Chest tubes clog after cardiac surgery. This is a known fact that has been acknowledged by 100% of surgeons surveyed, most of whom also report seeing serious adverse complications associated with clogged chest tubes.(1) When chest tubes clog in the presence of post-surgical bleeding, the evacuation of blood from around the heart and lungs can be impaired. This can lead to retained blood complex (RBC), which is a common cause for hospital readmission. But until now, the incidence of chest tube clogging after cardiac surgery has not been known.

In a recently published prospective, single center study from the Cleveland Clinic, investigators inspected the chest tubes of 100 cardiac surgery patients and found that 36% of these patients had clogged chest tubes.(2) Clogging was significantly more common after urgent procedures, reoperative procedures, and those with intraoperative blood use. Patients with clogged chest tubes tended to have longer hospital stays, more renal failure, and a trend toward higher rates of stroke and cardiac arrest.  One notable finding was that patients with chest tube clogging had a statistically significant increase in post-operative atrial fibrillation, a common complication after cardiac surgery that increases length of stay and readmissions.

Perhaps most surprising is that of the chest tubes that were clogged, 86% were not visibly recognizable by clinicians because the obstructions formed in the portion of the chest tube inside the patient (see illustration above). Though chest tube clogging is associated with serious complications, most of the time it goes unobserved and unaddressed.

One way to prevent chest tube clogging is to actively clear the chest tubes during the early recovery period. PleuraFlow ACT enables clinicians to actively prevent chest tube clogging, which studies have shown can improve the evacuation of post-surgical blood.(3, 4) PleuraFlow also provides clinicians with real-time feedback about obstructions that form in the portion of the chest tube inside the patient. This addresses the problem identified in this study where clogs go unnoticed and unaddressed.

Chest tube clogging occurs in more than one in three cardiac surgery patients, is statistically significantly associated with serious postoperative complications, and mostly goes unobserved. Doesn’t it seem like the right time to be PROACTive with this problem?

 

1)    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.

2)    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.

3)    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.

4)    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.