Development and Evaluation of Motion-activated System for Improved Chest Drainage: Bench, In Vivo Results, and Pilot Clinical Use of Technology.

Objective. The aim of this study was to evaluate a motion-activated system (MAS) that applies motion-activated energy (vibration) to prevent chest tube clogging and maintain tube patency. We performed chest tube blood flow analysis in vitro, studied MAS effects on intraluminal clot deposition in vivo, and conducted a pilot clinical test. Background. Chest tube clogging is known to adversely contribute to postoperative cardiac surgery outcomes. Methods. The MAS was tested in vitro with a blood-filled chest tube model for device acceleration and performance. In vivo acute hemothorax studies (n = 5) were performed in healthy pigs (48.0 ± 2 kg) to evaluate the drainage in MAS versus control (no device) groups. Using a high-speed camera (FASTCAM Mini AX200, 100 mm Zeiss lens) in an additional animal study (n = 1), intraluminal whole-blood activation imaging of the chest tube (32 Fr) was made. The pilot clinical study (n = 12) consisted of up to a 30 minutes device tolerance test. Results. In vitro MAS testing suggested optimal device performance. The 2-hour in vivo evaluation showed a longer incremental drainage in the MAS group versus control. The total drainage in the MAS group was significantly higher than that in the control group (379 ± 144 mL vs 143 ± 40 mL; P = .0097), indicating tube patency. The high-speed camera images showed a characteristic intraluminal blood "swirling" pattern. Clinical data showed no discomfort with the MAS use (pleural = 4; mediastinal = 8). Conclusions. The MAS showed optimal performance at bench and better drainage profile in vivo. The clinical trial showed patients' tolerance to the MAS and device safety.

Nurse and patient factors that influence nursing time in chest tube management early after open heart surgery: A descriptive, correlational study.

PURPOSE: Determine nurse characteristics and patient factors that affect nurses' time in managing chest tubes in the first 24-hours of critical-care stay. DESIGN: Prospective, descriptive. METHODS: Cardiovascular critical-care nurses and post-operative heart surgery patients with chest tubes were enrolled from a single center in Ohio. Nurses completed case report forms about themselves, comfort and time in managing chest tubes, chest tube placement and management factors. Analysis included correlational and comparative statistics; Bonferroni corrections were applied, as appropriate. RESULTS: Of 29 nurses, 86.2% were very comfortable managing chest tubes and oozing/non-secure dressings, but only 41.4% were very comfortable managing clogged chest tubes. Of 364 patients, mean age was 63.1 (±12.3) years and 36% had previous heart surgery. Total minutes of chest tube management was higher with≥3 chest tubes, tube size <28 French, and when both mediastinal and pleural tubes were present (all p<0.001). In the first 4-hours, time spent on chest tubes was higher when patients had previous cardiac surgeries (p≤0.002), heart failure (p<0.001), preoperative anticoagulant medications (p=0.031) and reoperation for postoperative bleeding/tamponade (p=0.005). CONCLUSIONS: Time to manage chest tubes can be anticipated by patient characteristics. Nurse comfort with chest tube-related tasks affected time spent on chest tube management.