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Discussion

Strippers in the ICU!

Are any of you still stripping chest-tubes post open-heart? I know the trend has been to discourage it and only 'gently milk' the tubes if needed...then there seemed to be a resurgence of nurses ( at least in a sister hospital of the one i'm employed by...and accepted by the surgeons there) using the 'rollers' more aggresively...more in the style of the 'old way'.

What is your instituations policy regarding this (if any??),

And have any of you ever seen a patient do poorly from over-aggresive stripping?

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DANG. Not the thread I thought it was gonna be.

I was gonna say it's like flowers, leave your wares at the nurses' station.

Sigh.

(We don't strip CTs. It's written in the Post Cab orders not to.)

~faith,

Timothy.

Thank God it's not the thread i thought it was going to be.

Our cardios prefer to be called before tube stripping is done.

Nope no stripping the CT allowed on ours....Milking only.

i've seen hookers in the icu, but no strippers!

seriously, our post op orders still say strip -- but our management team says don't. i think they need to get the orders caught up with current practice. that said, i do occaisionally strip -- wouldn't admit it at work, though!

ruby

Milking but not stripping

We have one surgeon who usually says "keep those tubes stripped" If we have a policy one way or the other, I don't know about it. I haven't seen anyone have problems after stripping.

I know that we are not supposed to strip them, but when it comes down to having a pt tamponade waiting on a resident come down at 2 am to suction CT or stripping it to pull a clot down, well what do you think I am going to do. No, I don't make it a frequent practice, but I use sound judgement. Keep the patient safe, bottom line.

I'm not sure if it is because we have incredible autonomy in my unit, but we do what we feel is prudent. We have a good amount of standing orders and policies to cover us, but nothing on stripping. That said-- if a fresh heart is juicy and becomes clotty, it would be doing harm to not strip your chest tubes.

Occasionally, a surgeon or intensivist will stop by and do a little stripping himself (scandalous, I know! :rotfl:)- they would rather you get the chunks out than end up sucking them out at the bedside an hour later when we have to crack the chest.

Our Dr's don't mind one way or another. I strip mine, and have never had a bad outcome in my almost 10yrs. of doing it that way. I have actually saved a few patients from having additional chest tubes placed by "assisting" in evacuating pleural effusions. On many occasions I've found that right where the collection system attaches to the actual CT, there can be clots and bits of tissues accumulate. One such patient had approx. 1000cc effusion and was already consented for a CT insertion in the morning when another nurse and I squeezed out a clot that was about 8" in length. It required all 4 hands to move from the CT to the collection tubing, then it "SPLASHED" into the cannister. A short while later, we had approximately 850cc more of sanguinous drainage in the cannister. The patients Hgb. was actually up 1.5 gr from the day before, and he felt as if he was breathing easier. The repeat CXR showed the effusion was now minimal, and he actually rather than have an additional CT placed had that one removed the following morning. I believe to ensure your patient has the best outcome gentle stripping clots from the tubing is best.

Darn it LOL the title made me think this was going to be funny thread......sorry I cannot contribute.......

renerian:rotfl:

We absolutely strip them, in fact the surgeons prefer it also. They don't want those chest tubes clotting off, cuz then they have to return to OR or else suction them otu. i've never seen a bad outcome either.

Our Dr's don't mind one way or another. I strip mine, and have never had a bad outcome in my almost 10yrs. of doing it that way. I have actually saved a few patients from having additional chest tubes placed by "assisting" in evacuating pleural effusions. On many occasions I've found that right where the collection system attaches to the actual CT, there can be clots and bits of tissues accumulate. One such patient had approx. 1000cc effusion and was already consented for a CT insertion in the morning when another nurse and I squeezed out a clot that was about 8" in length. It required all 4 hands to move from the CT to the collection tubing, then it "SPLASHED" into the cannister. A short while later, we had approximately 850cc more of sanguinous drainage in the cannister. The patients Hgb. was actually up 1.5 gr from the day before, and he felt as if he was breathing easier. The repeat CXR showed the effusion was now minimal, and he actually rather than have an additional CT placed had that one removed the following morning. I believe to ensure your patient has the best outcome gentle stripping clots from the tubing is best.

We don't strip ct's unless doctor says it's ok. One shouldn't strip as the location of the ct is unknown. I wouldn't want to suck a graft out.

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