How Leading Hospitals are Developing Protocols to Proactively Maintain Chest Tube Patency after Heart Surgery: 

Improving outcomes and reducing hospital costs is a continual effort in modern healthcare. For heart surgery patients, a good place to start is by focusing on something that is common to nearly all recovering patients. All cardiac surgery patients have some degree of post-operative bleeding and chest tubes are required to evacuate this blood from the pleural and/or pericardial spaces in all patients.^1,2 Chest tube clogging, which has been found to occur in 36% of heart surgery patients, can cause blood to be retained around the heart and lungs, which can lead to Retained Blood Syndrome (RBS).^3,4 Chest tube clogging and RBS is also associated with increased postoperative.^3,4 Keeping chest tubes free of obstructing clot can prevent these complications. Thus preventing chest tube clogging is an important clinical goal for all heart surgery programs.

The link between obstructed chest tubes, RBS and poor outcomes has led many hospitals to look at their postoperative chest tube patency maintenance protocols as an area for potential continuous quality improvement. Very few programs have written chest tube patency protocols.⁵ In the absence of defined tube management protocols to address chest tube clogging ICU nurses are left use makeshift methods like milking, tapping, stripping, and open suction. These approaches are all reactive, and none have been shown to have clinical benefit.^6-8 By the time clot is visualized in the chest tubes, the evacuation has often been impaired for some time, allowing to accumulate in the pleural and/or pericardial spaces. According to the most recent published best evidence topic by Day, the authors conclude that due to possible tissue damage and lack of demonstrable benefit, in most patients drainage tube manipulation with milking or stripping should not be performed.⁹ This has left many uncertain about what protocols should exist to train ICU nurses to optimally maintain chest tube patency after cardiac surgery.

Now your program can be proactive in maintaining chest tube patency with PleuraFlow ACT, 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.