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Nurses' knowledge of chest drain management in an Irish Children's Hospital
Abstract
Aims and objectives.
To explore contact with and knowledge regarding chest drain management among nurses.
Background.
Chest drains are commonly used in both adult and paediatric settings, for example, for cardiothoracic patients or postspinal surgery, where they are inserted intra-operatively to drain excess fluid. Despite a large number of children requiring chest drain insertion annually, current literature suggests that many nurses have reduced contact with chest drains and a knowledge deficit regarding their management. Further-more, the literature is limited in relation to chest drain management in the paediatric patient. Mismanagement of chest drains can have devastating consequences for patients.
Design.
A standardised descriptive survey approach was employed.
Methods.
The sample consisted of 121 critical care and ward nurses from a large urban paediatric hospital, who cared for chest drains on a regular basis. Data were collected using a 37-item questionnaire, adapted from a study in the adult setting. Statistical analysis was performed using SPSSV 15.
Results.
The findings demonstrate that increased exposure to caring for children with chest drains is synonymous with a greater perception of knowledge levels in this area of practice. While critical care nurses looked after children with chest drains more frequently than ward nurses, there was no difference in the knowledge assessment section of the questionnaire. This research identified where knowledge deficits exist.
Conclusions.
This study identified the key areas where overall uncertainties existed leading to a decreased knowledge perception. Nurses are engaging with methods of knowledge acquisition; however, those who have less contact with chest drains require regular updates.
Relevance to clinical practice.
Addressing misconceptions about chest drain management is imperative. Providing up to date guidelines in clinical areas will improve chest drain management. Strategic educational initiatives are in place to ensure identified knowledge deficits are addressed and a complete revision of chest drain guidelines has been undertaken
... For instance,a Nigerian study to measure the level of knowledge of care of chest drains among nurses working in different wards (ICU and medical surgical) in a teaching hospital revealed very poor knowledge of about 73.8% of the studied sample 13 . Also, a Turkish study revealed that approximately 44% of nurses had insufficient knowledge of chest drain care 14 .Magner et al. 15 reported that nurses had knowledge deficit of 22% concerning chest drain care, and another Irish study revealed poor knowledge among nursesof40% 16 with the lowestknowledge were noticed in the post-procedural care. For example, 85.5% of the nurses had poor knowledge on position of drainage system with relationship to waist level while mobilizing the patient, application of suction to chest drains 83% of the participant, daily changing of dressing over chest drain insertion site 72% of the nurses,and milking of tubes and drainage in a system with a dependent loop 41.1% of the nurses 13 ...
... Nursesneeds an updated about knowledge of care for patients with chest drain, there are many resources, including; in-service education, libraries, conferences, workshop, university education and discussion among colleagues 15 . Inan England descriptive study by Gerrish et al. 17 aimed to compare factors influencing the development of evidence-based practice revealed that, nurse depends heavily on personal experience and communication with colleagues rather than formal sources of knowledge. ...
... In many clinical settings, healthcare providers especially nurses deal with patients with chest drain. Regardless of the prevalent use of the chest tube drain, it would seem insufficient knowledge and clinical guidelines deficiencies that give an ambiguity regarding practice 15 .Patient may be exposed to undesirable outcomes and delay treatment and recovery as well as increase length of hospitalization stay due to improper care of chest drain 18 .Incompetent nursing care of patient with chest drain may lead to undesirable outcomes on patients including life-threatening conditions and complications 19 . Further, anxiety and psychological burden may be exhibited on patients, and healthcare costs may be increased 20 . ...
Background
Even though literature revealed the problem of nurses’ knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses’ level of knowledge regarding chest drain care.
Methods
Anon- experimental descriptive design using cross-sectional survey was used for evaluating nurses’ knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion.Data was analysis using the Statistical Package for Social Sciences (SPSS) program.
Results
The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n=134) followed by pleural effusion (6.3%, n=10).The results revealed that the mean score for nurses’ knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n=107 vs. 51.1%, n=115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%).Nurses from private hospitals had significantly higher (M=16, SD± 2.77) level of knowledge (F[2, 222] = 8.467, p<.001) than nurses from other sectors.
Conclusions
Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended.
... Drenler uygulama aşamasında cilde uygun şekilde sabitlenmeli ve dren hattı hastaya ya da hasta yatağına sabitlenmemelidir (12,13). Dren pansumanı aseptik şartlar korunarak sızdırmaz, emici olmayan bir pansuman materyali ile yapılmalı ve pansumanda gözle görülen bir kirlenme yok ise 72 saatte bir yenilenmelidir (9,10,(14)(15)(16)(17). ...
... Drenden gelen içeriğin kanlıdan seröze doğru bir değişim göstermesi beklenir. Tersi yönde bir durum olması durumunda hemşire durumu hekime iletmelidir (8,9,14). Lomber dreni ve eksternal ventriküler drenajı (EVD) olan hastalarda izlem daha sık yapılmalı ve EVD monitörize edilerek takip edilmelidir (5,(18)(19)(20). ...
... Göğüs tüplerinde emme basıncı 15-20 mmHg; hemovac, jackson-pratt (JP) dren gibi tüplü drenlerde ise tüpün negatif basıncı korunarak drenin işlev görmesi hedeflenir. Göğüs tüplerinde dren hattının ucu tüp içerisindeki steril sıvı içinde en fazla üç cm olacak şekilde tutulmalı ve tüp doldu ise değişimi sağlanmalıdır (9,10,14,16,24). Hemovac dren gibi drenlerde tüp basıncı pozitife döndü ise dren hattı klemplenip tüp boşaltıldıktan sonra tüp sıkıştırılarak negatif basınç ortamı oluşturulup tekrar bağlantı sağlanmalı ve klemp açılmalıdır (11). ...
Amaç: Bu çalışma hemşirelik bölümü öğrencilerinin dren takibi ve bakımı konusundaki bilgi düzeylerini belirlemek amacıyla yapıldı. Yöntem: Tanımlayıcı ve kesitsel nitelikteki bu çalışma 2016-2017 Eğitim-Öğretim Yılı Bahar Yarıyılı’nda Sağlık Bilimleri Fakültesi Hemşirelik bölümünde Cerrahi Hastalıkları Hemşireliği dersini almış (ikinci, üçüncü ve dördüncü sınıf öğrencileri) çalışmaya katılmayı gönüllü olarak kabul eden 233 öğrenci ile gerçekleştirildi. Veriler araştırmacılar tarafından “Öğrenci Tanıtım Formu” ve “Dren Uygulama ve Bakımına İlişkin Bilgi Değerlendirme Formu” kullanılarak toplandı. Elde edilen veriler SPSS 23 programında tanımlayıcı istatistikler kullanılarak yüzdelik dağılımlar, ortalamalar ve ki-kare testi kullanılarak değerlendirildi. İstatistiksel anlamlılık sınırı p< 0.05 olarak kabul edildi. Bulgular: Çalışmaya %53.07 (n=233) oranında katılım sağlandı, öğrencilerin %73.4’ü (n=171) kız , %36.9’u (n=86) üçüncü sınıf , %83.7’sinin (n=195) herhangi bir meslek eğitimi vermeyen liseden mezun olduğu, %7.3’ünün (n=17) sağlık sektöründe çalıştığı belirlendi. Öğrencilerin %63.5’inin (n=148) dren takibi ve bakımı konusunda daha önce eğitim aldığı, %50.6’sının (n=118) dreni olan bir hastaya bakım verdiği belirlendi. Öğrenciler, araştırmacılar tarafından hazırlanan bilgi değerlendirme sorularına %55 oranında doğru cevap verdiği saptandı. Çalışmamızda öğrencilerin sınıfları ile dren uygulaması ve bakımına ilişkin temel bilgileri içeren sorular arasındaki ilişki incelendiğinde ikinci sınıf öğrencilerinin üst sınıflara göre doğru bilme oranının (%44.3) daha yüksek olduğu belirlendi. Sonuç: Elde edilen sonuçlarda hemşirelik öğrencilerinin drenler konusunda bilgi düzeylerinin yeterli olmadığı kaydedildi. Bu bilgi yetersizliğinin özellikle dren tipindeki değişikler ve öğrencilerin bir üst sınıfa geçtikçe bu konuyla ilgili klinik uygulamalı derslerin bulunmamasından kaynaklandığı düşünülmektedir.
