Mediastinal chest drain clearance for cardiac surgery

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Clinical Nursing

Background:

• Cardiac tamponade is a risk after cardiac surgery due to fluid accumulation in the pericardial space.
• Mediastinal chest drains are standard post-operative to prevent tamponade.
• Nurses manipulate drains to prevent blockage by clots.

Purpose of the Study:

• To compare chest drain clearance methods for preventing cardiac tamponade post-cardiac surgery.
• To evaluate varying suction levels and manipulation techniques (milking, stripping, fanfolding, tapping).

Main Methods:

• Systematic review of randomized, quasi-randomized, or systematically allocated clinical trials.
• Searched multiple databases including Cochrane, MEDLINE, EMBASE, CINAHL.
• Included trials involving adults and children with mediastinal chest drains post-cardiac surgery.

Main Results:

• Three studies with 471 participants were included.
• Meta-analysis was not possible due to inadequate data from two studies.
• No significant difference found between groups regarding chest tube blockage, cardiac tamponade, or re-entry in single studies.

Conclusions:

• Insufficient comparative studies exist to support or refute the efficacy of different chest drain clearance methods.
• The necessity of chest drain manipulation cannot be confirmed or denied by current randomized controlled trial (RCT) evidence.