A research study at Cleveland Clinic found that early after cardiac surgery, nurses spent more time managing chest tubes in patients with a history of previous coronary artery bypass graft (CABG), valve surgery and heart failure, and when taking preoperative anticoagulant medications.
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When patients had three or more chest tubes, nurses spent more time managing them. Also, smaller chest tube size and nurse caregivers with less comfort in chest tube care were associated with more time spent managing chest tubes. Of all factors studied, chest tube management time was highest for patients who were reoperated for bleeding or tamponade.
Myra Cook, MSN, RN, ACNS-BC, CCRN, CSC, principal investigator of the study, used an investigator-developed case report form to learn the amount of minutes spent taking care of chest tubes, reinforcing dressings and dealing with patient-reported pain related to chest tube management. In total, 364 patients and 29 nurses were enrolled. Bedside nurses provided information about themselves and their comfort with managing chest tube care. Most non-chest-tube-related patient data was pulled from a hospital database.
More than three-fourths of nurses were very comfortable with general management of chest tubes; however, only 41 percent were comfortable managing clogged chest tubes. Laura Schenck, MBA, BSN, RN, CCRN, a study coinvestigator, said the results were not surprising. “Research results confirmed and validated nursing care experiences at the bedside,” she says, “and provide us with implications for nursing practice in the future, especially related to orienting newly hired nurses.”
“Now that we have quantified how much time it takes to manage chest tubes,” Cook says, “results will help us know the patients [or their conditions] that may require more nursing time. We can plan nursing care knowing the time needed to perform care requirements, and we can anticipate patient needs. We hope to employ strategies that improve nurses’ time spent on this type of care.”
Schenck says a physician-led research study that involved clot removal using a new type of chest tube sparked the team’s interest, especially because research papers were limited and off-topic. Chest tube management can take more time than assumed. Study results provide new knowledge about time needed to complete nursing actions, patients’ pain responses, and nurse and patient characteristics associated with chest tube management.
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