The Cardiac Surgery RBS Dilemma
Heart surgeons and their teams are often faced with a dilemma: They put in and manage chest tubes to drain shed blood from around the heart and lungs after heart surgery. This is because all patients bleed for a few hours after heart surgery until they are stabilized in the ICU. But now it’s been shown that up to 36% of these chest tubes clot off in the early hours after surgery.1 When this happens, patients can retain blood around their heart and lungs, leading to Retained Blood Syndrome (RBS). RBS includes any interventions required to wash out, remove or drain blood clot, blood or bloody fluid after an initial cardiac surgery procedure. This includes taking patients back to re-open the surgical incision and wash out clot, drainage of hemothorax, tamponade and bloody pleural and pericardial effusions. Estimates suggest that approximately 17% of cardiac surgery patients can be shown to have RBS during recovery.
This poses a dilemma in the ICU: Do you strip and milk the tubes? These maneuvers have been found ineffective in randomized trials, and may be harmful.2,3 Do you take apart the system and advance catheters and balloons up the chest tube to try to re-open it in a “reactive” maneuver that requires one to break the sterile field and runs the risk of advancing the balloon catheter beyond the tip of the chest tube potentially injuring internal organs?4
Or better yet, why not use Active Clearance Technology with PleuraFlow, the only regulatory cleared device to with FDA labeling to proactively prevent chest tube clogging and RBS?5. PleuraFlow has been shown not only to safely and effectively reduce RBS, but also associated complications such as post operative atrial fibrillation (POAF).
The proof is growing: It’s better to be proactive than reactive.