# Chest tubes



## AEMTstudent (Dec 4, 2013)

I am currently learning about them In school. Has anyone started one/ maintained a chest tube in their internship?? Where else can I find information aside from what's on PPTs. Thanks!


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## VFlutter (Dec 4, 2013)

I highly doubt any paramedics, outside of flight, are placing chest tubes. The only time you will likely see a chest tube is CCT. Maintenance of most modern chest tube drainage systems, we use pleurevac, is pretty straight forward. Hook to suction if ordered, check for air leak, and monitor the insertion site and dressing. Know what to do if the tube gets pulled out.


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## NomadicMedic (Dec 4, 2013)

The management and monitoring of PLACED chest tubes is part of the NREMT-P to NRP transition. If you're newly licensed you should have learned about them... If not, ask about a transition course for your state.


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## Handsome Robb (Dec 4, 2013)

Chase said:


> I highly doubt any paramedics, outside of flight, are placing chest tubes. The only time you will likely see a chest tube is CCT. Maintenance of most modern chest tube drainage systems, we use pleurevac, is pretty straight forward. Hook to suction if ordered, check for air leak, and monitor the insertion site and dressing. Know what to do if the tube gets pulled out.



Idk what the difference in NV is but we don't really have ground CCT here. If it's outside of a Paramedic's scope the flight team just rides in the ambulance.

With that said I've taken a patient with bilateral chest tubes who was intubated and had to manage his sedation with versed boluses vs his drip he was on the the ICU. The receiving ICU wasn't happy with how much I had to give him. 

I don't really have much else to add to what's already been said.
 In my program we learned about maintenance as well as placement. I was lucky enough to place one in a cadaver and then assist a surgeon in the ER during clinicals.


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## Carlos Danger (Dec 4, 2013)

AEMTstudent said:


> I am currently learning about them In school. Has anyone started one/ maintained a chest tube in their internship?? Where else can I find information aside from what's on PPTs. Thanks!



As far as management, you'll find some good info here.

As far as placement, placement of a TRUE chest tube (as opposed to something like the Arrow kit or similar, which people sometimes call "chest tubes" but really aren't) by paramedics is very rare. I'm sure there are some agencies somewhere that do it, but it's highly uncommon. Even among HEMS and CCT, I bet only 10% or so of programs have chest tubes in their protocols. I don't think it is a technically difficult procedure, but it is pretty high risk - you don't want to drain a large hemothorax in the field if you don't have blood available, and for pneumo's, a good needle decompression usually works just fine as a temporizing measure.


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## Akulahawk (Dec 5, 2013)

Chase said:


> I highly doubt any paramedics, outside of flight, are placing chest tubes. The only time you will likely see a chest tube is CCT. Maintenance of most modern chest tube drainage systems, we use pleurevac, is pretty straight forward. Hook to suction if ordered, check for air leak, and monitor the insertion site and dressing. Know what to do if the tube gets pulled out.


When I went to school back in 2000, we were trained to manage/monitor a placed chest tube as well. It really isn't any more complicated to do than Chase stated above. Being that most of us were expecting to remain employed in California, most of us didn't expect to have to do this very often. We also went over the placement procedure because it's good to know how it's done, why they're done, and the like so that if/when we have to work with a patient with chest tubes, we know what's going on, not just know what tube goes where...


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## AEMTstudent (Dec 6, 2013)

I am just going to learn what I need to pass the exam and leave the rest for employer training, only because I have enough information to remember as is.  Our EMT-Ps will manage chest tubes, but they do not initiate them as far as I know.   Thanks for your input everyone.


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