... This negative pressure moves the drained collected effusion through the drainage tube in some millimetres (at this moment the oscillation or swinging of the debit can be observed). This oscillation can be also presented in the water-seal drainage system 9,12,16,18,20 . ...
... During exhalation, the diaphragm and intercostal muscles relax; there is lung elastic recoil, which creates a positive intrapleural pressure. At this time, this positive intrapleural pressure makes air moves out of the lungs by flowing down its pressure gradient, while the pleural effusion is forced to move throughout the drainage-tube to the collector 9,12,16,18,20 . ...
... As the depth inside the collector increases, so does the hydrostatic pressure, therefore, it becomes harder for the air to push through a higher level of water. In other words, the level of water in the water seal chamber represents the amount of negative pressure being generated ( Figure 3A) 9,11,13,17,19,20 . In this type of drainage, the bottles and collection apparatus of the system must be kept 30-40 cm below the level of the chest to prevent backflow and to promote gravity drainage 8,11,[18][19][20] . ...
Resumo
Context: The drained pleural contents may vary, as well as their drainage, however closed drainage system is the most frequent one and reaches flaws along those who are in charge of their management. Objetive: Provide a comprehensive review about close chest drainage. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: chest tubes AND drainage. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system. Representative pictures were also developed in order to facilitate additional care in the field. Conclusions: Bringing information together about chest tube management in closed drainage system may imply in a better approach to the patients, minimize institutional cost, minimize material waste and promote efficient communication among the multidisciplinary staff. Understanding details about tubular tube, pig tail tube, one-way bag, one-way valve and collectors is the only way to perform a better approach to the patient who needs closed drainage system.
... In the present study, while the knowledge level of 55.6% of the nurses was sufficient and intermediate, it was found to be insufficient in 44.4% of the nurses. In a study conducted in Ireland, it was found that the knowledge level of 78% of the nurses on the management of patients with chest tubes was sufficient and moderate (4). This finding shows that there is a need for training programs for nurses on the management of patients with chest tubes. ...
... In the other studies conducted on the management of patients with chest tubes, the mean scores that the nurses obtained from the information questions and their descriptive and occupational characteristics were not compared (4,6). The average scores obtained from the information questions involving the nurses who worked in the operating room and surgical units and who encountered patients with chest tubes every day were found to be higher in the present study. ...
... In the present study, these two statements were answered by almost half of the nurses, and the percentage of correct answers was similar. In the study of Magner et al. (4), the expression related to oscillation was correctly answered by 92.6% of the nurses, which is a considerable difference compared with the present study. Whether the chest tube is functional or not can be understood by observing the oscillations; this information is also vital in the follow-up of patients with chest tubes. ...
Objective: The physician is responsible for inserting one or more chest tubes into the pleural space or the mediastinal space and connecting them to an appropriate drainage system. When the general principles about care of patients with chest drains were implemented correctly and effectively by nurses, nurse will contribute to accelerate the healing process of patients. In this context, the aim of this study was to determine the nurses’ level of knowledge regarding the care of patients with chest drains.
Methods: The study was conducted with 153 nurses who worked in a chest diseases and thoracic surgery hospital in July 2014. Questionnaire form of 35 questions prepared by investigators was used to collect data. For the analysis of results, frequency tests, independent sample t-test and oneway ANOVA test were used.
Results: 69.3% of nurses stated that they had obtained information from colleguages. 35.3% considered their knowledge about chest drain management to be inadequate. 55.6% scored 13 points and above from knowledge questionnaire about chest drain management. There were statistically significant difference between knowledge level and educational background, clinic work type, working unit, years of professional experience and institutional experience, frequency of contact patients with chest drain and perception of knowledge level (p
... A substituição do frasco do sistema de drenagem só deve acontecer no caso de acumulação de fluídos ter preenchido o recipiente ou quando este perde a sua funcionalidade (Magner et al, 2013). ...
... A substituição do frasco do sistema de drenagem só deve acontecer no caso de acumulação de fluídos ter preenchido o recipiente ou quando este perde a sua funcionalidade (Magner et al, 2013). A utilização de exercitadores respiratórios como o inspirómetro de fluxo e de volume (figuras 5 e 6) também pode ser benéfico para contribuir para restaurar a função pulmonar. ...
The core value of big data is an important change in
the fields of thinking, economics, and management. Big
Data Science should be a focus of concern for all nurses.
Nursing has much to gain and to contribute to a health
system based on the best evidence and research results
by Big Data Science. Nursing involvement in these
domains exists and is enabling nurses to contribute to
advances in improving health.
... While caring a patient with chest tube drainage by the nurses, thecritical thinking abilityand problem solving skillsare required.The nurse's responsibility to maintain a patent (clear) and intact pleural drainage systemafter the chest tube has been inserted.As a result of the carelessness of the health care professionals, several complications may be occurring when managing a patient with chest tube drainage [8].Appropriate training in the management of chest drains should be receivedby the nursesto ensure that patients are cared for safely and competently [9]. ...
... 2. The knowledge and practices of nurses who providecaring of patients with chest tube will improve after educational program. (8,9,10) to assess practice of nurses about , patient's assessment,assessment and preparationof chest drainage system,nursing care provided to patient with chest of tube, changing the drainage system, chest tube dressing and removal, preventing post-operative complication after thoracic surgery , and documentation . ...
Since nurses are the first people after chest tube placement on the patient's bedside, so they should have enough information on the care of chest tube. Nursing care of chest drains can either be pre-procedural or post-procedural. Pre-procedural care includes obtaining an informed consent and providing health education to the patient, preparing the equipment and assisting the procedure for tube thoracostomy. Post-procedural care entails monitoring vital signs, assessing and documenting drainage, caring the water seal drainage system, assisting patients during change of position and in removing of the chest tube after it has served its function. Appropriate training in the management of chest drains should be received by the nurses to ensure that patients are cared for safely and competently. Aims of the Study: To assess knowledge, practice and of nurses regarding care of chest tube and to evaluate the impact of educational program on knowledge and practices of nurses about caring of patient with chest tube. Subjects and Methods: A quasi experimental study design was utilized to accomplish this study.The study was performed in two sittings, Thoracic surgery unite at Tanta Emergency University Hospital and intensive care unit at Tanta Educational hospital All available nurses were taken from the settings that previously mentioned. The total number was 40 nurses. Tow tools were used to collect data for this study. They included two sheets of Interview questionnaires and sheet of observational checklists. Results: The study revealed that more than half of nurses 52.5% less than 30 years old and 55% 0f them had technical education, while 65% of them had experience less than 5 years in caring of chest tube. Majority of studied nurses 95% had no past training in caring of chest tube. The mean posttest knowledge scores of studied nurses regarding chest tube had significantly higher than their mean pretest knowledge scores as test P< 0.05 level of significance.Total performance level was unsatisfactory less than 60% in preprogram implementation,while immediate post program 40% of studied nurses had satisfactory performance and after month of program implantation 42.5% of nurses performance needed improvement Conclusion and Recommendations: The study concludes that planned teaching on care of patient with chest tube drainage was found to be effective in increasing the knowledge of staff nurses. Staff nurses had a significant gain in knowledge and skill regarding care of patient with chest tube drainage. Nurse's educational needs regarding chest drains care should be assessed to improve clinical practice and reducing unnecessary complications.
