title: Chest tube removal practices in critical care units in the United States.
abstract: BACKGROUND
  Pain assessment and management are recognized as major problems in critical care settings. However, little is known about pain management practices related to medical procedures performed in the ICU, particularly removal of chest tubes.
  
  
  OBJECTIVE
  To describe practices related to chest tube removal in the United States, with an emphasis on pain assessment and management.
  
  
  METHODS
  A survey instrument was developed and mailed to 995 members of the American Association of Critical-Care Nurses who cared for patients with chest tubes. They were asked about chest tube removal practices in their institutions.
  
  
  RESULTS
  Chest tubes are removed primarily by physicians and house staff, although 11% of respondents reported that specially trained nurses removed the tubes. Only 16% indicated that a prescription for pain medication was routinely available before chest tube removal. The drug administered most frequently was intravenous morphine sulfate, but the dose varied considerably. Nurses were generally satisfied (65.6%) with practices related to chest tube removal in their unit; nurses who were not satisfied (34.4%) wished to see better pain management practices (45%), removal of tubes by the patient's assigned nurse (17.8%), a protocol for tube removal (13.9%), notification of the nurse before removal (12.2%), and other changes (10%).
  
  
  CONCLUSIONS
  Practices associated with chest tube removal, especially pharmacologic management of procedure-related pain, vary in critical care units. Caregivers are advised to develop practice policies to guide decisions about management of acute pain in this patient population.
authors.affiliation: Center for Nursing Research, University of Alabama at Birmingham, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Kinney
authors.forename: K T
authors.initials: KT
authors.lastname: Kirchhoff
authors.forename: K A
authors.initials: KA
authors.lastname: Puntillo
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D015505:Chest Tubes; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods*; D006801:Humans; D008482:Mediastinum; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D010147:Pain Measurement; D010818:Practice Patterns, Physicians'; D011292:Premedication; D014481:United States
chemical_list: D000700:Analgesics