Q: Are there evidence-based or best practice guidelines related to stripping or milking of mediastinal and pleural tubes after cardiothoracic surgery in pediatric patients? Does the evidence support stripping or milking of chest tubes?

A: Patrick Loughran, bs, rn, ccrn, replies:

Stripping, milking, fan folding, and tapping chest tubes are common practices in adult and pediatric centers, but are these techniques supported by evidence? Even though the intention is to prevent an adverse event (cardiac tamponade), is the potential harm related to these techniques clearly understood?

The presence of mediastinal and pleural tubes is common in patients after surgery for congenital heart disease. However, variation in the size of the tubes, which can range from 10F to 32F, is unique in the pediatric setting. Among pediatric cardiac patients in the postoperative period, the suction pressure in chest tubes is routinely set between 10 and 20 cm H...

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