... These results were in partial agreement with those of Magner, et al. (2021), who conducted a study in Ireland and found that around three quarters of the nurses had sufficient and moderate knowledge level regarding management of patients with chest tubes. According to Schilling, et al. (2021), who revealed that there is a worrying poor level of knowledge among nurses in their study. ...
Chest tube is a postoperative therapeutic intervention widely applied to the respiratory tract and cardiothoracic care. A chest tube can be a life-saving intervention for patients with pneumothorax, effusion and hem thorax. However, it is associated with significant morbidity and mortality. Aim: To assess nurses’ knowledge and practice regarding care of patients undergoing chest tube. Design: A descriptive exploratory study design was used _Setting: Intensive Care Unit, Surgical and Operational Departments, in El-Mahalla Chest Hospital, and El-Mahalla Cardiac Center. Sample: A convenient sample of all available nurses (60 nurses )who work with patient undergoing chest tube. Tools: 1) Self-administered interview questionnaire consists of two parts part 1: Nurse’s demographic data characteristics, part 2: Nurse’s knowledge about chest tube. Tool 2) Observational checklist. Results: Findings of the present study showed that more than one third (41.7%) of the studied nurses had average knowledge regarding management of patient with chest tube drainage. While one third and less than one quarter (35% &23.3%) of them had poor and good knowledge, respectively. Moreover, nearly two-thirds (60%) of the studied nurses had incompetent practice regarding management of patient with chest tube drainage. On the other hand more than one third (40%) of them had competent practice regarding management of patient with chest tube drainage. Finally, There was a highly statistical correlation between total nurse's knowledge and their total practice regarding management of patient with chest tube drainage (P<0.01). Conclusion: the majority of the studied nurses had insufficient knowledge and practice regarding management of patient with chest tube drainage. Recommendations: 1) Development of in-service training programs to maintain efficient performance of nurses, 2) Replication of the study on a larger sample and in different geographical areas in Egypt for generalization of findings.
... Estos hallazgos muestran oportunidades de mejora para la gestión de los servicios, poniendo el foco en la comunicación y socialización de las guías de práctica clínica. 20 El estudio presenta una situación preocupante dado que más de un tercio, luego de aplicado el cuestionario, queda dentro del margen de conocimientos inapropiados. Para la realización del cuidado de pacientes que tienen tubos torácicos es importante entender completamente qué hacer en caso de problemas, así como poder evaluar posibles alteraciones o riesgos a los que está expuesto el paciente. ...
Objetivo principal:
Conocer la percepción de los profesionales sobre la calidad de los cuidados en pacientes con drenaje de tórax respecto a la protocolización, capacitación, conocimientos y habilidades auto-percibidas en la atención de enfermería en servicios de internación.
Metodología:
Estudio transversal en 424 sujetos de hospitales de 3 regiones de Uruguay. Se analizaron 18 variables agrupadas en categorías referidas al personal, protocolización, capacitación y conocimientos, autopercepción de habilidades.
Resultados principales:
41% no había recibido capacitación sobre el tema, 79% conocía el protocolo, 46% había presenciado un evento adverso relacionado a este cuidado. El 7% del personal responde correctamente el 100% de las variables sobre conocimiento, el 47% responde correctamente el 80% de ellas, el 43% dijo sentirse capacitado y con destrezas para orientar a otros, el 28% contaba con habilidades pero no se sentía seguro, el resto no se siente con habilidades suficientes.
Conclusión principal:
La percepción sobe la calidad de los cuidados difiere según el área estudiada. La capacitación y la implementación de programas de educación continua, que brinden conocimientos y se desarrollen con metodologías innovadoras para mejorar habilidades y seguridad de los cuidados, se muestran necesarios para desarrollar en los servicios.
Amaç: Bu çalışmada bir araştırma ve uygulama hastanesinde çeşitli branşlarda görev alan hemşirelerin göğüs cerrahisi uygulamaları hakkındaki bilgi düzeylerini ölçmek, bunları etkileyen faktörleri tespit etmek ve çalışanların bilgi düzeylerini yükseltmek için yapılması gerekenleri belirlemek amaçlanmıştır. Gereç ve Yöntem: Bir araştırma ve uygulama hastanesinde çalışan tüm hemşirelere ulaşılmaya çalışıldı. Hemşirelerin tamamı çalışma kapsamına alınmış ve 175 çalışana ulaşılmıştır. Veriler profesyonel çevrimiçi anket değerlendirme ve oylama platformu aracılığıyla toplandı. Tek değişkenli analizde anlamlı bulunan parametreler lineer regresyon modeline alınarak; etki eden değişkenler değerlendirildi. Bulgular: Ankete katılanların göğüs cerrahisi uygulamaları bilgi düzeyi ortalama puanı 69,8±12,6 olarak tespit edildi. 30 yaşın üzerinde olanların puanı, 30 yaş ve altında olanlardan daha yüksekti (p
Objective
The lack of chest tube maintenance and management knowledge in nurses can lead to serious adverse consequences. The purpose of this study was to develop a chest tube maintenance and management knowledge questionnaire for clinical nurses, and to verify its reliability and validity.
Methods
Based on literature review and expert consultation, a questionnaire on chest tube maintenance and management knowledge of clinical nurses was designed, and the reliability and validity of the questionnaire were tested in 60 clinical nurses.
Results
The initial questionnaire of chest tube maintenance and management knowledge for clinical nurses included 20 items, and three dimensions were finally determined by expert consultation method, including 15 items. The Cronbach's α coefficient of the questionnaire was 0.850, and the Cronbach's α coefficient of each dimension ranged from 0.704 to 0.743. Spearman‐brown's split reliability was 0.756. The content validity (content validity index [CVI]) of each item of the questionnaire ranged from 0.833 to 1.000, and the total CVI was 0.978.
Conclusions
The clinical nurses' knowledge questionnaire developed in this study has good reliability and validity, which can effectively and objectively evaluate clinical nurses' mastery of chest tube maintenance and management knowledge.
Aims and objectives:
This study aims to reveal nurses' self-reported practice of managing chest tubes and to define decision-makers for these practices.
Background:
No consensus exists regarding ideal chest-tube management strategy, and there are wide variations of practice based on local policies and individual preferences, rather than standardized evidence-based protocols.
Design:
This article describes a cross-sectional study.
Methods:
Questionnaires were emailed to 31 hospitals in Tianjin, and the sample consisted of 296 clinical nurses whose work included nursing management of chest drains. The questionnaire, which was prepared by the authors of this research, consisted of three sections, including a total of 22 questions that asked for demographic information, answers regarding nursing management that reflected the practice they actually performed and who the decision-makers were regarding eight chest-drain management procedures. The McNemar's test was used to analyse the data.
