Chest tubes are the “Gold Standard” for drainage following cardiac surgery, but are large, uncomfortable, and painful. They require a PleurovacR which is cumbersome. Flexible, 19F drains with ridges (BlakeR), connected to 50cc grenade bulbs fitted with “Heimlich” one-way valves could provide effective and comfortable drainage following cardiac operations, but there is fear that these drains cannot handle potential bleeding.
146 consecutive adult pts undergoing cardiac surgery from the inception of a new cardiac surgery program had two 19F BlakeR drains (Ethicon, Summerville, NJ) placed; one in the left pleural space when a LIMA was harvested, and the other wrapped around the heart. Valve cases had both drains placed in the pericardium. Double IMA’s had 3 drains, one in each pleural space. All drains exited the midline and were connected to 50cc bulbs. Drain tubing was stripped routinely. Drains were removed when drainage was <100cc/12 hrs. Pts were assessed for cardiac tamponade, take-back for bleeding, pleural effusions, and perceived comfort.
There were no early or late episodes of tamponade. There were no early or late returns to the OR for bleeding. There were no pleural effusions requiring drainage. Pts were ambulatory immediately post-op with their drains clipped to their robes. Redo pts rated BlakeR drains superior in comfort and ease of removal over their previous chest tubes.
BlakeR drains meet and/or exceed all criteria for mediastinal and pleural drainage following cardiac surgery, result in superior pt comfort and mobility, and should be considered standard of care.
Chest tubes and their removal remain one of the most painful parts of cardiothoracic surgery. Blake drains provide equal or better drainage ability but also offer superior comfort.
S.R. Gundry, None.