The Challenges of Keeping a Chest Tube Patent at the Bedside after Heart Surgery

shutterstock_436689169Chest tubes are used on every case after heart surgery to drain blood from around the heart and lungs in the early hours of recovery.1,2  If there is any bleeding, or even oozing tissues, the blood must be immediately drained externally by the chest tubes. But chest tubes frequently clot, which can lead to Retained Blood Syndrome (RBS), which includes the need for re-interventions to wash out clot, remove blood or bloody fluid, or long term, even fibrosis around the heart or lungs.3,4  Blood, even in small volumes left around the heart after surgery can cause an inflammatory response, triggering complications such as Post Operative Atrial Fibrillation (POAF).

Nurses have long recognized the frequent problem of chest tube clogging. In the absence any reliable and consistent solutions, many will strip or milk the chest tubes, or at times, the chest tube will be opened and suctioned out in the ICU, which breaks the sterile field.   None of these approaches have been shown to work and in fact, it’s published they may be harmful.5,6,7,8,9

Now nurses in the ICU can proactively and routinely keep chest tubes patent at the bedside without the need for milking and stripping or open suction.  This can be done without breaking the sterile seal. PleuraFlow ACT is the only FDA approved device to prevent chest tube clogging and retained blood. PleuraFlow has been shown to be clinically efficient, to improve the evacuation of post-surgical blood, and to reduce the volume of blood retained in the surgical spaces.10-12 Utilizing PleuraFlow ACT in a defined preventive protocol has been shown to reduce RBS by 43% and POAF by 33%.13 With PleuraFlow ACT, a growing number of hospitals are now formally implementing chest tube clearance protocols to proactively maintain chest tube patency in the early hours after surgery in the ICU. By actively and systematically maintaining chest tube patency, top hospitals are working to improve the clinical efficiency of chest tube management process, and decreasing the incidence of RBS and POAF by reducing the volume of retained post-surgical blood.

For more information about how developing chest tube patency protocols and PleuraFlow ACT can help your facility address this common and costly problem, contact us.

  1. Dixon, B., Santamaria, J.D., Reid, D., Collins, M., Rechnitzer, T., Newcomb, A.E., Nixon, I., Yii, M., Rosalion, A., and Campbell, D.J. 2012. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? Transfusion.
  2. Christensen, M.C., Dziewior, F., Kempel, A., and von Heymann, C. 2012. Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth 26:46-51.
  3. Karimov JH, Gillinov A M, Schenck L, Cook M, Kosty Sweeney D, Boyle EM, Fukamachi K. Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study. Eur J Cardiothorac Surj 2013; 1-8.
  4. Boyle EM, Gillinov AM, Cohn WE, Ley SJ, Fischlein T, Perrault LP. Retained Blood Syndrome After Cardiac Surgery: A new look at an old problem. Innovations in cardiovascular and thoracic surgery. 2015 Sept/Oct:10(5):296-303.
  5. Shalli S, Saeed D, Fukamachi K, Gillinov AM, Cohn WE, Perrault LP et al. Chest tube selection in cardiac and thoracic surgery: a survey of chest tube-related complications and their management. J Card Surg 2009;24: 503–9.
  6. Wallen M, Morrison A, Gillies D, O’Riordan E, Bridge C, Stoddart F. Mediastinal chest drain clearance for cardiac surgery. Cochrane Data- base of Systematic Reviews 2002.
  7. Pierce JD, Piazza D, Naftel DC. Effect of two chest tube clearance protocols on drainage in patients after myocardial revascularisation surgery. Heart and Lung 1991;20:125–130.
  8. Isaacson JJ, Brewer MJ. The effect of chest tube manipulation on mediastinal drainage. Heart and Lung 1986;15:601–605
  9. Day TG, Perring RR, Gofton K. Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interactive CardioVascular and Thoracic Surgery. 2008, 7(5), 878-890.
  10. Shiose, A.; Takaseya, T.; Fumoto, H.; Arakawa, Y.; Horai, T.; Boyle, E. M.; Gillinov, A. M.; Fukamachi, K. Improved drainage with active chest tube clearance. Interactive CardioVascular and Thoracic Surgery 10 (5): 685–688.
  11. Arakawa, Yoko; Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Kim, Hyun-Il; Boyle, Edward M.; Gillinov, A. Marc; Fukamachi, Kiyotaka. “Superior Chest Drainage With an Active Tube Clearance System: Evaluation of a Downsized Chest Tube.” The Annals of Thoracic Surgery 91 (2): 580–583.
  12. Perrault, Louis, Michel Pellerin, Michel Carrier, Raymond Cartier, Denis Bouchard, Philippe Demers, Edward M. Boyle. The PleuraFlow Active Chest Tube Clearance System: Initial Clinical Experience in Adult Cardiac Surgery. Innovations in cardiovascular and thoracic surgery.2012;7:354-358.
  13. Sirch J, Ledwon M, Puski T, Boyle EM, Pfeiffer S, Fischlein T. Active Clearance of Chest Drainage Catheters Reduces Retained Blood. Journal of Thoracic and Cardiovascular Surgery. 2015 Oct 22. pii: S0022-5223(15)01970-4. doi: 10.1016/j.jtcvs.2015.10.015.