Results:
The results indicated that most respondents thought that it was necessary to manipulate chest tubes to remove clots impeding unobstructed drainage (91.2%). Most respondents indicated that dressings would be changed when the dressing was dysfunctional. At the same time, more than half of respondents approved of changing dressings routinely, and the frequency of changing dressings varied. Respectively, when drainage was employed for pleural effusion and for a pneumothorax, 64.6% and 94.5% of respondents, respectively, considered that underwater seal drainage bottles should be changed routinely, and the frequency of changing bottles both varied. The results indicated that nurses were the primary decision-makers in the replacement of chest tubes, manipulation of chest tubes and monitoring of drainage fluid.
Conclusions:
There was considerable variation in respondents' self-reported clinical nursing practice regarding management of chest drains. The rationale on which respondents' practices were based also varied greatly. This study indicated that nurses were the primary decision-makers for three out of eight procedures regarding management of chest drains, which reflects that clinical nurses' decision-making power regarding management of chest drains was weak. This article is protected by copyright. All rights reserved.
Background/Objective
Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria.
Methods
A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires.
Results
The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of <10 years, low-rank nurses and those working in the female medical ward; however, the relationship cant (P > 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop.
Conclusion
The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains.
To describe the experiences of registered nurses (RNs) who enrolled in a web-based course from either their home or the workplace.
In order to maintain competency in rapidly changing health care systems, and meet the challenge of overcoming traditional barriers to continuing education, RNs need access to innovative educational delivery methods. As yet, little is known about the web-based learners' experience, particularly when courses are accessed from the nursing practice setting.
The article focuses on the results from questionnaires conducted with 57 RNs enrolled in a web-based, postdiploma course. These findings emanate from a larger study using survey method and focus group interviews. Nurses' experiences were measured using the Online Learner Support Instrument which was developed and tested for use in the study.
Most nurses found the course highly satisfactory. Not all experiences were positive however, and a number of challenges were faced. Access to the course from home was reported as very satisfactory for the majority, while work users encountered a number of serious barriers such as insufficient time and limited computer access. The RNs made significant gains in their learning with e-mail, Internet, keyboarding and word processing skills during the 16-week course. Lack of computer skills, erroneous perceptions of course workload and inadequate preparation for web learning were largely responsible for the majority of withdrawals.
Web-based learning can be an effective mode of delivery for nursing education. Advance preparation by educational institutions, employers and prospective students is essential. Teachers, peers, technology, course design and the learning environment are key variables that influence the learners' experience and success.
This article discusses different types of pneumothorax and aspects of management, including physiotherapy and the insertion and removal of chest drains.
La aspiración endotraqueal de secreciones es imprescindible para el mantenimiento de la permeabilidad de la vía aérea artificial, este procedimiento puede estar asociado a riesgos para los pacientes. Por este motivo, es de gran importancia conocer si las enfermeras lo realizan correctamente, y si la práctica está basada en la evidencia científica. Los objetivos de esta investigación son: evaluar la competencia práctica de las enfermeras, así como los conocimientos científicos que tienen sobre dicho procedimiento, en una unidad de cuidados intensivos polivalente, y analizar si existen discrepancias entre la competencia práctica y los conocimientos científicos. Este estudio descriptivo, realizado en 34 enfermeras, ha analizado la realización de la aspiración endotraqueal de secreciones mediante observación directa, utilizando para la recogida de datos una parrilla estructurada que incluía 19 aspectos a evaluar, agrupados en 6 categorías. Del mismo modo, se analizaron los conocimientos acerca del procedimiento, utilizando un cuestionario autoadministrado de 19 ítems, agrupados también en 6 categorías, que evaluaban los mismos aspectos observados
The authors present a review of the pathophysiology of pneumothoraces, the indications and the procedures required for the insertion of chest drains, and review paediatric practice using the recently developed Seldinger-style percutaneous chest drains.
Background: Morphine is commonly used for chest drain removal pain, although a few studies in adults suggest that inhalation agents may be effective for this procedure. Little is known about chest drain removal pain and its management in children.
Methods: Three separate studies were carried out at a large tertiary pediatric hospital to examine the characteristics and management of chest drain removal pain in children. Study 1 examined the prevalence and clinical characteristics of pain and analgesic practices in 135 nonventilated children aged 1 week to 18 years having chest drains removed. Study 2 was an observation study to determine the efficacy and safety of self‐administered Entonox (50% nitrous oxide and oxygen) for chest drain removal pain in 30 children aged 7–18 years. Study 3 was a pilot randomized controlled trial comparing intravenous morphine and continuous flow Entonox for chest drain removal pain in 14 children aged 3.5 months to 2.75 years.
Results: In study 1, the prevalence of moderate to severe pain during chest drain removal was 76%. Morphine was commonly given preprocedure, but the dose varied considerably. In study 2, children experienced a significant increase in pain during the procedure compared with preprocedure pain at rest, despite receiving Entonox, morphine and/or diclofenac. However, procedure pain was no worse than preprocedure pain during movement or deep breathing. A few minor side effects occurred, which resolved spontaneously. In study 3, no differences were found in pain between the two treatment groups. Children experienced moderate to severe pain during the procedure, despite receiving Entonox or morphine.
Conclusions: Morphine or Entonox alone are unlikely to provide adequate analgesia for chest drain removal pain in children. More research is needed to determine the most effective interventions for this procedure.
Caring for and managing an infant or a child with a chest drain may cause the children's nurse some anxiety because, although the management is relatively simple, there is potential for disconnection of the equipment, re-accumulation of the pneumothorax and complications--such as pain and infection--that adversely affect the health and wellbeing of the child. Understanding the underlying anatomy and physiology, the pathology behind air leaks, the principles of asepsis, and the assessment and management of a child with a chest drain will enhance the children's nurse's confidence and reduce the likelihood of adverse incidents.
The practice of pediatric cardiac intensive care depends on a collaborative effort from all disciplines involved in the care of critically ill pediatric patients with cardiovascular disease. The 8th International Conference of the Pediatric Cardiac Intensive Care Society was reflective of this collaborative effort as experts from several disciplines, including neonatology, critical care, cardiology, neurology, anesthesia and surgery, gathered to discuss the latest advances in the care of pediatric cardiovascular disease, beginning with the fetus and extending into adulthood. Discussion on innovations in imaging and mechanical circulatory devices, the impact of genetics on outcomes, hybrid techniques (that bridge the catheterization laboratory and the operating room), surgery in very low birthweight neonates, and the discussion of adults with congenital heart disease were demonstrative of this collaborative, multidisciplinary effort.
This research study explored the factors which influenced the ability of children's nurses to urethrally catheterise children in their care.
There is currently limited evidence to inform the clinical skills training of children's nurses and the impact of competencies and other educational documents on practice. The project aimed to use data to inform local service provision and the design and development of future training programmes in an acute paediatric hospital.
A mixed method study using questionnaires and focus groups.
Data were obtained through two focus groups (n = 10) and questionnaires (n = 34, response rate 88%) with trained children's nurses to explore the influencing factors on their ability to conduct this clinical skill.
The children's nurses discussed that barriers to being competent and confident to catheterise included a lack of exposure to the clinical skill, increasing awareness of the role of competencies and litigation and the presence of specialist roles. Current catheterisation training was evaluated positively with most nurses stating their knowledge and clinical skills had increased; despite this only 55% (n = 18) identified that would feel able to catheterise a child in their care.
