the JP, what's the normal amount that should be drained? Because for example, a post operative patient after 4 hours had 10 ml drain output then after 45 minutes, the output suddenly increased to 75 ml.

[OgopogoLPN, LPN, RN]

I'm an LPN in BC and I have removed JPs and hemovacs. I can also be the 2nd nurse in a chest tube removal.

[POTR]

can i ask something?

For the JP, what's the normal amount that should be drained? Because for example, a post operative patient after 4 hours had 10 ml drain output then after 45 minutes, the output suddenly increased to 75 ml.

There are so many variables involved there that this question is unanswerable. Ask your Charge what they think, and no matter what they think, if it still concerns you after to talk it over with them, call the Doctor.

[wessie17]

well, this a case study and we just have to know what the normal amount is. what we know is 50 ml. since the patient had 75 ml all of a sudden...meaning it's abnormal.

[LeaRN627]

I have been a surgical RN for 36 years and have practiced in GA, NJ, SC, CA, TX, NE, and CT. I have always removed various drains and tubes and retention sutures. All of those places had policies in place. However, I think you were right to question and should not have been criticized in front of others or made to feel as you were for questioning. It is a smart nurse who questions when in doubt and if you are uncomfortable with an unfamiliar procedure it is the responsibility of the supervisor to get you training. That being said, I also would not condone telling the patient you were not familiar if nurses can do that procedure. You have now compromised the nurse who is familiar with that technique, but now the patient will be fearful of allowing a nurse to do any procedure. I would suggest that you simply tell the patient you need to check on the order before proceeding, then contact your supervisor and tell him/her that you have not done this and you are not clear if this is an allowed RN task. You have every right to refuse to do a skill set you have not been properly trained in, but you should be careful to not undermine the skills of nurses in general when the doubt may simply be in your mind, not in other nurses already skilled in this technique. Once a patient hears you say you are not sure about something, the patient is going to be wary of all the nurses in your agency. Just my humble opinion. Good job of seeking answers and poo to your supervisor for making you feel bad asking questions!