Modernizing Your ICU Chest Tube Patency Protocol?

How Leading Hospitals are Developing Protocols to Proactively Maintain Chest Tube Patency after Heart Surgery:  Improving outcomes and reducing hospital costs is a continual effort in modern healthcare. For heart surgery patients, a good place to start is by focusing on something that is common to nearly all recovering patients. All cardiac surgery patients have some degree of post-operative bleeding and chest tubes are required to evacuate this blood from the pleural and/or pericardial spaces in all patients.1,2Chest tube clogging, which has been found to occur in 36% of heart surgery patients, can cause blood to be retained around the heart and lungs, which can lead to Retained Blood Syndrome (RBS).3,4Chest tube

With Retained Blood, Bleeding Begets More Bleeding after Cardiac Surgery

All patients who have surgery have some degree of bleeding in the mediastinum in the immediate postoperative period, called Shed Mediastinal Blood (SMB). Usually this is a microvascular oozing rather than dramatic surgical bleeding. SMB must be cleared by chest tubes placed to evacuate it until the bleeding stops, usually in the first 12 hours after surgery.1 Any impairment in the evacuation of SMB by chest tubes can result in retained blood around the heart.2 Numerous studies have documented that SMB is high in inflammatory mediators, suggesting that when the blood sits in this space, neutrophils are attracted and oxidative stress ensues.3 One biomarker that has been documented acutely in the postoperative

Level 1A Evidence that Reducing Retained Blood Prevents POAF and Effusions After Cardiac Surgery

The Journal of Thoracic and Cardiovascular Surgery published a recent manuscript entitled “Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery”. Nineteen randomized controlled trials enrolled 3,425 patients who were analyzed to determine if efforts to reduce retained blood around the heart after heart surgery might reduce postoperative atrial fibrillation (POAF), retained blood syndrome (pericardial effusions, tamponade, pericardial effusions), hospital resource utilization, and death.1 The focus was the addition of the surgical technique known as “posterior pericardiotomy,” where the surgeon creates a long incision in the posterior pericardium to drain any retained blood into the pleural space, thereby shunting

Preparing to Implement an ERAS Cardiac Surgery Value Quality Care Initiative

Most hospitals are exploring opportunities to improve outcomes and achieve positive financial results with bundled continuous quality improvement programs, but “Where to start?” is a common question. Bundled payment sets a single spending target for all applicable health care servicesprovided during a clinical episode of care over a specified time period. One way this is getting done in cardiac surgery is with MIPS and MACRA.  The goal of these changes is to create financial incentives that encourage hospitals and providers to coordinate care across treatment settings, reduce unnecessary services, and expand initiatives that can help patients recover quickly. High cost programs like post cardiac care will be the focus of many

Expert Consensus Opinion Suggest Preventing Retained Blood To Reduce Infections After Cardiac Surgery

All patients having heart surgery are required to have drainage catheters to remove shed blood from around the heart and lungs in the early hours of recovery following surgery. Evidence has shown that these drainage catheters have a high failure rate due to clogging. Chest tube clogging when a patient is still bleeding can lead to Retained Blood Syndrome (RBS). Retained blood can be demonstrated in up to 20% of patients after heart surgery. Patients with retained blood have far greater hospital acquired infections (HAI) after cardiac surgery. • Patients with interventions for retained blood had a four-times increase in overall infection rate when compared to patients without interventions for