Comprehensive training of all children's nurses in an acute care setting may not provide a workforce, which is competent and confident in urethrally catheterising children, and resources for training may be more appropriately deployed to ensure the optimum care of children and families.
This study highlights the difficulties encountered for clinical nurses to remain competent in infrequently used clinical skills. This has relevance to the challenges of providing a multi-skilled workforce in children's nursing.
This article provides a step-by-step approach to the removal of chest drains and offers a rationale for practice. It also discusses indications for chest drain removal and potential complications associated with the procedure.
The purpose of this study was to determine if chest tubes that are not milked or stripped occlude more frequently than milked or stripped tubes, and if the amount of drainage varies according to the treatment of the tubes. Following coronary artery bypass graft procedures, 49 male subjects had their chest tubes milked every 2 hours, had them stripped every 2 hours, or served as controls (i.e., their tubes were neither milked nor stripped). An analysis of variance was applied to the results. There was no significant difference in total drainage volume, hourly zero drainage, heart rate, or occurrence of arrhythmias among the three groups of subjects. Four to 16 hours postoperatively, a significantly higher volume of drainage occurred in the subjects whose chest tubes had been stripped. Stripping is particularly discouraged during this interval. The chest tubes remained patent with or without milking or stripping. We conclude that neither milking nor stripping is necessary for the proper care of chest tubes. We recommend that tubes be positioned such that they promote continuous drainage.
Stripping of chest tubes to promote drainage of the thorax of postthoracotomy patients has been routine practice, based on tradition. Recent published findings indicate that significant negative pressures are generated in the tube during stripping that could cause pain, bleeding and possible damage to the patient's lung tissue.
To determine whether pediatric oncology patients whose chest tubes were not stripped would differ in frequency of pain, fever or lung complications from patients who underwent routine tube stripping.
Data were collected at multiple points during the first 72-hour postoperative period from 16 patients assigned to the stripped or unstripped groups. Pain was measured by the Faces Pain Scale and the Visual Analogue Scale; temperature, by electronic thermometer; and lung complications, by stethoscope and radiographs. Both groups, which were comparable for age, primary diagnosis and prior history of lung problems, received identical supportive nursing and medical care, with the physicians blind to group assignment.
The two groups did not differ significantly in frequency of pain, incidence of fever, breath sounds or radiographic findings across measurement points. A strong correlation was found between the pain scores using the two instruments.
Patients whose tubes were not stripped did not have an increased risk of infection or lung complications. Study findings indicated that stripping did not increase the frequency of pain.
Stripping of chest tubes as a routine postoperative measure is questioned.
Caring for a child with a chest tube is a nursing challenge. By following a logical system of assessment, the critical care nurse will be able to master the art of chest drainage with little difficulty. This update provides the quick assessment procedure to assure proper chest drainage.
The insertion of an intercostal chest drain to relieve the pleural cavity of unwanted air or liquid is a common procedure. It is simple to perform and should be associated with a low mortality and morbidity. However, unnecessary problems are often encountered, both during and after the procedure.
Most hospital doctors will, at some stage, insert a chest drain, either urgently in cases of trauma or electively for a pneumothorax or pleural effusion. An adequate understanding of the anatomy and pathophysiology of the pleural space is vital, as is proper teaching of the technique of insertion and subsequent management of chest drains.1 2 3
The aim of drain insertion is to restore and maintain the negative intrathoracic pressure necessary for lung expansion and drainage of the pleural cavity.4 The physiological mechanisms maintaining full expansion depend on removal of excess liquid and gas from this space. The basic principle of chest drainage is to ensure this by re-establishing the negative intrapleural pressure. When at rest (that is, at functional residual capacity), the elastic forces of the chest wall and lung try to separate the visceral and parietal pleural layers, and create a …
The evacuation of empyemas first performed centuries ago, marked the beginning of thoracic drainage. The subsequent acquisition of a greater knowledge of the anatomy, physiology, and pathology of the pleural space directed the design of thoracic catheters and drainage systems and the development of the methods by which they are used. Furthermore, a better understanding of the physics of vacuum and air flow brought about improvements in the use of suction with drainage. Today, thoracic catheters, chest drainage systems, and most vacuum sources are well designed and well made and incorporate components needed to achieve the best care of the pleural-mediastinal space. This review covers the development and important considerations in the current use of thoracic drainage.
Chest drains are routinely inserted during thoracic surgery and to conservatively manage spontaneous pneumothorax.
An extensive search of the literature revealed only a small number of highly prescriptive articles to advise the nurse on the specific care needs of this patient group.
An exploratory study undertaken with 18 patients drew attention to the persistent discomfort and pain experienced by patients throughout the entire time that the chest drain remained in situ.
Most of the patients also experienced short‐lasting but intense pain when the chest drain was removed.
Patients appeared ill‐prepared for their experiences despite opportunities to obtain verbal and written information from staff.
This article discusses different types of pneumothorax and aspects of management, including physiotherapy and the insertion and removal of chest drains.
Chest tubes are placed to empty the pleural space of air or fluid which prohibits full lung expansion. The function of these tubes is dependent on adequate placement, effective drainage and frequent re-evaluation of the patient and the chest drainage system. Knowledge of the principles of chest tube drainage is important to evaluate adequately the function of a tube thoracostomy.
The nursing practice of avoiding dependent loops in the tubing of chest drainage systems because such loops may impede drainage and alter the intrapleural pressure is not research based.
To determine if the volume of fluid drained and pressure vary when the chest drainage tubing is straight, coiled, has a dependent loop, or has a dependent loop that is periodically lifted and drained.
A repeated-measures design was used. For each tubing position, 500 mL of fluid was infused into the pleural space of 8 adult pigs during 45 minutes. The volume of fluid drained and the pressure at 2 locations within the drainage tubing were measured for 1 hour.
After 60 minutes, significantly less fluid (least significant difference test, P = .03) was drained with the dependent-loop tubing position (65 mL) than with the other 3 positions. However, the amount of fluid drained was not significantly different among the lift and drain (250 mL), coiled (301 mL), or straight (337 mL) tubing positions. Throughout the entire study, pressure at the connection between the chest tube and the drainage tube was significantly higher (least significant difference test, P = .003) for the dependent loop with and without periodic lifting and draining.
Straight and coiled tube positions are optimal for draining fluid from the pleural space. If a dependent loop cannot be avoided, lifting and draining it every 15 minutes will maintain adequate drainage.
Although the use of chest drains is common in medicine, there appear to be wide variations in practice. A survey was therefore conducted to establish the current status of chest drain management in the Northwest region. A questionnaire targeted consultants practising in the specialties of chest medicine, general surgery, accident & emergency and cardiothoracic surgery. The questionnaire consisted of five sections encompassing aspects of the insertion, day-to-day care and removal of chest drains. With an overall response rate of 75.3% (110/146), important variations in every major aspect of the practice of chest drains were found between the specialties and to a large extent within each specialty. We have made a number of recommendations which aim to encourage good practice and reduce unnecessary complications, including the adoption of standardised protocols for inserting and managing chest drains.
