1) Surgeon wants the chest tube(s) to be removed. RN informed.
2) Introduce yourself and explain the procedure to the patient.
3) Ask if patient has sat up in bed/chair.
4) Wash your hands.
5) Auscultate chest – breath sounds and heart sounds.
6) Check for air-leaks in pleuravac.
7) Check if chest tube drainage (pleuravac) is less than 100 ml/8hrs or 150 ml x 24 hours.
8) Check Hemoglobin, platelets, PTT, PT, INR. (Plts > 60K).
9) If steps 4, 5, 6, and 7 are WNL, proceed to remove CT.
10) Check most recent time that pain medication was given. If time exceeded over 4 hours and patient complaints of pain. Give pain medication. Revaluate pain scale, 30 minutes later.
11) Get materials:
a) Bio-hazard bucket (red).
b) Protective pad
c) Vaseline or Xeroform gauze (Surgeon’s preference)
d) 4 x 4 sterile gauzes
e) Abdominal pad dressing
f) Silk or transparent tape (impervious tape)
g) Suture removal kit or scalpel.
h) Kelly’s clamp as needed.
12) Wash or sanitize your hands with alcohol gel/foam. Glove
13) Set up for the procedure
a) Have patient lay in bed. Raise bed to your comfortable working height.
b) Cover lower torso of patient with protective pad.
c) Have dressing ready. Place 4 x 4 gauze on ABD dressing, and place Vaseline/xeroform gauze on 4 x 4.
14) Remove dressings.
15) Remove sutures holding the CTs.
16) Manipulate tubes gently to make sure they are freely movable.
17) Apply dressing with the Vaseline/xeroform gauze against the patients chest.
18) Apply tape strips in overlapping pattern on dressing. Leave only the lower edge of dressing free.
19) Have patient breath slowly and deeply x 3 times and on the third breath or when you are ready, ask patient to hold his breath in inspiration. Apply gentle pressure to dressing and pull the chest tube quickly and smoothly.
20) Apply tape to cover the lower edge of dressing, making the dressing layer occlusive and air-tight.
21) Clean up area, and patient.
22) Dispose biohazard bucket with pleuravac inside in the soiled utility room.
23) Reassess breath sounds.
24) Wash hand after procedure.
25) Make sure patient is comfortable. Lower bed to the lowest height.
26) Order, STAT, portable CXR. Document procedure in chart. Check CXR.
27) Revaluate patient and check dressing before end of your shift.