Reasons for extended length of stay following chest tube removal in general thoracic surgical patients

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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Clinical descriptors of pneumothorax following chest tube removal in paediatric cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951120003467 ◽

2020 ◽

pp. 1-4

Author(s):

Christine LaGrasta ◽

Mary McLellan ◽

Jean Connor

Keyword(s):

Cardiac Surgery ◽

Chest Radiograph ◽

Chest Tube ◽

Clinical Characteristics ◽

Clinical Status ◽

Surgical Patients ◽

Paediatric Cardiac Surgery ◽

Tube Removal ◽

Chest Tube Removal ◽

Clinically Significant

Abstract Background: There is limited data describing the characteristics of paediatric post-operative cardiac surgery patients who develop pneumothoraces after chest tube removal. Patient management after chest tube removal is not standardised across paediatric cardiac surgery programmes. The purposes of this study were to describe the frequency of pneumothorax after chest tube removal in paediatric post-operative cardiac surgical patients and to describe the patient and clinical characteristics of those patients who developed a clinically significant pneumothorax requiring intervention. Methods: A single-institution retrospective descriptive study (1 January, 2010–31 December, 2018) was utilised to review 11,651 paediatric post-operative cardiac surgical patients from newborn to 18 years old. Results: Twenty-five patients were diagnosed with a pneumothorax by chest radiograph following chest tube removal (0.2%). Of these 25 patients, 15 (1.6%) had a clinically significant pneumothorax and 8 (53%) did not demonstrate a change in baseline clinical status or require an increase in supplemental oxygen, 14 (93%) required an intervention, 9 (60%) were <1 year of age, 4 (27%) had single-ventricle physiology, and 5 (33%) had other non-cardiac anomalies/genetic syndromes. Conclusions: In our cohort of patients, we confirmed the incidence of pneumothorax after chest tube removal is low in paediatric post-operative cardiac surgery patients. This population does not always exhibit changes in clinical status despite having clinically significant pneumothoraces. We suggest the development of criteria, based on clinical characteristics, for patients who are at increased risk of developing a pneumothorax and would require a routine chest radiograph following chest tube removal.

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Chest tube removal algorithm is associated with decreased chest tube duration in pediatric cardiac surgical patients

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.03.120 ◽

2019 ◽

Vol 158 (4) ◽

pp. 1209-1217 ◽

Cited By ~ 2

Author(s):

Rebecca A. Bertrandt ◽

David M. Saudek ◽

John P. Scott ◽

Michael Madrzak ◽

Mary Beth Miranda ◽

...

Keyword(s):

Chest Tube ◽

Surgical Patients ◽

Tube Removal ◽

Chest Tube Removal

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Autologous Blood Pleurodesis: What Is the Optimal Time Interval and Amount of Blood?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1727129 ◽

2021 ◽

Author(s):

Alessio Campisi ◽

Andrea Dell'Amore ◽

Yonghui Zhang ◽

Zhitao Gu ◽

Angelo Paolo Ciarrocchi ◽

...

Keyword(s):