Eutectic mixture of local anesthetics (EMLA; Astra Pharmaceuticals, Wayne, PA) has been shown to reduce the pain of blood draws in children. We investigated the use of EMLA versus IV morphine for providing analgesia during chest tube removal (CTR) in children. One hundred twenty pediatric cardiothoracic surgery patients were enrolled. Patients were randomly assigned to receive either morphine (0.1 mg/kg up to 10 mg IV 30 min before CTR) or EMLA cream (5 g per chest tube cutaneously 3 h before CTR). A single, trained observer rated the patient's pain before, during, and after CTR using a 10-cm visual analog scale. The sites were evaluated for adverse effect. Methylhemoglobin levels were monitored in infants. Before CTR, the pain scores of the children who received morphine were rated lower than those who received EMLA (P < 0.01). During CTR, there was no difference in the pain score between the morphine or EMLA group. The change from baseline pain score in the morphine group was significantly larger than in the EMLA group (P < 0.01). We conclude that EMLA is safe and useful for blunting the pain of CTR.
Recurrent pneumothorax is the most significant complication after discontinuation of thoracostomy tubes. The primary objective of the present study was to determine which method of tube removal, at the end of inspiration or at the end of expiration, is associated with a lesser risk of developing a recurrent pneumothorax. A secondary objective was to identify potential risk factors for developing recurrence.
A prospective study of 102 chest tubes in 69 trauma patients (1.5 tubes per patient) randomly assigned to removal at the end of inspiration (n = 52) or the end of expiration (n = 50).
Recurrent pneumothorax or enlargement of a small but stable pneumothorax was observed after the removal of four chest tubes in the end-inspiration group (8%) and after discontinuation of three chest tubes (6%) in the end-expiration group (p = 1.0). Of those, only two tubes in the end-inspiration group and 1 tube in the end-expiration group required repeat closed thoracostomy. Multiple factors were analyzed that did not adversely affect outcome. These included patient age, Injury Severity Score, Revised Trauma Score, mechanism of injury, hemothorax, thoracotomy, thoracostomy, previous lung disease, chest tube duration, the presence of more than one thoracostomy tube in the same hemithorax, or a small (but stable) pneumothorax at the time of tube removal.
Discontinuation of chest tubes at the end of inspiration or at the end of expiration has a similar rate of post-removal pneumothorax. Both methods are equally safe.
The management of pain for patients with chest drains has been largely neglected. This article reviews the evidence and describes how applying a theoretical model can help patients undergoing this painful invasive procedure.
The aim of this systematic review was to summarise the best available evidence relating to the nursing management of chest drains. Studies included were those involving hospital patients with a chest drain in situ. A comprehensive and systematic search of the literature was undertaken that included all major databases. Methodological quality was assessed using a developed checklist. The randomised controlled trial (RCT) design was rarely used and therefore evidence was summarised using a narrative discussion. Studies using other methods were also assessed for inclusion in this narrative summary. The findings of this review highlight the lack of research on most aspects of the nursing management of patients with chest drains in situ. RCTs suggest that chest drains remain patent with or without stripping and milking of tubes, but that the total drainage was greater from manipulated tubes. There is little evidence relating to other aspects of chest drain management such as dressing of insertion site, actions following accidental disconnection and tube removal. There is therefore a need for rigorous research in many areas of the nursing management of chest drains, particularly with subjects under the age of 18 years.
Critical care courses for noncritical care nurses are developed to meet staff nurses' needs for additional skills because of increasing patient acuities. To be successful it is imperative that staff development nurses provide input to ensure that course content is directed to meet the needs of nurses in their facilities: hospitals, nursing homes, and home care settings.
Critical care courses are usually developed as a cooperative effort among clinical agency personnel-usually staff development nurses-and nurse educators who have expertise in critical care nursing in concert with an agency representative who can clearly address the needs of nurses working in specific hospital units. Thus, a consortium is formed in a specific geographic area that may be a temporary or ongoing association. The structure of that partnership is determined by those representatives of the institutions involved and can be informal or highly structured. The staff development nurses are able to identify patient acuity trends within their specific agency-or their healthcare system-and interact with staff nurses to identify what competencies those professionals see as essential to meet patients' needs. Agency educators bring the information to consortium meetings to ensure that course development will be relevant to the anticipated attendees, in addition to appropriately applying the general critical care core curriculum guidelines. The service-academic liaisons can become permanent and be used to continue updating staff nurses' skills without major, time-consuming difficulties. In some areas, hospital personnel have negotiated and developed a consortium-a group of agencies working together-to develop critical care courses that are made available to all employees of those agencies.
The consortium approach has been used over the last decade to help nurses upgrade their critical care skills. The process of developing such an approach (Articola, 1998), a method for developing basic critical care curriculum (Sammut, 1994), and the need for advanced education for critical care nurses (Earp et al., 1992) have been documented. All of those authors supported the idea that melding the educational skills of nurses employed in staff development and academic settings has been beneficial to all involved. Other outcomes cited were that care delivery agencies supported consortium endeavors because of the cost-saving benefit and the increased quality of care provided by current staff. Staff nurses from a variety of service settings increased their skills, formed new collegial relationships, and became more satisfied in their work environments. Staff development and academic educators achieved group and individual satisfaction regarding their achievement, and the gap between service and education was narrowed.
During the 1990s, there was an enormous shift to increased acuity levels of patients admitted to general medical and surgical care floors as well as nursing homes and other community-based care settings. That ongoing change is a result of the wide acceptance of managed care, case management, and other healthcare trends focused on hospital cost containment (Cohen & Cesta, 1997). At the same time, the role of staff nurses has become more technically complex, workload has increased, and there has been a continuing evolution of nursing education in hospitals (Shi & Singh, 1998). Congruent with staff nurses' awareness of the increased complexity of care required to meet the needs of that higher acuity patient population is their awareness that their current knowledge may need to be updated and expanded. Thus, it seems that all the critical care concepts have become increasingly vital for inclusion into the repertoire of skills of nurses in a variety of hospital and other healthcare delivery areas.
The consortium model for updating staff nurses' skills appears to be a win-win situation. However, none of the literature located to date has been specifically focused on identifying what critical care content should be included in continuing education programs to help noncritical care nurses expand their skills to efficiently care for the high acuity patients transferred or admitted to general floors. Information available includes global ideas and infers that nurses will be assisted to retool for a role change to become critical care nurses. Documents used for course construction include the critical care practice standards and core curriculum as well as current textbooks (American Association of Critical Care Nurses [AACN], 1977; Bucher & Melander, 1999).
The purpose of this article is to present a format that will assist healthcare organization personnel to develop a critical care course for noncritical care nurses that meets the needs of the specific healthcare organization(s). Because the skills update requirement of nurses varies within and between groups, no attempt is made to present one course detailed enough to be applicable in any setting. However, each group can use the basic format presented here and adapt the content to the needs of the specific audience.
The primary focus of such a course is on providing essential critical care knowledge to general staff nurses who need to upgrade their skills, rather than retool for a critical care career. Given that patients are discharged earlier and sicker than in the past, and that a nursing shortage seems imminent (Peterson, 1999), the knowledge that staff nurses will gain from such a program will be invaluable as they continue striving to meet patients' needs for quality care.
Chest tubes are often placed in children after elective thoracic surgical procedures. Depending on surgeon preference, tubes can be pulled directly from suction or after a trial of water seal. Removal of the tube without water seal potentially allows earlier removal, decreased postoperative pain, and earlier discharge from the hospital. No randomized, prospective study has been performed to compare the two methods to determine whether omission of the water seal period is safe after elective thoracic surgery in children.
