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Since 1999, Atrium University has been the most authoritative Website for noncommercial information about chest drainage

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Explore and search our site for evidence-based resources to help you write evidence-based policies, procedures and presentations.

Multimodal Strategy to Improve Hand Hygiene

The World Health Organization has been doing research on ways to improve compliance with hand hygiene worldwide since 2010. From highly industrialized nations to rural Africa, the experts at the WHO have resources, toolkits, and education for educators and influencers. Their "calls to action" are designed for: Health care workers...
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Benefits of Beating Heart CABG After MI

Researchers from Australia have published (before print) an analysis of non-elective CABG using bypass, cardiac arrest and aortic cross clamping compared with beating-heart revascularization. They did a retrospective review of 5851 patients who had urgent CABG within 7 days of acute MI (AMI). Only 77 patients had beating-heart surgery. Factors...
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Evidence-Based Competency Curriculum

Nurses at the University of Alabama at Birmingham have published a detailed competency-based curriculum to assess nurse practitioner's transition into the critical care practice role. Unfortunately, the authors note that often, there is little to no time set aside for the transition from critical care bedside nurse to advanced practitioner;...
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Time to Talk About Grief

The most recent issue of AACN Advanced Critical Care has two important articles about nurses dealing with grief. In Creating a Healthy Workplace, author Hui-wen Sato from Children's Hospital Los Angeles makes these observations: Nurses carry a unique and complicated burden of grief, trauma and moral distress Critical Care is...
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Orders for Chest Drainage

Q. Hi, I am a practicing clinical RN at a adult transplant ICU in a large teaching hospital. The residents in our hospital always argue with me on how to write chest tube orders. So there is water seal, which does not require any suction, except gravity. Sometime they would write...
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Subcutaneous Air

Q. What causes subcutaneous emphysema in a patient with a pleural chest tube with a persistent air leak? Is it treatable and what assessments should be considered in patient care? A. Subcutaneous air, also called subcutaneous emphysema or surgical emphysema, occurs in patients with chest tubes when air leaks under...
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Suction: Wet or Dry?

Q. Is there any research to show that the water (wet) suction is more reliable than your dry suction? What are the advantages/disadvantages of each? A. I’m happy to discuss wet and dry suction in general. For individual product specifications, I’ll have to refer you to the manufacturer of the...
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Patient Transports

Q. Hi, I am wondering what the best practice is for air transporting a patient with a pneumothorax treated with a chest tube. Is a commercial 3 bottle system sufficient or should you also place a Heimlich valve with the 3 bottle system or simply a Heimlich valve for air...
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Assessing Bubbling in the Water Seal

Q. I have been asked to do a chest tube competency for our surgical unit staff and have not had any experience myself. After viewing the video about managing chest drainage and asking others here questions I am still a little confused about the water seal chamber. Bubbling in the...
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Clamping Chest Tube Before Removal

Q. Is it necessary to clamp a chest tube prior to d/c the chest tube? What is best practice to go from suction to water seal, then clamp and d/c or suction to water seal and then d/c? Can you give me any contact information on references for best practice...
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Effects of PEEP and CPAP in the Pleural Space

Q. Is there any information about how much PEEP or CPAP is transmitted to the pleural space? A. The amount of PEEP transmitted to the pleural space is determined by the compliance of the chest wall and the lung. If lung compliance is low (the lung is stiff), but the...
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Bubbling and Pneumothorax

Q. Can you please advise whether continuous bubbling should be present in the air leak chamber whilst on continuous wall suction in a patient with a spontaneous pneumothorax who is breathing spontaneously with a dry suction drain? By the way - if the patient was ventilated, what would the difference...
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