Do you think this is worryingly incompetent

Nurses General Nursing

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I work on an acute medical elderly care ward, several weeks ago I came onto a night shift and one of my patients, who had been with us for several weeks, had had a chest drain inserted that day due to a pleural effusion.

At handover there was 400ml in the canister, it was not swinging or bubbling. I checked the drain with the day nurse; the 3 way tap was open, there was fluid in the tubing and we went over the care plan.

By 11pm, the drain had not drained any further fluid and was still not swinging/bubbling. I informed the nurse in charge who advised me to finish the routine work and then deal with issue (patient was saturating on room air, no breathlessness).

I discussed with a nurse on a respiratory ward (we do not normally care for surgical patients or chest drains) they advised it can be normal for the chest drain to stop swinging/draining and that action may be to flush the drain.

I discussed with FY1 on call (junior doctor), they advised that they would not take action overnight and to continue to monitor. Also discussed with the critical response nurse who advised the same.

I continued the obs on the drain (not swinging/bubbling or draining) and the patient stayed saturating on room air/no breathlessness throughout night. Handed over to day team.

When I came back the next night, the day team stated at the board handover that the chest drain had not drained anything overnight as it had been CLAMPED closed. The other nurses at the board were saying how terrible and dangerous that was. When i took the bedside handover, tbe nurse informed me that the matron had come to check the drain during the day shift and the 3 way tap was at a 30 degree tilt from the open position, as though it had been knocked. However, with tap in position, there had been no further fluid drained from the original 400ml and the drain was still not swinging/bubbling. I had not checked the 3 way tap that morning before handing over however I feel it is very unfair for the nurse to have stated that it had been closed and that's why it wasn't draining.

The repeat xray showed that the effusion had been drained and then the drain was removed.

I know the most important thing is that no harm came to the patient, however I feel very anxious at work yhat my colleagues see me as someone dangerous and incompetent that would not pick up on something like that.

Would you feel this way about a colleague in this situation?

The senior nurse approached me to ask what I had done about the drain not draining the previous night, I told him and he advised I should have escalated to the registrar (senior doctor) to review. He stated I had not done anything wrong but I feel he said this because he could see I was worried as I later heard him talking to the ward sister about it being 'clamped' overnight and them both shaking their heads/shocked at how terrible that was.

Specializes in Critical Care; Cardiac; Professional Development.

This is lengthy and confusing. Was it clamped?

Incompetent? No I don't think so. Inexperienced? Probably more accurate. You did everything right but you missed the first step and it's kind of important. Any time you have a drain, tube or line that isn't doing what you think it should be doing the very first intervention is to assess it. Actually you should do this at the beginning and end of each shift. Start at the patient and work your way to the other end checking for kinks, pinches, clamps, occlusions or anything else that might explain its malfunction. That way you can confidently report and document that all is in order and there won't be any doubt that you missed something. By your own admission you did not look at the stopcock (what we call them in the US) so as it stands now it's your word against hers. Sorry you're in this predicament.

Specializes in Critical Care; Cardiac; Professional Development.
By your own admission you did not look at the stopcock (what we call them in the US) so as it stands now it's your word against hers. Sorry you're in this predicament.

That is what I was missing. I could not figure out what a 3-way valve was. Derp on me.

The thing is I did check the stopcock during my shift and it was in the correct position, it was during the day shift morning that they found it knocked BUT as you say it should be checked at the end of the shift and I didn't check at handover to next shift.

My issue as well is that they stated that was the reason it hadn't drained but that was incorrect because it wasn't draining at any time after the first few hours post procedure.

But I'm just rambling on, you are right I should have checked it at regular intervals with the other observations and documented, thank you for your reply.

Specializes in ICU, LTACH, Internal Medicine.

If something electrical suddenly stops working, first check if it is plugged in.

If a tube suddenly stops draining, first check if it is obstructed in any way, then check if it is still where it belongs.

No, in my opinion, it was not negligence. It was lack of experience of working with chest tubes. For those of us who have this experience, such things as checking for obstruction come automatically.

BTW, with 400cc drainage over previous 12 hours patient should have quite a bit of fluid accomulating over time you had him. Did you do a full chest assessment with auscultation both sides? Does your protocol for patients with chest tubes include mandatory daily chest X ray?

It looks like you are not in the USA so I do not know how in-service education looks like in your country, but everything to be done to avoid such problems in the future is mandatory education for every nurse in unit.

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

Some pleural effusions clear quickly with chest tube.....using some form of water sealed drainage system as pleura ac, provides a lot of safety......from your physical assessment.......no real harm done...

Specializes in Critical Care; Cardiac; Professional Development.

Generally speaking, the tubing should be checked together during shift hand-off with the eyes of both nurses, including marking the output for the shift on the canister with date and initials. Gross negligence? No. But not best practice. You will remember next time for sure, as this practice along with good documentation would eliminate any pointed fingers next time.

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