This is a single-blinded, randomized study conducted between June 1998 and June 2000. Children undergoing elective, noncardiac, nonesophageal thoracic operations were placed into water seal or a nonwater seal groups. Groups were compared for development of pneumothorax or pleural effusion after chest tube removal.
Fifty-two children participated in the study, with 28 in group I (suction) and 24 in group II (water seal). Operations included both pulmonary and nonpulmonary thoracic operations performed both thoracoscopically and open. No child developed a major pleural effusion after chest tube removal. Three children (11%) in group I and eight (33%) in group II developed pneumothorax. No child required reinsertion of the chest tube and all were successfully treated with observation and oxygen. There was no marked difference between the groups regarding development of pneumothorax, but the power of the study is low.
A water seal trial is not necessary for safe removal of chest tubes in children undergoing elective surgery. Chest tubes can be removed safely and earlier when pulled directly from suction for both pulmonary and nonpulmonary thoracic pediatric procedures.
Use this guide to understand when your patient may need a chest tube and how to manage the drainage system.
This disease can range from indolent to aggressive. Find out about testing, treatment, and patient teaching.
• In 1997, a revised system was introduced at the University of Glamorgan, Wales, to assess student nurse clinical competency. This was firstly as a result of concerns that the previous system was based on limited documentary evidence, and, secondly as the Welsh National Board for Nursing and Midwifery issued new competency statements.
• This article reports an evaluative research study which aimed to determine whether the revised system was an effective measure of clinical competency.
• A series of focus groups were conducted with students, tutors and clinical preceptors to discuss their experiences of using the revised system. A content analysis was conducted of all evidence written by students to support the achievement of clinical competency.
• The findings of the focus groups indicated that each group had some initial problems with the assessment process. The main concern for all groups was lack of consistency and uncertainty in the assessment process. Although the introduction of written evidence to support clinical competency was welcomed, many felt that too much evidence was required.
• Content analysis of competency documentation aimed to compare student evidence and to determine whether there were inconsistencies in the assessment process.
• There were many variations in the evidence obtained from students, in particular the amount of evidence written by each student.
• The findings clearly indicate that further revisions are necessary to ensure that the system is implemented in the most effective way.
• The Fitness for Practice report (UKCC, 1999) has ensured that competency-based assessment is here to stay in the UK. Evaluative research of this type is important to ensure that we adopt the most suitable approach to assessing clinical competency.
These guidelines have been replaced by BTS Pleural Disease Guideline 2010 Superseded By BTS Pleural Disease Guideline 2010: BTS Guidelines for the Management of Pleural Disease. Thorax 2003 May; 58(Suppl 2): 1–59.
This article seeks to demonstrate how the current debate around nursing skills is derived from an economic model of care and competency that has been based on the needs of the adult population. The professional perspective of children's nursing has been unheard in policy and decision-making circles concerning the skills agenda debate within educational and clinical practice. As a consequence, the need of children's nurses has been assumed to be the same as those of general/adult nursing. This article argues that children's nursing has followed a different historical and professional pathway on its progression to maturity. These differences call for alternative educational and clinical solutions for children's nurses in the issue of skills acquisition. In the children's nursing context, this is the difference between having a skill and being skilled. Recognition of this could ensure that children's nursing has a valuable contribution to make to the debate from its unique perspective.
Tracheal suctioning is essential to maintain permeability of the artificial airway. This procedure may be associated to risks for the patients. Thus, it is very important to know if the nurses perform it correctly and if the practice is based on scientific evidence. This investigations objectives are: evaluate practical competence of the nurses, as well as the scientific knowledge that they have on this procedures in a Polyvalent Intensive Care Unit and analyze if there are discrepancies between the practice competence and scientific knowledge. This descriptive study, performed in 34 nurses, analyzed the performance of tracheal suctioning by direct observation, using the data collection of a structured grid that included 19 aspects to evaluate, grouped into 6 categories. In the same way, knowledge on the procedure was analyzed, using a 19-item self-administered questionnaire, also grouped into 6 categories, which evaluated the same aspects observed. The total mean score obtained in the practice observation grid (P) was 12.09 for a maximum score of 19, while it was 14.24 in the knowledge questionnaire (Q). When analyzed by categories, discrepancies were obtained in the following aspects: in the need for hand washing prior to suctioning (P = 55.9%; Q = 97.1%), in cleaning of the suction catheter after each suctioning during the procedure (P = 0%; Q = 38.2%), in the correct performance of hyperoxygenation and hyperinsuflation, before, during and after the procedure (P = 11.8%; Q = 941%), in the correct selection of the size suction catheter in relationship with endotracheal tubes internal lumen (P = 0%; Q = 52.9%), in the maximum time the catheter remains in the trachea (P = 100%; Q = 23.5%), in the maximum number of times that the catheter should be introduced in each suctioning (P = 100%; Q = 73.5%) and in the non-instillation of saline solution (P = 29.4%; Q = 58.8%). When the total scores obtained were compared, both in practice and knowledge, with the years of experience in ICU, no statistically significant differences were found. It is concluded that the study nurses have scientific knowledge of the suctioning procedure that are better than their practice competence. Discrepancies between practice and knowledge were also found in several of the aspects evaluated, which orients towards the specific needs of training in this procedure.
Cardiac tamponade may occur following cardiac surgery as a result of blood or fluid collecting in the pericardial space compressing the heart and reducing cardiac output. Mediastinal chest drains (including pericardial drains) are inserted as standard post-operative practice following cardiac surgery to assist the clearance of blood from the pericardial space and to prevent cardiac tamponade. To prevent chest tubes from blocking and so causing tamponade nurses manipulate them to prevent or remove clots. Manipulation methods including milking, stripping, fanfolding and tapping may be applied to the tubes to keep them from blocking. Evidence is required as to the safest and most effective means of preventing chest tube blockage and preventing cardiac tamponade.
To compare different methods of chest drain clearance (i.e. varying levels of suction or suction in combination with milking, stripping, fanfolding and tapping of chest drains) in preventing cardiac tamponade in patients following cardiac surgery.
Over both the initial review and the 2004 revision, we searched the Cochrane Heart Group trials register, the Cochrane Controlled Trials Register (CCTR) (Issue 4, 2003) The Cochrane Database of Systematic Reviews (CDSR), the Database of Abstracts of Reviews of Effectiveness (DARE), Issue 4, 2003, MEDLINE (1966 to Nov Week 2, 2003), EMBASE (1980 to 2003 Week 47), CINAHL (1982 to Nov 2003), the Clinical Trials site of the NIH, (USA) (24.11.03) and reference lists of articles.
Randomised, quasi-randomised or systematically allocated clinical trials of chest tube manipulation methods in adults and children with mediastinal chest drains following cardiac surgery were included.
Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information where required. Adverse effects information was collected from the trials.
Three studies with a total of 471 participants were included. There was no data, however, which could be included in a meta-analysis. This was due to inadequate data provision by two of the studies. Where adequate data were provided there were no common interventions or outcomes to pool. On the basis of single studies there was no evidence of a difference between groups on incidence of chest tube blockage, heart rate, cardiac tamponade or incidence of surgical re-entry.
There are insufficient studies which compare differing methods of chest drain clearance to support or refute the relative efficacy of the various methods in preventing cardiac tamponade. Nor can the need to manipulate chest drains be supported or refuted by results from RCT's.
