How soon should drainage tubes be removed after cardiac operations?
YM Smulders, ME Wiepking, AC Moulijn, JJ Koolen, HB van Wezel and CA Visser
Department of Cardiopulmonary Surgery, University of Amsterdam, The Netherlands.
Pericardial effusion frequently occurs after cardiac operation. Despite its high incidence, the etiological process of postoperative pericardial effusion remains unclear. Residual blood or thrombus has often been suggested as a possible cause, implying that the occurrence of pericardial effusion could be related to the effectiveness of postoperative thoracic drainage. This possible relationship, however, has never been studied. We found that prolonging the duration of thoracic drainage by 24 hours often increases total chest tube output considerably but does not affect the incidence of postoperative pericardial effusion: approximately 55% of 100 patients in this study were shown by two-dimensional echocardiography to have pericardial effusion on the sixth postoperative day, regardless of the duration of postoperative drainage. Because of this, and because a long period of drainage causes discomfort for the patient, mechanical irritation to the heart and the pericardium, and an increased risk of infection, we recommend removing drains as soon as their efficacy has peaked, preferably on the first postoperative day.
(Chest. 2003; 124:108-113.)
Silastic Drains vs Conventional Chest Tubes After Coronary Artery Bypass*
Timothy
L. Frankel, BS; Peter C. Hill, MD, FCCP; Sotiris C. Stamou, MD, PhD;
Robert C. Lowery, MD, FCCP; Albert J. Pfister, MD
;
Arvind Jain, MS and Paul J. Corso, MD, FCCP
* From the Sections of Cardiac Surgery, Washington Hospital Center (Mr. Frankel, and Drs. Hill, Lowery, Pfister, and Corso) and Georgetown University Hospital (Dr. Stamou); and MedStar Research Institute (Mr. Jain), Washington, DC. Deceased.
Correspondence to: Timothy L. Frankel, BS, 3401 N Street NW, Washington, DC 20007; e-mail: tfrankel@gwu.edu
Study objectives: To investigate differences in drainage amounts and early clinical outcomes associated with the use of Silastic drains, as compared with the conventional chest tube after coronary artery bypass grafting (CABG).
Design: Retrospective nonrandomized case control study.
Setting: A tertiary teaching hospital.
Patients and participants: Outcome data from 554 patients who underwent postoperative pericardial decompression using small Silastic drains were compared with those from 556 patients who had conventional chest tubes after first-time CABG at our institution between January 1 and August 1, 2000.
Measurement and results: Univariate analysis of preoperative characteristics was used to ensure similarity between the two patient groups. Operative mortality, mediastinitis, reoperation for bleeding, and early and late cardiac tamponade occurred in 9 patients (1.6%), 6 patients (1.1%), 6 patients (1.1%), 6 patients (1.1%), and 1 patient (0.2%), respectively, in the Silastic drain group, compared with 11 patients (2.0%), 9 patients (1.6%), 4 patients (0.7%), 2 patients (0.4%), and 6 patients (1.1%) in the conventional group. No statistically significant differences between the two drains were identified. Drainage amounts (mean ± SD) were 552.2 ± 281.8 mL and 548.8 mL ± 328.7 mL for the Silastic and conventional groups, respectively (p = 0.51). Postoperative length of stay was longer for the conventional chest tube group (median, 5 d; range, 1 to 119 d) when compared to the Silastic drain group (median, 4 d; range, 1 to 66 d; p = 0.01).
Conclusions: We demonstrated that small Silastic drains are equally as effective as the conventional, large-bore chest tubes after CABG with no significant risk of bleeding or pericardial tamponade. Additionally, use of Silastic drains allows more mobility than the conventional chest tubes. As a result of this study, there was a change in our clinical practice toward the exclusive use of Silastic drains after all cardiac surgical procedures.
Key Words: cardiac surgical procedures • comparative study • drainage/methods
Ann Thorac Surg 2000; 70:1109-1110