Chest Tube ◽

Autologous Blood ◽

Optimal Time ◽

Time Interval ◽

Air Leak ◽

Increased Risk ◽

Tube Removal ◽

Blood Patch ◽

Prolonged Air Leak ◽

Chest Tube Removal

Abstract Background Air leak is the most common complication after lung resection and leads to increased length of hospital (LOH) stay or patient discharge with a chest tube. Management by autologous blood patch pleurodesis (ABPP) is controversial because few studies exist, and the technique has yet to be standardized. Methods We retrospectively reviewed patients undergoing ABPP for prolonged air leak (PAL) following lobectomy in three centers, between January 2014 and December 2019. They were divided into two groups: Group A, 120 mL of blood infused; Group B, 60 mL. Propensity score-matched (PSM) analysis was performed, and 23 patients were included in each group. Numbers and success rates of blood patch, time to cessation of air leak, time to chest tube removal, reoperation, LOH, and complications were examined. Univariate and multivariate analysis of variables associated with an increased risk of air leak was performed. Results After the PSM, 120 mL of blood is statistically significant in reducing the number of days before chest tube removal after ABPP (2.78 vs. 4.35), LOH after ABPP (3.78 vs. 10.00), and LOH (8.78 vs. 15.17). Complications (0 vs. 4) and hours until air leak cessation (6.83 vs. 3.91, range 1–13) after ABPP were also statistically different (p < 0.05). Air leaks that persisted for up to 13 hours required another ABPP. No patient had re-operation or long-term complications related to pleurodesis. Conclusion In our experience, 120 mL is the optimal amount of blood and the procedure can be repeated every 24 hours with the chest tube clamped.

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“Chest Tube” Removal after Liver Transgression

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.10.010 ◽

2012 ◽

Vol 23 (2) ◽

pp. 275 ◽

Cited By ~ 6

Author(s):

Chris Hegarty ◽

Jan F. Gerstenmaier ◽

David Brophy

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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The use of cold therapy, music therapy and lidocaine spray for reducing pain and anxiety following chest tube removal

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2018.12.001 ◽

2019 ◽

Vol 34 ◽

pp. 179-184 ◽

Cited By ~ 3

Author(s):

Yeşim Yaman Aktaş ◽

Neziha Karabulut

Keyword(s):

Music Therapy ◽

Chest Tube ◽

Cold Therapy ◽

Tube Removal ◽

Chest Tube Removal ◽

Lidocaine Spray

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Technique for chest tube removal

ASVIDE ◽

10.21037/asvide.2017.226 ◽

2017 ◽

Vol 4 ◽

pp. 226-226

Author(s):

Kyung Soo Kim

Keyword(s):

Chest Tube ◽

Tube Removal ◽

Chest Tube Removal

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Safety of early discharge with a chest tube after pulmonary segmentectomy

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa097 ◽

2020 ◽

Vol 58 (3) ◽

pp. 613-618

Author(s):

Feichao Bao ◽

Natasha Toleska Dimitrovska ◽

Shoujun Hu ◽

Xiao Chu ◽

Wentao Li

Keyword(s):

Chest Tube ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Early Discharge ◽

Air Leak ◽

Tube Removal ◽

Prolonged Air Leak ◽

Life Threatening ◽

Chest Tube Removal ◽

Hospital Days

Abstract OBJECTIVES Early removal of chest tube is an important step in enhanced recovery after surgery protocols. However, after pulmonary resection with a wide dissection plane, such as pulmonary segmentectomy, prolonged air leak, a large volume of pleural drainage and the risk of developing empyema in patients can delay chest tube removal and result in a low rate of completion of the enhanced recovery after surgery protocol. In this study, we aimed to assess the safety of discharging patients with a chest tube after pulmonary segmentectomy. METHODS We retrospectively reviewed a single surgeon’s experience of pulmonary segmentectomy from May 2019 to September 2019. Patients who fulfilled the criteria for discharging with a chest tube were discharged and provided written instructions. They returned for chest tube removal after satisfactory resolution of air leak or fluid drainage. RESULTS In total, 126 patients underwent pulmonary segmentectomy. Ninety-five (75%) patients were discharged with a chest tube postoperatively. The mean time to chest tube removal after discharge was 5.6 (range 2–32) days, potentially saving 532 inpatient hospital days. Overall, 90 (95%) patients experienced uneventful and successful outpatient chest tube management. No life-threatening complications were observed. No patient experienced complications resulting from chest tube malfunction. Five (5%) patients experienced minor complications. Overall, all patients reported good-to-excellent mobility with a chest tube. CONCLUSIONS Successful postoperative outpatient chest tube management after pulmonary segmentectomy can be accomplished in selected patients without a major increase in morbidity or mortality.

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