How is Chest Tube Clogging Currently Managed?
When clinicians (mostly nurses and doctors) caring for patients in the perioperative period following chest surgery and trauma notice that there is clot forming in the blood in the tube, they often undertake measures to try to remove the clot to prevent the aforementioned complications.Tapping and Milking the Tubes
One method is to simply tap the tubes and try to break up the clot. Another technique is to "milk the tubes". This method involves taking your fingers, or a rudimentary home made device devised of a pair of pliers with roller heads fashioned onto it, and compress the chest tube over the clotted blood to break it up. This has the effect of pulling some of the clot more distally to the larger drainage tubes that go to the closed suction device. This is time consuming, and generally ineffective, and if the patient is awake and alert, it is painful to the patient.Fan Folding
Another technique is fan folding. In this technique, the nurse of doctor bends the chest tube in various ways in an attempt to break up any long clots and facilitate distal flow to the chest tube canister. Any manipulation of the tube in this fashion can be quite painful to the patient.Stripping
Another technique is known as “stripping”. In this technique, the clinician takes two fingers, lubricated in some fashion, and compresses the tubing just beyond the end of the chest tube, and strips the tube distally, towards the closed suction canister. This is done repeatedly to work the clot along towards the canister. The “stripping” technique in general is only marginally successful, and it is known to generate short bursts of extremely negative pressure at the ends of the tubes. This can be dangerous, and pressures of upwards of -300 cm of water can be generated adjacent to suture lines on coronary anastomosis, etc, which can disrupt some of the work that was done surgically during the operation. None of these techniques are uniformly successful, and it takes up valuable nursing time in the postoperative period.Open Suctioning
One of the most dramatic techniques is open chest tube suctioning. While this is impractical, it is an effective technique to clear a clogged chest tube. This is done by creating a sterile field at the end of the chest tube, then detaching the chest tube from the drainage tube to the canister at the tubing coupler. The operator then passes a catheter down the chest tube to break up and remove the clot and debris at the end of the chest tube inside the patient. The physical action of the open suction tube moving back and forth inside the chest tube breaks up the clot and other debris, and allows it to pass down the tube into the open suction device or down the chest tube drainage conduit itself. This open suction technique is generally effective, but it is highly undesirable for a number of reasons.- First, it requires the loss of the sterile internal environment of the chest tube system, potentially introducing bacteria inside the chest.
- Second, it requires that the seal be broken between the chest tube and the chest tube canister, and thus the physiologic negative pressure is lost inside the chest and the lungs can collapse (pneumothorax) while the suction is being carried out.
- Additionally, the suction catheter can easily be passed beyond the end of the chest tube, which has the potential to injure the heart or lungs, which could be life threatening.
- Finally, it is time consuming for the nurses or doctors who carry this procedure out.
Specialty Tube Coatings
Heparin-coated chest tubes were introduced with the hope of addressing this problem. These tubes are prepared by dipping the tube into a heparin solution which leads to an ionic bond with the tube. While this approach seems promising, in practice, the ionic bonds turn out to be weak and unstable, and the heparin washes off quickly, within a few hours of use. While various companies have come out with tubes with such coatings with various degrees of affinity for the tube, this has not been perceived by the market as a significant value add as clot and thick material formation still occurs, debris still accumulates, and the clinical benefit is generally marginal. To date specialty coating of the tubes has done little to impact the clogging issue likely due to the fact that when blood encounters the foreign surfaces of any tube, it coagulates.>> Next: The Clear Catheter Systems Product Advantage