EDUCATIONAL WEBINAR: Evidence-Based Strategy in the Prevention of Complications due to Retained Blood

An Educational Webinar with Presenters: Marc Gillinov, MD, Marc Gerdisch, MD, and Alyson Mehringer, RN discussing the basic principles of Chest Tube Management, the results of a 1 year quality improvement study and the operational perspective from the ICU Nursing Staff.

Clinical References

  1. Arakawa, Y., Shiose, A., Takaseya, T. et al. Superior Chest Drainage With an Active Tube Clearance System: Evaluation of a Downsized Chest Tube. Ann Thorac Surg. 2011;91:580-583. doi: 10.1016/j.athoracsur.2010.10.018.
  2. Christensen, M., Krapf, S., Kempel, A. et al. Costs of excessive postoperative hemorrhage in cardiac surgery. J Thorac Cardioasc Surg. 2009;138(3):687-93. PMID: 19698857.
  3. Day, T., Perring. R., Gofton, T., Is manipulation of mediastinal chest drains useful or harmful after cardiac surgery? Interact CardioVasc Thorac Surg. 2008;7:888-890.
  4. Dixon, B., Santamaria, J.D., Reid, D., et al. The association of blood transfusion with mortality after cardiac surgery: cause or confounding? Transfusion. 2013;53(1):19-27. doi: 10.1111/j.1537-2995.2012.03697.x.
  5. Hannan, E., Zhong, Y., Lahey, S., et al. 30-day readmissions after coronary artery bypass graft surgery in New York State.  J Am Coll Cardiol Intv. 2011;4(5):569-576. doi:10.1016.jcin 2011.01.010.
  6. Karimov, J.H., Gillinov, A.M., Schenck, L., et al. Incidence of chest tube clogging after cardiac surgery: a single-centre prospective observational study. Eur J Cardiothorac Surg. 2013;44(6):1029-1036. doi:10.1093/ejcts/ezt140.
  7. Lee, Y.C., Vaz, M.A., Ely, K.A., McDonald, E.C., Thompson, P.J., Nesbitt, J.C., and Light, R.W. 2001. Symptomatic persistent post-coronary artery bypass graft pleural effusions requiring operative treatment : clinical and histologic features. Chest 119:795-800.
  8. Light, R.W., Rogers, J.T., Moyers, J.P., et al. Prevalence and Clinical Course of Pleural Effusions at 30 Days after Coronary Artery and Cardiac Surgery. Am J Respir Crit Care Med. 2002;166:1567-1571. doi: 10.1164/rccm.200203-184OC.
  9. Mangus, P.C., et al. Causes of 30-Day Readmission After Cardiac Surgery in Northern New England, Abstract 13474. Circulation. 2011;124-134.
  10. Perrault, L.P., Pellerin, M., Carrier, M., et al. The PleuraFlow Active Chest Tube Clearance System: Initial Clinical Experience in Adult Cardiac Surgery. Innovations (Phila). 2012;7(5):354-8. doi: 10.1097/IMI.0b013e31827e2b4d.
  11. Shalli, S., Saeed, D., Fukamachi, K., et al. Chest Tube Selection in Cardiac and Thoracic Surgery: A Survey of Chest Tube-Related Complications and Their Management. J Card Surg. 2009;24:503-509. doi: 10.1111/j.1540-8191.2009.00905.x.
  12. Shiose, A., Takaseya, T., Fumoto, H., et al. Improved drainage with active chest tube clearance. Interact Cardiovasc Thorac Surg. 2010;10:685-688. doi: 10.1510/icvts.2009.229393.
  13. Wallen, M.M., Morrison, A.L., Gillies D, et al. Mediastinal chest drain clearance for cardiac surgery (Review). The Cochrane Library. 2008, Issue 3.
  14. Wheatcroft, M., Shrivastava, V., Nyawo, B., Rostron, A., and Dunning, J. 2005. Does pleurotomy during internal mammary artery harvest increase post-operative pulmonary complications? Interact Cardiovasc Thorac Surg 4:143-146.
  15. Based on over 313,000 US adult heart surgery patients. Data extracted using  ICD-9 codes from the 2010 Nationwide Inpatient Sample (NIS), from the DHHS Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP).
  16. 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. 2016. Mar; 151(3):832–838.
  17. Presented at IARS 2015 Annual Meeting and International Science Symposium 03/21/2015.
  18. Halm, M.A. To strip or not to strip? Physiological effects of chest tube manipulation. Amer J Crit Care. 2007 Nov;16(6):609-612,
  19. Based on analysis of CMS Proposed FY 2015 impact life. Data may not be inclusive of all facilities included in P4P programs. Actual number of facilities receiving various combinations of HAC, VBP and readmissions adjustments may differ when final rule is released.
  20. Baribeau, Y., Westbrook, B., et al. Active clearance of chest tubes is associated with reduced postoperative complications and costs after cardiac surgery: a propensity matched analysis. J Cardiothoracic Surg 14, 192 (2019) doi:10.1186/s13019-019-09
  21. Samuel St-Onge, Vincent Chauvette, Raphael Hamad, Denis Bouchard, Hugues Jeanmart, Yoan Lamarche, Louis P. Perrault and Philippe Demers. Active clearance vs conventional management of chest tubes after cardiac surgery: a randomized controlled study. Journal of Cardiothoracic Surgery. March 23, 2021. 16:44.
  22. Iribarne A, Burgener JD, Hong K, Raman J, Akhter S, Easterwood R, Jeevanandam V, Russo MJ. Quantifying the incremental cost of complications associated with mitral valve surgery in the United States. J Thorac Cardiovasc Surg. 2012 Apr;143(4):864-72.
  23. Patel PA, Ernst FR, Gunnarsson CL. Ultrasonography guidance reduces complications and costs associated with thoracentesis procedures. J Clin Ultrasound. 2012 Mar-Apr;40(3):135-41.