RN's removing chest tubes/heimlich valves and urostomy drains

[Miss RNC]

This week I have been asked to remove a heimlich valve and a urostomy drain. The MD told me that our CCU nurses have been removing chest tubes for a long time. Are any floor nurses doing these 2 procedures. Our house supervisor told me not to do either of these until they approved it through our Board of Nursing.

[frann]

I've never done either of those things. And with all the new nonnursing jobs I have to do, how come the Doc can't do his job? What gives? I'm tired of doing everyone elses job.

[Marcy Long]

At my facility we do remove hemovacs and some smaller drains, but not chest tubes. A lot of the time the docs do dc the drains on their rounds. I don't see why this can't be left for the docs to do. After all it just takes a few seconds.

[KTB]

Hi, At our small community hospital, we do not remove chest tubes and I would refuse if asked by a Doc. to do it. We do remove hemovacs occasionally, penrose's, staples, etc. At our hospital, we usually only have one MD in the building in the ER and if he is tied up and cannot run up to reinsert a chest tube if nec., the patient is the one who suffers.

[BRITISH R.N.]

How strange the perceptions of a nurses job and a doctors job are in different countries. UK nurses would be appalled at the thought of doctors removing just about any drain, chest drains included. We also do all dressings, suture removal etc. British nurses are far more knowledgeable about how to dress wounds than most doctors. Indeed in Britain research into techniques, materials and equipment for dressings is nurse led.

[14togo]

How strange the perceptions of a nurses job and a doctors job are in different countries. UK nurses would be appalled at the thought of doctors removing just about any drain, chest drains included. We also do all dressings, suture removal etc. British nurses are far more knowledgeable about how to dress wounds than most doctors. Indeed in Britain research into techniques, materials and equipment for dressings is nurse led.

Hi there. At the hospital I work in Canada, the ward nurses extract all manner of drains; chest tubes, perc nephrostomy tubes, uretral stints and external ventricular drains. There is no question of the procedure being a "doctor's" duty. It encompasses part of the patient's care and is done as such. We have protocols and policies and procedures to address the various tasks and employ nursing educators to teach the uninitiated. Moreover, It is my belief that mastery of such skills can only lead to the individual nurses betterment in their profession.

Patient acuity is on the increase with increasing numbers of complex patients showing up on the nursing wards. By necessity then rather than choice are we required to master these skills. I believe we are better nurses for it. ta J

[caroladybelle, BSN, RN]

This week I have been asked to remove a heimlich valve and a urostomy drain. The MD told me that our CCU nurses have been removing chest tubes for a long time. Are any floor nurses doing these 2 procedures. Our house supervisor told me not to do either of these until they approved it through our Board of Nursing.

I have removed regular CT tubes, but not pleurex/heimlich or urostomies. However, this practice varies place to place. Personally, I feel it is the MDs job, and would wonder why s/he did not do so, as most here do their own.

I have had them recently ask me to talc/pleuradese a tube which I refused. That falls well outside of Nursing duties per most practice acts. Interestly, the MD did not want to do it as he never had done it. Many PAs will try to talk nurses into doing so, even though it is outside our scope, because many of the PAs are inexperienced in talcing the tube.

[obliviousRN]

I've removed CT's in a few of the hospitals I've worked at. And all other drains. At my curren rural hospital, the docs will not allow the RN's to remove CT's. - only everything else.

[bulletproofbarb]

How strange the perceptions of a nurses job and a doctors job are in different countries. UK nurses would be appalled at the thought of doctors removing just about any drain, chest drains included. We also do all dressings, suture removal etc. British nurses are far more knowledgeable about how to dress wounds than most doctors. Indeed in Britain research into techniques, materials and equipment for dressings is nurse led.

Same in Australia. We remove all sorts of drains, pigtails, chest drains, all wound drains, sutures, staples, epidurals. You name it, we remove it. I'm glad we do, makes the job more interesting.

Nurses do the dressing stuff as well. The doctors don't have a clue, they rely on us for that.

[NRSKarenRN, BSN, RN]

Around the world and especially in the US, our nursing practice act guides us in what activites are considered inside or outside our scope of practice.

Most have language that with education, supervised practice, protocal and understanding risks, physicians can delegate these activities. However, some states have explicit lists of tasks outside scope of practice: chest tube removal and pleuradese one that comes to mind. 25 years ago, removing chest tube was physician task. With advent of CVC units,open heart surgery and heart transplants, chest tube removal has become a nursing skill permissable by most states BON.

Working respiratory unit, assisted in over 25 CT pleuradses with talc/antibotic, still not in my states scope of practice. No policy of procedure in your facility on certain advanced task, you'd be hung out to dry in court of law as unable to prove within facilities practice standards.

Know thy practice act!

[sarahlh]

We only remove Penrose or JP's. Our Cardiac PA's remove pacer wires and CT.

[Foreverlearning]

You are very smart to follow the Sup's instructions . Always consider your Nursing License before pleasing a Dr. that "doesn't have time".