Sucking Chest Wound???

[SCNuttyMeg]

I am a cardiac nurse and I was taking care of a post CABG. During the day shift the pt developed a sucking chest wound on the lower part of the inscion. It was pressure dressed but continued to drain moderate amounts of blood. This was the first time Ive had a patient with this type of wound. Could anyone help me with the precautions that should have been taken. I wouldnt allow the patient to get out of bed, stop resp treatments because the coughing increased the bleeding etc. What else should I have done????

Thanks for the Input

[unknown99, BSN, RN]

What did the surgeon say to do?

[CCU NRS]

I am sure you did but? You informed the Physician correct? I know these things happen but you shopuld always make that call. He/she may want to come and take a look and may even place a chest tube or if it is a bleeder he may return to surgery.

I guess a little more infois needed is this immediately post op or day two or what? You mention not letting Pt get up to chair so I assume at least 24 hours post. but if it is a bleeder depending on size and location direct pressure may work just like when you pull a sheath of course this is going to cause much greater pain for post CABG on lower end of incision. (I think this is where you said)

so what did you do?

[zambezi, BSN, RN]

I have seen this once, post op day 2 or 3 at the site of a removed CT. Can't remember if dressing was on or off but when noticed the sucking noise we put vaseline gauze with lots of 4x4s on top, taped three sides...(wasn't primary rn so I can't remember all the details). This was noticed just after our normal CXR time. Pt in no resp. distress etc. Waited until CXR back, can't remember now if there was a pneumo or not. Surgeon was notified of wound, pt condition and RNs CXR intrepretation (which we all know is not within our scope of practice...:) ) but I don't think he came in early, (all this done by 530 am, docs usually come it by 700am. He either kept a dressing on it or put in another CT when he came in. I guess that dosen't answer your question but that was the only experience that I have had

[SCNuttyMeg]

Of course the doctor was called, vasoline guaze applied, 4x4s and spongefoam tape applied. The patient was sitting up in the chair when this happened and his chest tubes and wires were pulled the day before. The patient had received a resp. tx which caused him to cough and then the sucking noise began. No resp distress. What im trying to ask is what are the patients limitation while this wound is awaiting to be addressed in 12+ hours in the OR? He was going for a sternal wound reclosure that morning.

Thanks again for the help :)