Chest Tube Clogging

  1. We are doing some research on chest tube clogging. Our view is this mostly impacts the ICU nurse taking care of the patient after surgery. We are curious regarding nurses opinions on how often this happens. If you define chest tube clogging by seeing strands of thick clot or fibrin that you have to work on physically to get down the tube (by whatever means you use, such as milking, stripping, fan folding, etc), how often do you have to do this after heart surgery?
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  3. by   NotReady4PrimeTime
    I'm not sure my input will be of any value since I work with peds CV surgical patients, but here it is anyway...

    Despite the fact that our chest tubes have a much smaller ID than those used in adults, we have a fairly low incidence of mediastinal chest tube clogging. This can be explained in part by the fact that our surgeons all place mediastinal sumps which are flushed with sterile saline at a minimum of q30 minutes in the immediate post-operative period. If there's been a lot of bleeding we'll flush as often as q5 minutes until the returns are pale pink or clear. When the surgeons first started using sumps, we did have a problem with clogging, and it wasn't uncommon to see our CV fellow at a bedside at 3 am, Fogarty in hand. But as we got more familiar with them the frequency dropped dramatically. Now, if an attempt to flush fails (the saline drips out of the side port and there's no audible feedback) the issue is addressed immediately and usually can be fixed with a little judicious stripping and more vigorous flushing. Once the actual drainage drops to minimal, the sump is converted to conventional water-seal suction, usually by the following morning.
  4. by   TakeBack
    I see it infrequently. If it occurs I either use manual milking (alcohol prep or skin cream on the tube and strip it) or run an ETT suction cath up the tube to evacuate it.

    FWIW we have started using 24 fr blake drains in half our pts and they don't clot.
  5. by   Post Oper
    We see it every night. The patient comes back from the operating room, they are bleeding through the chest tubes, and it starts to thicken. Then we tap and strip and milk the tubes to keep them open. If you dont do it, they clog up and stop draining. Its a common problem that I would say happens everynight. Nurses spend a lot of time, as noted in the first post, keeping them open. Its an active, time consuming process. And its not always succesful, as stated above, since sometimes you have to open the tubes and suck them out.

    By the way, we use 24 Blakes, but only on straight forward cases where we dont expect much bleeding. Not on cases with lots of bleeding. They clot off.
  6. by   TakeBack
    Quote from Post Oper
    By the way, we use 24 Blakes, but only on straight forward cases where we dont expect much bleeding. Not on cases with lots of bleeding. They clot off.
    This doesn't make sense from a conceptual standpoint, and we haven't seen it in practice for the last 4 yrs we've been using blakes.

    A standard arglye tube has 3-4 isolated ports at the end. These clot, and the tube dies unless it is evacuated.
    Blakes have a continuous channel on 4 sides of the drain. There is no closed lumen to occlude.
    Our reop bleeders have the same rate of detection between the two types of tubes, and I have not seen a case of tamponade with blakes. Interesting.
  7. by   michellehoong
    we often seen oso... however we will do manual milking and it is effective to prevent from blocking the tube.. eventually i see the strand/fibrin will be hanging in the tube but it wouldnt block the tube.... and draining the haemoserous...
  8. by   KeepItRealRN
    Well if you have been able to get rid of all the "visible" blood/clots in the chest tube and it still isn't draining, one thing that was shown to me by a mentor of mine is somthing called the "reverse strip". This is basically the same thing as milking/strippint the chest tubes but in the opposite direction. If there is something blocking the holes at the end of the tube a lot of times this will take care of it. In an emergency situation where the patient will tamponade if patency of the chest tube is not re established it works.

    Disclaimer: In no way do I adovcate doing this unless it is in your hospital P and P manual to do so