Talcing or TPAing Chest Tubes.

[caroladybelle, BSN, RN]

Recently I was given an order to TPA and the later to Talc (pleuradese) a double chest tube. I declined as this falls outside my experience. While I have assisted with the procedure and taken care of the patient following the procedure, I had never physically injected the meds.

Is this something that falls inside of a staff nurse's scope of care?

[begalli]

We strip mediastinal CT's all the time to hopefully prevent clots, but I've never done what you're talking about and actually never even seen that done.

[NRSKarenRN, BSN, RN]

not within the scope of practice in pa to instill anything into chest tubes. assisted the docs many times when worked pulmonary unit. talc worked well >95 %, better than antibiotic. turning side to side every 15 min, even to prone if can tolerate helps to distribute talc and promte internal scaring to seal lung.

chemical pleurodesis links:

http://www.cancerhelp.org.uk/help/default.asp?page=5291

http://www.vh.org/adult/provider/internalmedicine/pulmonarycorecurric/pleuraleffusion/pleuraleffusion.html

http://www.medscape.com/viewarticle/424726_9

[dianah, ASN]

Our Interventional Radiologists did this, or instructed the Residents how to do it (although some of them I'd not trust with stopcocks, if you KWIM). I would NOT do it. Check w/your state BON.

[caroladybelle, BSN, RN]

Not within the scope of practice in PA to instill ANYTHING into chest tubes. Assisted the docs many times when worked pulmonary unit. Talc worked well >95 %, better than antibiotic. Turning side to side every 15 min, even to prone if can tolerate helps to distribute talc and promte internal scaring to seal lung.

Well, I am on assignment in Florida, but I refused as I am not comfortable with doing this procedure.

As I work oncology and most of my pleural effusion pts are malignant in origin or ca related, the success rate on pleuradesing is not nearly so good.

I was just amazed that this facility will not permit cardiac gtt on the onco unit and are very fussy on KCL boluses/cardiac pushes on the onco unit, but would ask us to TPN/talc a chest tube.