Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study

Karimov, Jamshid H.; Gillinov, A. Marc; Schenck, Laura; Cook, Myra; Sweeney, Denise Kosty; Boyle, Edward M.

doi:10.1093/ejcts/ezt140

Cited by 50 publications

(66 citation statements)

References 15 publications

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“…6 This is a critical time when chest tubes have a high potential to clot and impair drainage. 7,8 This led us to form the hypothesis that the high volume of early bleeding combined with a potentially high rate of chest tube clogging may contribute to the elevated need for reinterventions for retained blood in this population. We carried out this analysis to determine whether a dedicated protocol to keep chest tubes patent during this time period might help reduce the need to re-explore and wash out or drain retained blood in patients recovering after LVAD implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Chest tubes can become clogged while the patient is still bleeding, leading to retained blood around the heart and lungs. 7,8 Current methods of clearing chest drainage catheters of clot, such as milking, stripping, and open suction are not beneficial, and can be harmful. 8,9 Studies have demonstrated that maintaining chest tube patency with active clearance can reduce the incidence of retained blood, however, protocols of actively maintaining chest tube patency have never been studied in a LVAD population.…”

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confidence: 99%

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Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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Chest tubes are utilized to evacuate shed blood after left ventricular assist device (LVAD) implantation, however, they can become clogged, leading to retained blood. We implemented a protocol for active tube clearance (ATC) of chest tubes to determine if this might reduce interventions for retained blood. A total of 252 patients underwent LVAD implantation. Seventy-seven patients had conventional chest tube drainage (group 1), whereas 175 patients had ATC (group 2). A univariate and multivariate analysis adjusting for the use of conventional sternotomy (CS) and minimally invasive left thoracotomy (MILT) was performed. Univariate analysis revealed a 65% reduction in re-exploration (43–15%, p < 0.001), and an 82% reduction in delayed sternal closure (DSC; 34–6%, p <0.001). In a sub-analysis of CS only, there continued to be statistically significant 53% reduction in re-exploration (45% vs. 21%, p = 0.0011), and a 77% reduction in DSC (35% vs. 8%, p < 0.001) in group 2. Using a logistic regression model adjusting for CS versus MILT, there was a significant reduction in re-exploration (odds ratio [OR] = 0.44 [confidence interval {CI} = 0.23–0.85], p = 0.014) and DSC (OR = 0.20 [CI = 0.08–0.46], p <0.001) in group 2. Actively maintaining chest tube patency after LVAD implantation significantly reduces re-exploration and DSC.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

et al. 2016

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“…Concerning the clamping of the drain, it is indicated to perform it when it is known that the tube will be removed, in the determination of air leakage or in the exchange of collection flasks (10)(11) . The tube should remain closed for as short time as possible, especially if the use of the tube was indicated due to the presence of pneumothorax, because disclamping prevents the occurrence of a new pneumothorax (10) , or when the blood is being drained and where clotting could result in a risk of cardiac tamponade (11) .…”

Section: Discussionmentioning

confidence: 99%

“…The tube should remain closed for as short time as possible, especially if the use of the tube was indicated due to the presence of pneumothorax, because disclamping prevents the occurrence of a new pneumothorax (10) , or when the blood is being drained and where clotting could result in a risk of cardiac tamponade (11) . Clamping of the tube was also demonstrated in activity, presenting a high validation index.…”

Section: Discussionmentioning

confidence: 99%

Nursing intervention: post-operative care with chest tube in adults

et al. 2018

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Objective: to validate the nursing activities for intervention established by the Nursing Interventions Classification "chest tube care". Methods: content validation study carried out in two intensive units, in which 30 specialist nurses evaluated each activity belonging to the intervention "chest tube care, according to importance and objectivity. The activities were analyzed through a Likert-type scale to determine the index of content validation and reliability. Results: of the 38 activities that are part of the intervention, thirty-five were considered validated. The three non-validated activities were related to the determination of the indication for chest drain, availability of non-traumatic clamps, and occlusion of the device. Conclusion: based on the analysis of the participating nurses, the intervention could be considered as validated and feasible in the Brazilian care practice in order to facilitate the implementation of systematized care. Descriptors: Validation Studies; Nursing Process; Perioperative Nursing; Postanesthesia Nursing; Thoracic Surgical Procedures; Drainage. Objetivo: validar as atividades de enfermagem para intervenção estabelecida pela Nursing InterventionsClassification "cuidados com dreno torácico". Métodos: estudo de validação de conteúdo, realizado em duas unidades intensivas, nas quais 30 enfermeiros especialistas avaliaram cada atividade pertencente à intervenção "cuidados com dreno: torácico", conforme importância e objetividade. Atividades analisadas a partir de uma escala de Likert para determinação do índice de validação de conteúdo e confiabilidade. Resultados: das 38 atividades constituintes da intervenção, trinta e cinco foram consideradas validadas. As três atividades não validadas tratavam sobre determinação da indicação para o dreno de tórax, disponibilidade de clampe não traumático e oclusão do dispositivo. Conclusão: a partir da análise dos enfermeiros participantes, a intervenção pôde ser considerada validada e passível de realização na prática assistencial brasileira, de forma a facilitar a realização de cuidado sistematizado.

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“…If these tubes are clogged, accumulated blood in the chest may compromise cardiac function and cause pericardial tamponade unless the sternum is reopened, or bleeding is drained into an open pleura cavity. Partial, or completely clogged chest tubes, have been reported in up to 36% of patients after cardiac surgery [1,2]. Residual mediastinal blood may, in susceptible patients, trigger postoperative atrial fibrillation [3].…”

Section: Introductionmentioning

confidence: 99%

Active chest tube clearance after aortic valve surgery did not influence amount residual pericardial fluid after aortic valve replacement in a randomised trial

Malgerud

Maret

Reitan

et al. 2020

Scandinavian Cardiovascular Journal

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Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study

Cited by 50 publications

References 15 publications

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Active Clearance of Chest Tubes Reduces Re-Exploration for Bleeding After Ventricular Assist Device Implantation

Nursing intervention: post-operative care with chest tube in adults

Active chest tube clearance after aortic valve surgery did not influence amount residual pericardial fluid after aortic valve replacement in a randomised trial

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