After heart, lung and chest trauma surgery, fluid or air can accumulate in the chest, which can lead to complications and even death if not properly drained.
Chest tubes are the primary mode of drainage, and are used in nearly all heart and lung surgery cases. Chest tubes are long, semi-stiff, clear PVC or silicone tubes that are inserted into the chest after heart, lung and trauma surgery to drain collections of fluids or air. They can be inserted in the pleural space around the lungs (pleural tubes) or around the heart (mediastinal tubes).
Chest tubes are connected to a closed drainage system that is attached to suction. This drainage system is made up of a tubing coupler, which couples the chest tube to the drainage tubing that leads to the drainage canister. The drainage canister contains a water or dry seal mechanism to regulate pressure and prevent air from traveling back towards the chest.
Because the pressure is generally lower in the closed suction drainage system than in the chest, the blood, fluid and air travel into the tubes and out to the drainage canister.
Any blockage of the chest tube impairs drainage and can have significant adverse clinical consequences including death.
How is Clogging Currently Managed?
When clinicians (mainly nurses and doctors) caring for patients in the perioperative period following chest surgery and trauma notice that there is clot forming in the tube, they often undertake measures to try to remove the clot.
When clogging occurs in the visible portion of a chest tube, the options to clear the obstructed tube are limited. Even if the visible portion of the chest tube where it exits the skin appears patese, obstructing clot can occur in the tube inside the chest where it is not visible.
Options to address clogging are limited, but often include squeezing, stripping and “milking” the tubes, or applying open suctioning – all of which undesirable for nurses and often dangerous activities for patients.
Complications from Chest Tube Clogging
Regardless of diameter size, any tube used to drain the chest after surgery can become clogged. This usually happens in the setting of bleeding. Bleeding and clotting in the tube in this circumstance can be life threatening for two reasons.
First, the amount of blood that comes out is very carefully monitored as a measure of the seriousness of the bleeding. If blood pools in the chest, for example, unnoticed because it is not coming out of the tubes, the patient can lose a large volume of blood. This can have severe consequences, including circulatory collapse and death.
Second, if blood pools in the pericardial space, it can compress the heart, impairing the return of blood to the heart, and thus the ability of the ventricle to fill and empty. This condition, known as pericardial tamponade, likewise results in shock and can be fatal.
In the setting of an air leak from the lung, clogging of the chest tube can lead to a pneumothorax, subcutaneous emphysema, or even death when the air builds up under pressure in the pleural space.
The PleuraFlow® Active Tube Clearance® System was developed to allow nurses and doctors to better manage these issues in the post operative setting, leading to safer, more efficient and less painful heart and lung surgery.