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Should nurses be able to pull chest tubes?

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by Ninjateagan Ninjateagan (New) New

Hi! Im a nursing student and during clinical I was put in an odd situation of being asked by a physician to pull a chest tube. I am from the state of Idaho (idk what regulations other states have) and for the most part, this procedure is per facility's policy. I didnt end up pulling it, as I have had no training to do so. So I pose the question.. Should Registered Nurses be able to pull chest tubes as part of their scope of practice?

I am posing this question for an assignment, so I appreciate the feedback

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Honestly, no.

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MurseJJ

Specializes in Neurosurgery, Neurology.

Did the RN of the patient pull it?

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

i have pulled for decades

but I have decades of experience

i document "assisted dr soinso pulling right axilary chest tube, dressing applied,

etc....

the NP critical care and senior, experienced nurses as me do.

but "in association with".......way out of scope with being a student.

facillity p&p, along with NPA play into factors

The RN that I was working with in clinical that day did pull it. She had never pulled one before and did not know facility policy regarding pulling a chest tube (which is a definite NO, to all nurses). Im looking for good opinions with rationale with this question.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

It's been nurses that pull chest tubes everywhere I've worked. It's not particularly complex and certainly isn't out of the realm of what nurse's do everyday. It does need to be something where a competency is acquired, confirmed, and maintained just like sheath pulls which I'd argue are far more complex than pulling a chest tube.

I am now an RN in PA. During our critical care semester, in our hospital based school, I, and many of my classmates, did pull chest tubes, with our instructor guiding and teaching the whole way. It was an awesome feeling to snip the sutures and tug on that tube until it came out with that 'shlorp' sound. An amazing learning experience.

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

The right answer is never do anything you haven't been trained for and always check hospital policy before doing any procedure.

Tenebrae, BSN, RN

Specializes in Mental Health, Gerontology, Palliative. Has 9 years experience.

I am assuming when you say "pulling a chest tube" you are talking about removing it?

Is your preceptor comfortable letting you do this if you have talked through the procedure?

I would often take out a drain following surgery. Not something I had learned as a stiudent however went through the process with my preceptor prior to performing the procedure in the patients room.

As student nurses we didnt have a specifically defined scope of practice, it was laid down by the skills taught in school and the skills we learned on the ward.

I left open heart surgery a long time ago but I taught enough residents how to pull them that I have no doubt whatsoever that it's a skill anybody can learn. ;)

sallyrnrrt, ADN, RN

Specializes in critical care, ER,ICU, CVSURG, CCU.

i have been pulling for four +decades

BrnEyedGirl, BSN, MSN, RN, APRN

Specializes in Cardiac, ER. Has 18 years experience.

I've pulled them for years. I don't see why this is a problem as long as you're taught how to do it!

FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience.

Honestly, no.

Why not?

I used to put them in, why shouldn't I or anybody else who is properly trained in their removal and has the critical assessment skills needed to monitor the patient be able to take them out?

Not meaning to be argumentative just very curious as to your reasoning.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

Why not?

I used to put them in, why shouldn't I or anybody else who is properly trained in their removal and has the critical assessment skills needed to monitor the patient be able to take them out?

Not meaning to be argumentative just very curious as to your reasoning.

I would never make a blanket statement that all nurses should be able to pull chest tubes. Especially in the scenario the OP posted: a surgeon "asking" a student nurse to pull a cheat tube, or having the attending nurse that had never pulled one do so without supervision. That is bad practice of both nursing and medicine.

If a nurse has been taught and is deemed competent, there is a hospital policy allowing, and there is a written order, than perhaps that's ok. But it seems like liability that (most) nurses don't need. Just my opinion.

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FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience.

I would never make a blanket statement that all nurses should be able to pull chest tubes. Especially in the scenario the OP posted: a surgeon "asking" a student nurse to pull a cheat tube, or having the attending nurse that had never pulled one do so without supervision. That is bad practice of both nursing and medicine.

If a nurse has been taught and is deemed competent, there is a hospital policy allowing, and there is a written order, than perhaps that's ok. But it seems like liability that (most) nurses don't need. Just my opinion.

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I totally agree that it would be inappropriate in the scenario the OP put forward. That surgeon was an idiot and frankly so was the nurse that actually did it not knowing how. I, personally, am comfortable with the idea of nurses in the right situation with the right training and the right amount of functional brain cells doing this procedure.

BostonFNP, APRN

Specializes in Adult Internal Medicine. Has 10 years experience.

I totally agree that it would be inappropriate in the scenario the OP put forward. That surgeon was an idiot and frankly so was the nurse that actually did it not knowing how. I, personally, am comfortable with the idea of nurses in the right situation with the right training and the right amount of functional brain cells doing this procedure.

My question would be how you decide who has the training and/or functional brain cells ;)

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FlyingScot, RN

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc. Has 28 years experience.

My question would be how you decide who has the training and/or functional brain cells ;)

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Good point, though I think it's usually pretty clear. I can pretty much divide the nurses I work with into the yesses, the no ways, and the maybes pretty easily. Which now that I think about it is kind of scary.

In every situation check the hospital Policy/Clinical Standards. Beyond that, KNOW your state Nurse Practice Act to know if it is within your scope. I recently heard of several ER nurses and a manager who were fired bc they were inserting external jugular lines. Their rationale was that if paramedics can do it within the field, they could within the hospital. It was against hospital policy AND state practice act. It's YOUR license on the line.