Chest tube and transport

[caligas]

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You are transporting a trauma patient from ICU to OR for an ortho procedure. He has chest tube for pneumothorax. Do you:

1) put it on water seal
2) use mobile suction
3) ask the ICU nurse or trauma team if they need suction or just water seal
4) assess for yourself what the patient needs

 

[Wiscoblue]

It should already be in a water seal. But if he is intubated and manually ventilated it doesn't matter if it's open to air for the short ride I guess.

 

[deleted87051]

It depends on how much air/blood/whatever is coming out of it. If there's not much it's fine to transport on water seal.

 

[deleted162650]

I always just clamp them 😉.

 

[ThoracicGuy]

In most cases, someone who is on suction for a chest tube will not need suction during the transport phase. The amount of blood/air/whatever that is being drained is irrelevant to suction or not.

 

[caligas]

In most cases, someone who is on suction for a chest tube will not need suction during the transport phase. The amount of blood/air/whatever that is being drained is irrelevant to suction or not.

So far, I'm going with this guy based on his profile name.

 

[deleted87051]

Despite what I said earlier I've never transported anyone on suction.

 

[partydoc]

we transport fresh hearts with portable suction

 

[deleted87051]

we transport fresh hearts with portable suction

We transport on water seal after the bleeding has slowed😉

 

[ThoracicGuy]

we transport fresh hearts with portable suction

We never transported from the OR to the ICU on any of our hearts after the surgery was completed...

 

[partydoc]

We transport on water seal after the bleeding has slowed😉

Your surgeons must be better than ours

 

[pgg]

Doesn't matter. People in training should do whatever gets them hassled least.

If you clamp it, pay attention, especially if the patient is getting PPV. Tension pneumo and cardiovascular collapse in a hallway is best avoided ... even if all you have to do is unclamp the tube for a second.

 

[Ronin786]

Doesn't matter. People in training should do whatever gets them hassled least.

If you clamp it, pay attention, especially if the patient is getting PPV. Tension pneumo and cardiovascular collapse in a hallway is best avoided ... even if all you have to do is unclamp the tube for a second.

I know of one ICU attending that refuses to allow chest tubes to be clamped. Reasoning being that if a tension pneumo does end up causing arrest, people are likely to ignore that in the differential due to the presence of a chest tube.

I personally wouldn't go to that extreme, but in an elevator or hallway I can easily see that happening.

 

[drmwvr]

I know of one ICU attending that refuses to allow chest tubes to be clamped. Reasoning being that if a tension pneumo does end up causing arrest, people are likely to ignore that in the differential due to the presence of a chest tube.

I personally wouldn't go to that extreme, but in an elevator or hallway I can easily see that happening.

Why would you clamp a chest tube to transport?

 

[sigrhoillusion]

Why would you clamp a chest tube to transport?

Worst thing I ever saw happen was transporting a cardiac patient (Think he was several days post-op) coming back from OR for a washout. As we were getting into elevator we hit a "snag"... turns out the snag was the stretcher wheel rolling over the CT which the surgery resident wasn't watching carefully. Well the rubbing got rolled over and got trapped and pinched/rolled in between the wheel and the wheel casing. We tried 10 minutes to try and unwrap it and go back the way it came. Nothing worked and the surgical resident had to cut the tubing which then caused all this blood to spill in the elevator and hallway by the elevator.

Patient did fine, but what a mess...