Active clearance of chest drainage catheters reduces retained blood.
OBJECTIVE
Chest tubes are used to clear blood from around the heart and lungs after heart surgery, but they can be obstructed by a blood clot, leading to retained blood syndrome (RBS). We sought to examine the frequency of RBS and associated morbidity, and to determine the influence of a preventative active chest tube clearance (ATC) protocol on these outcomes.


METHODS
A multidisciplinary team developed a simple protocol to institute ATC to preventatively clear chest tubes of clot during the first 24 hours after heart surgery. An extensive educational in-service was performed before universal implementation (phase 1). We retrospectively compared data collected prospectively from 1849 patients before universal implementation (phase 0) with data from 256 patients collected prospectively after universal implementation (phase 2), and then used propensity matching for outcomes assessment.


RESULTS
In propensity-matched patients, 19.9% of patients had interventions for RBS (phase 0). After the implementation of ATC (phase 2), the percent of patients with interventions for RBS was reduced to 11.3%, representing a 43% reduction in RBS (P = .0087). These patients had a 33% reduced incidence of postoperative atrial fibrillation from 30% (78 out of 256) in phase 0 to 20% (52 out of 256) in phase 2. (P = .013).


CONCLUSIONS
ATC is associated with a reduced need for interventions for RBS and postoperative atrial fibrillation. Our findings underscore the importance of maintaining chest tube patency in the early hours after cardiac surgery.
['Sirch|Joachim|J|', 'Ledwon|Miroslaw|M|', 'Püski|Tamas|T|', 'Boyle|Ed M|EM|', 'Pfeiffer|Steffen|S|', 'Fischlein|Theodor|T|']
D000368:Aged D001281:Atrial Fibrillation D006348:Cardiac Surgical Procedures D061807:Catheter Obstruction D002404:Catheterization D002408:Catheters, Indwelling D004322:Drainage D004867:Equipment Design D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010490:Pericardial Effusion D057216:Propensity Score D058996:Quality Improvement D019984:Quality Indicators, Health Care D012189:Retrospective Studies D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
atrial fibrillation pericardial effusion pleural effusions