significance of chest drain

TennRN2004 · Mar 17, 2006

i had a patient who had cabg he has single chest tube. the drain from tube is 80 to 100 ml for first three hours. what we can do in this situation.

I'm not exactly sure if you mean he had a total of 80-100 ml for 3 hours (in which case, that is not a considerable amount to worry about), or if he had between 80-100 mls each hour for the first 3 hours (still not really a considerable amount). If you're having a lot of bleeding from the chest tube, there are several things you can do. You can give calcium, which affects the coagulation cascade and can stop bleeding. You also want to check your basic coag labs- PT, PTT, platelet count, because if they are off you can give platelets or FFP to stop bleeding. Another thing to consider is if the patient got their pump blood back that was heparinized, we also give protamine to counteract the heparinized blood when the pt gets their cell saver (or pump blood) back. Also, did pt take plavix or aspirin before surgery- did anyone do a teg to see how much coagulation the pt has from these meds? That may need to be addressed.

Several other things can make cabg pts have a lot of chest tube drainage immediate post op period. One is the surgeons technique ie) do they suture tight so their pts don't ooze a lot or is it a surgeon who is known to have pts ooze quite a bit after surgery, another is if the surgeon suctions out the chest cavity well before closing up the sternum. If they don't, you can expect the pt to dump out for the first few hours just the fluids/blood that wasn't sucked out of the chest. Also, the location of the chest tube is a factor. You expect a medistinal chest tube to drain more than a left or right pleural tube would.

On our cabgs, we have standing orders to notify the surgeon if chest tube output is over 100mls/hr. There is some discretion with this though, because if you've been averaging 20-30 mls output every hour, you sit the patient up for the first time, they may dump 110 just from the position change. Look at the patient- is the bp stable, how are your cardiac indexes UOP, CVP, PA numbers looking? Are they the same or showing signs of the patient deteriorating? You know if you have a major bleed problem- they may dump out 400-500 in 10-15 minutes, then you probably have a graft blown and pt needs to go back to surgery stat.

The short answer is there are many factors to consider when evaluating your chest tube output to figure out the causes and possible treatments.

Geeg · Mar 21, 2006

In short, determine if the bleed is medical, from coagulapathy or surgical, i.e. tamponade and go from there.