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 retained blood (from 4% to 16%);
• Patients with interventions for retained blood had an increase in pneumonia (from 1% to 9%);
• Patients with interventions for retained blood had an increase in sepsis (from 1% to 7%);
• Patients with interventions for retained blood had statistically significant increases in superficial wound, deep wound, and urinary tract infections;
• The average cost to treat a patient with a major hospital acquired infection is nearly $40,000 (J Am Coll Cardiol. 2015;65(1):15-23. doi:10.1016/j.jacc.2014.09.079)
In the October 2016, edition of the Journal of Thoracic and Cardiovascular Surgery, Lazar and colleagues published evidenced based expert consensus guidelines for the prevention and management of wound infections after cardiac surgery. In this document, the authors emphasized that retained blood coagulum is an excellent culture medium, and therefore every attempt should be made to avoid this problem.
One way to minimize retained blood is to maintain chest tube patency and thus maximally evacuate shed blood within the mediastinum. Active clearance of chest tubes can reduce this. In a propensity-matched study by Sirch, et al, also in the Journal of Thoracic and Cardiovascular Surgery, patients who had active clearance of chest tubes had a 43% reduction in retained blood (from 20% to 11%) and a 33% reduced incidence of postoperative atrial fibrillation (from 30% to 20%). This included a significant reduction in the time on the ventilator postoperatively in the ICU. Studies are ongoing to analyze the impact active clearance of chest tubes has on reducing infection after cardiac surgery.
How are you addressing your need to minimize hospital acquired infections after cardiac surgery at your hospital? Maybe it’s time to take a look at Active Chest Tube Clearance.