Chest drains are a common feature of patients admitted to acute respiratory or cardio-thoracic surgery care areas. Chest drains are either inserted intraoperatively or as part of the conservative management of a respiratory illness or thoracic injury. Anecdotally, there appears to be a lack of consensus among nurses on the major principles of chest drain management. Many decisions tend to be based on personal factors rather than sound clinical evidence. This inconsistency of treatment regimes, together with the lack of evidence-based nursing care, creates a general uncertainty regarding the care of patients with chest drains. This study aimed to identify the nurses' levels of knowledge with regard to chest drain management. The research objective of this study was to describe the nurses' levels of knowledge regarding the care of the patient with chest drains. The data were collected using survey method. The results of the study revealed deficits in knowledge in a select group of nurses. Several service-led options exist with regard to improving knowledge in this area, such as service study days as well as ward-based tutorials. However, in an era of increasing accountability together with the impetus for each nurse to provide evidence-based care, it is crucial for individual nurse responsibility in the pursuit of knowledge in this area. Nurses must be supported by local practice development and through personal portfolio use to identify gaps in knowledge and seek appropriate training and resources.
The purpose of this review was to analyse critically the published research on chest drain removal pain and its management. The findings of descriptive and non-pharmacological intervention studies were summarized and studies of analgesic efficacy were critiqued in depth.
The removal of a chest drain is a painful and frightening experience, particularly for children. However, there is limited research regarding the amount of pain experienced or effectiveness of analgesia for this procedure.
Fourteen studies were reviewed, including five descriptive studies; three studies of non-pharmacological interventions; and six randomized controlled trials of morphine, local anaesthetics and Entonox. The search revealed only two paediatric studies. Many of the studies had design limitations or were poorly reported. The majority of studies indicated that patients experienced moderate to severe pain during chest drain removal, even when morphine or local anaesthetics were given.
Morphine alone does not provide satisfactory analgesia for chest drain removal pain. Non-steroidal anti-inflammatory drugs, local anaesthetics and inhalation agents may have a role to play in providing more effective analgesia for this procedure.
Analgesic protocols for the management of painful procedures such as chest drain removal are unsatisfactory and practice in this area should be revised. More research is needed to determine the efficacy of drugs other than morphine, particularly Entonox and to investigate multi-modal techniques of management further.
Morphine is commonly used for chest drain removal pain, although a few studies in adults suggest that inhalation agents may be effective for this procedure. Little is known about chest drain removal pain and its management in children.
Three separate studies were carried out at a large tertiary pediatric hospital to examine the characteristics and management of chest drain removal pain in children. Study 1 examined the prevalence and clinical characteristics of pain and analgesic practices in 135 nonventilated children aged 1 week to 18 years having chest drains removed. Study 2 was an observation study to determine the efficacy and safety of self-administered Entonox (50% nitrous oxide and oxygen) for chest drain removal pain in 30 children aged 7-18 years. Study 3 was a pilot randomized controlled trial comparing intravenous morphine and continuous flow Entonox for chest drain removal pain in 14 children aged 3.5 months to 2.75 years.
In study 1, the prevalence of moderate to severe pain during chest drain removal was 76%. Morphine was commonly given preprocedure, but the dose varied considerably. In study 2, children experienced a significant increase in pain during the procedure compared with preprocedure pain at rest, despite receiving Entonox, morphine and/or diclofenac. However, procedure pain was no worse than preprocedure pain during movement or deep breathing. A few minor side effects occurred, which resolved spontaneously. In study 3, no differences were found in pain between the two treatment groups. Children experienced moderate to severe pain during the procedure, despite receiving Entonox or morphine.
Morphine or Entonox alone are unlikely to provide adequate analgesia for chest drain removal pain in children. More research is needed to determine the most effective interventions for this procedure.
Background. The treatment of thoracic kyphosis and lumbar lordosis with the C-D method remains controversial. Material and methods. The lateral radiographs of 70 patients with King I, II, III, IV idiopathic scoliosis, treated with C-D instrumentation, were retrospectively analyzed. The average age was 14 +/- 1.8 years. Thoracic kyphosis between T2 and T12 and lumbar lordosis between L1 and L5 were measured. Results. Normalization of thoracic kyphosis occurred in 15 of the 22 hypokyphosis patients. The largest kyphosis correction (average +12 +/- 8 degrees ) was in the preoperative hypokyphosis group. A deep hyperkyphosis (average 64 degrees ) was found preoperatively in patients with postoperative hyperkyphosis. Kyphosis correction in the instrumented region was often reverse to the uninstrumented region correction. Lumbar lordosis remained normal in 29 (63%) and hypolordosis occurred in 14 (31%) of the 45 patients with normal preoperative lordosis. When instrumentation below L1 was performed, a greater decrease in lumbar lordosis was observed. Conclusions. The C-D method enables good kyphosis and lordosis correction in scoliotic patients, but problems may occur in greater deformities. Longer lumbar instrumentation may result in decreased lumbar lordosis.
The administration of intramuscular (IM) injections is an important part of medication management and a common nursing intervention in clinical practice. A skilled injection technique can make the patient's experience less painful and avoid unnecessary complications.
This paper is a report of a study to compare factors influencing the development of evidence-based practice identified by junior and senior nurses.
Assessing factors influencing the achievement of evidence-based practice is complex. Consideration needs to be given to a range of factors including different types of evidence, the skills nurses require to achieve evidence-based practice together with barriers and facilitators. To date, little is known about the relative skills of junior and senior clinical nurses in relation to evidence-based practice.
A cross-sectional survey was undertaken at two hospitals in England, using the Developing Evidence-Based Practice Questionnaire administered to Registered Nurses (n = 1411). A useable sample of 598 (response rate 42%) was achieved. Data were collected in 2003, with comparisons undertaken between junior and senior nurses.
Nurses relied heavily on personal experience and communication with colleagues rather than formal sources of knowledge. All respondents demonstrated confidence in accessing and using evidence for practice. Senior nurses were more confident in accessing all sources of evidence including published sources and the Internet, and felt able to initiate change. Junior nurses perceived more barriers in implementing change, and were less confident in accessing organizational evidence. Junior nurses perceived lack of time and resources as major barriers, whereas senior nurses felt empowered to overcome these constraints.
Senior nurses are developing skills in evidence-based practice. However, the nursing culture seems to disempower junior nurses so that they are unable to develop autonomy in implementing evidence-based practice.
An Audit of Pain Management Practices During Chest Drain Removal. The Centre for Nursing and Allied Health Professions Research Poster Day, Institute of Child Health
- E Bruce
- R Howard
- L Franck
Bruce E, Howard R & Franck L (2003) An
Audit of Pain Management Practices
During Chest Drain Removal. The
Centre for Nursing and Allied Health
Professions Research Poster Day, Institute of Child Health, London.
Pediatric Cardiac Intensive Care
- A Chang
- F Hanley
- G Wernovsky
- D Wessel
Chang A, Hanley F, Wernovsky G & Wessel D (1998) Pediatric Cardiac Intensive Care. Lippincott Williams &
Wilkins, London.
The Stationary Office
Data Protection Act (2003) The Stationary
Office, Dublin.
Chest drainage. In Practices in Children's Nursing; Guidelines for Hospital and Community
- M Dixon
Dixon M (2000) Chest drainage. In Practices in Children's Nursing; Guidelines for Hospital and Community,
2nd edn (Trigg E & Mohammed T
eds). Churchill Livingstone Elsevier,
Edinburgh.
Chest drains and pleural drainage
- Welch J
Welch J (1993) Chest drains and pleural
drainage. Surgical Nurse 6, 7-12.