Chest tube stripping in pediatric oncology patients: an experimental study

Abstract

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. DISCUSSION: 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. CONCLUSIONS: Stripping of chest tubes as a routine postoperative measure is questioned.

The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy

“…In Thoracic Surgery, this technique was introduced historically in patients who had drainage of empyemas. Early studies highlighted the importance to drain blood clots after thoracic surgery (21). Subsequently, several studies questioned the effectiveness of chest tube milking after cardiac surgery (22)(23)(24)(25).…”

Nurses' knowledge of chest drain management in an Irish Children's Hospital

“…Limited evidence regarding specific aspects of chest drain management in children includes research into chest tube stripping by Oakes et al . (). They found no difference in the incidence of infection or lung complications between the 16 patients assigned to stripped and unstripped groups.…”

“…Oakes et al . () describe stripping as manual compression of the chest drain tubing from the chest wall towards the collection chamber often using a roller device, and milking as fanfolding the drainage tubing into segments and squeezing. However, these terms are used interchangeably by many authors (Welch , Gallon , Dixon ).…”

“…Oakes et al . () examined chest tube stripping in paediatric postoperative oncology patients. No significant differences in lung complications, pain or increased risk of infection between the stripped and unstripped groups were found; however, the practice of routinely stripping chest tubes was questioned.…”

Chest drain removal pain and its management: a literature review

“…Did not include removal of drain. Oakes et al (1993) Chest tube stripping in paediatric oncology patients: an experimental study.…”