Should nurses be able to pull chest tubes?

Nurses Safety

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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

Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
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.

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Specializes in Adult Internal Medicine.
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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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
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.

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Specializes in Adult Internal Medicine.
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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Specializes in Peds/Neo CCT,Flight, ER, Hem/Onc.
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.

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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.

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Specializes in Critical Care, Education.

Depends on your tolerance for being thrown under the bus. If 'anything' occurs that 'could' be attributed to this action... no matter whether it is actually true or not ... the nurse will be blamed. Back in the day (when the Earth's crust was still cooling)... it was not uncommon for ICU nurses to extubate, pull central lines & A-lines, DC chest tubes, drains, etc..... but the liability climate has changed all that.

FYI, very few NPAs have specific do's and don'ts for clinical tasks unless it is in the form of a Position Paper. There is no logical rationale for comparing anything that is done by First Responders to activities that are permissible within the controlled environment of a hospital. That dog won't hunt.

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Specializes in Medical-Surgical/Float Pool/Stepdown.

Honestly, our CVICU HCT's are trained to pull chest tubes. They DC A-lines too. Our ED techs do all kinds of things I would have never imagined doing as a CNA. I almost got to learn how to pull femoral sheaths as a monitor tech/HCT but they were having a hard enough time getting all of the cardiac nurses competent at the time. All go through competency's and are checked off on after so many pulls/DC's before being labeled competent.

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Nurses do not ever pull chest tubes where I work (peds).

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