Once again the question of nurses pulling out post op drains has surfaced at my hospital. My question is...if you allow nurses to pull drains at your institution, what policy do you work under (copy appreciated) and do you limit to only certain operative procedures, certain types of drains,anyhtin else? How do you document competency?

Michelle Egan, RN, ONC
Sacred Heart Medical Center
Spokane, WA

Nurses do not pull drains in our hospital , the residents or attending do that. in my mind the nurse should not pull drains. drains are inserted directly into the surgical incision and should be pulled by a surgeon or resident.
Pauline Esoga RNc, ONC

I had pulled drain but it was not placed in ortho-related surgery. But our ortho pts would only have its drains d/c'd by the attendings or residents

Michelle,

When I was a CNS/manager on a joint center in 2005(Missouri), I created the competency checklist for pulling TJR drains (including joint capsule pain med infusion tubing). The chief of ortho signed off on it (copy kept as a record of agreement), all nurses demonstrated competency according to the list under my observation, and that completed list was housed in their individual files.

Jan Foecke, MS, RN, ONC
NAON Director of Programs

We have been pulling non-sutured Ortho drains for about 4 years now. We wrote a policy and procedure. Each nurse must pass a competency before able to pull a drain independently. We priamarily pull HemoVacs.
Marisa Swain
Hoag Hospital
Newport Beach, CA

Policy does vary by institutions I have worked. I have worked on unit where nurses pulled drains (sutures and non-sutured) after completing a competency checklist as mentioned by Jan. In my professional life, I have found and believe ortho nurses have are best suited for this task.Ortho nurses educate the patient before the procedure, reduce anxiety, can pre-medicate when it is actually time to pull and then use proper cleaning and dressing techniques. As much as I respect my orthopaedists, 5 AM fast and furious rounds do not always allow for the best drain pulling experience for a patient.
Laura Woodward
Baltimore

The nurses on our unit just recently started to pull out pain busters. We are not able to do the blood drains yet--sometimes they fall out and we change the dressing. So far there have been no issues. On a rare occassion I have seen a few blood drains in which the tubing was left in patient and then had to be surgically removed!! Ouch. Right now we just have to have an order to pull pain buster and the nurses were inserviced.

This issue was just brought up at the hospital where I work. Currently our nurses pull drains, but we do not have a specific policy or procedure guideline, could you post what your hospital uses?

Thanks,

Laura Smith-Tucker

We pull our drains, constavcs and hemavacs, have had no problems. Had one drain that I did not think was safe to pull all, called surgon who came and tried, then took the person to OR and removed it. He had sutured the tubing during close. But I have been pulliing drains for 13 years. But if someone has a copy of a competency I would like a copy as I trying to get our program JACO certifed and been Ortho specific competency on the unit.

The nursing staff pull all drains for our orthopaedic staff (JP's, constavac, penrose, etc..) sutured and non-sutured. We've done this for years and I can't remember there ever being an issue. We have occasionally had a drain that was difficult to pull and called the PA or surgeon in to assist.