Authors:
Linda L Oakes RN, MSN,
CCRN
Pamela Hinds RN. PhD, CS
Bhaskar Rao, MD
Paula Bozeman,
MD
Barbara Taylor, RN, BSN
Dennis Stokes, MD
Diane Fairclough
DPH
From St Jude Children's Hospital Memphis, Tenn (LLO, PH, BR, PB. BT, DF)
and
Department of Pediatrics, Vanderbilt University, Nashville, Tenn
(DS).
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. (American Journal of Critical Care. 1993;2:293-301).
The authors acknowledge the assistance of the ICU nursing staff, the members of the Surgical Department, the University of Tennessee faculty, Gale Simpson, RN, and Christie Wright (Scientific Editing Department), in their support of this study. This article is a condensed version of the paper in which the first author was recognized as the recipient of the Tennessee Nurses Association Student Research Award.
Linda L. Oakes, RN, St Jude Children's Research Hospital, 332 North Lauderdale St. Memphis, TN 38101.
Terry Chan, AAGN Journals Department, 101 Columbia, Aliso Viejo, CA 92656.
March 15, 2002
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