Tube Management Research Articles

The Society for Translational Medicine: clinical practice guidelines for the postoperative management of chest tube for patients undergoing lobectomy.

The Society for Translational Medicine and The Chinese Society for Thoracic and Cardiovascular Surgery conducted a systematic review of the literature in an attempt to improve our understanding in the postoperative management of chest tubes of patients undergoing pulmonary lobectomy. Recommendations were produced and classified based on an internationally accepted GRADE system. The following recommendations were extracted in the present review: (I) chest tubes can be removed safely with daily pleural fluid of up to 450 mL (non-chylous and non-sanguinous), which may reduce chest tube duration and hospital length of stay (2B); (II) in rare instances, e.g., persistent abundant fluid production, the use of PrRP/B <0.5 when evaluating fluid output to determine chest tube removal might be beneficial (2B); (III) it is recommended that one chest tube is adequate following pulmonary lobectomy, except for hemorrhage and space problems (2A); (IV) chest tube clearance by milking and stripping is not recommended after lung resection (2B); (V) chest tube suction is not necessary for patients undergoing lobectomy after first postoperative day (2A); (VI) regulated chest tube suction [-11 (-1.08 kPa) to -20 (1.96 kPa) cmH2O depending upon the type of lobectomy] is not superior to regulated seal [-2 (0.196 kPa) cmH2O] when electronic drainage systems are used after lobectomy by thoracotomy (2B); (VII) chest tube removal recommended at the end of expiration and may be slightly superior to removal at the end of inspiration (2A); (VIII) electronic drainage systems are recommended in the management of chest tube in patients undergoing lobectomy (2B).

Temporary tracheostomy: a practical approach to the placement and management of a tracheostomy tube

A temporary tracheostomy can be a life-saving intervention when there is a structural or functional obstruction of airflow at, or rostral to, the level of the larynx. In most instances, the intervention is intended for short-term use, with appropriate diagnosis and treatment of the primary underlying condition instigated as soon as possible. Surgery can usually be performed on the stable, anaesthetised and intubated patient. Single-lumen uncuffed tubes are ideal for most instances, unless the patient is to be maintained on a ventilator. If commercial tubes are not available then a cut-down endotracheal tube may be used. The diameter of the tube should not be more than 50% the diameter of the trachea. While a relatively simple technique, temporary tracheostomy can be associated with a high complication rate, including tube dislodgement, obstruction and dyspnoea; coughing/gagging; pneumonia; dysphagia, vomiting/regurgitation; aspiration; tracheal stenosis; tracheocutaneous fistula; and laryngeal nerve injury.

PRACTICAL ASPECTS ABOUT CLOSED CHEST DRAINAGE CARE: A LITERATURE REVIEW

Context: The drained pleural contents may vary, as well as their drainage, however closed drainage system is the most frequent one and reaches flaws along those who are in charge of their management. Objetive: Provide a comprehensive review about close chest drainage. Methods: A systematic search of the PubMed and Medline databases was conducted on closed drainage system using the following keyword combination: chest tubes AND drainage. Results: From eight hundred eight-three articles retrieved after our preliminary search, 17 articles were chosen for final analysis. Representative schemes were drawn to better understanding of the three types of chest drainage systems for pleura effusion: (i) the closed drainage system; (ii) the open drainage system; and (iii) the suction drainage system. Representative pictures were also developed in order to facilitate additional care in the field. Conclusions: Bringing information together about chest tube management in closed drainage system may imply in a better approach to the patients, minimize institutional cost, minimize material waste and promote efficient communication among the multidisciplinary staff. Understanding details about tubular tube, pig tail tube, one-way bag, one-way valve and collectors is the only way to perform a better approach to the patient who needs closed drainage system.

A comparative study on the properties of the mortar with the cathode ray tube funnel glass sand at different treatment methods

With the rapid advances of the electronic industry, the management of the cathode ray tube (CRT) glass waste has become a major environmental problem. In this study, the CRT funnel glass sand untreated with nitric acid (n-TFG) and treated with nitric acid (TFG) were used to replace river sand as fine aggregate for the production of the mortar. The TFG glass sand series mortars exhibit the worse fluidity and fluidity preservation, the shorter setting times, the lower wet density and mechanical properties than those with n-TFG glass sand. The use of TFG glass sand in the mortar also results in the lower drying shrinkage, alkali-silica reaction (ASR) expansion and leaching content of lead than the blended n-TFG glass sand mortars. Moreover, at the drying shrinkage period of 56days, the drying shrinkage values of the mortars with TFG glass sand are within the limit of 0.075%. The mortars prepared by TFG glass sand have a low ASR expansion, at the tested age of 14days, which are below permissible limits (0.10%). The lead leaching of the mortars with TFG glass sand comply with the regulatory limits.

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

PurposeDetermine nurse characteristics and patient factors that affect nurses’ time in managing chest tubes in the first 24-hours of critical-care stay. DesignProspective, descriptive. MethodsCardiovascular 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. ResultsOf 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). ConclusionsTime to manage chest tubes can be anticipated by patient characteristics. Nurse comfort with chest tube-related tasks affected time spent on chest tube management.

Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System

We sought to evaluate the clinical utility of chest tube management after pulmonary resection based on objective digital monitoring of pleural pressure and digital surveillance for air leaks. We prospectively recorded the perioperative data of 308 patients who underwent pulmonary resection between December 2013 and January 2016. We used information from a digital monitoring thoracic drainage system to measure peak air leakage during the first 24 hours after the operation, patterns of air leakage over the first 72 hours, and patterns of pleural pressure changes until the chest tubes were removed. There were 240 patients with lung cancer and 68 patients with other diseases. The operations included 49 wedge resections, 58 segmentectomies, and 201 lobectomies. A postoperative air leak was observed in 61 patients (20%). A prolonged air leak exceeding 20 mL/min lasting 5 days or more was observed in 18 patients (5.8%). Multivariate analysis of various perioperative factors showed forced expiratory volume in 1 second below 70%, patterns of air leakage, defined as exacerbating and remitting or without a trend toward improvement, and peak air leakage of 100 mL/min or more were significant positive predictors of prolonged air leak. Fluctuations in pleural pressure occurred justafter the air leakage rate decreased to less than 20mL/min. Digital monitoring of peak air leakage and patterns of air leakage were useful for predicting prolonged air leak after pulmonary resection. Information on the disappearance of air leak could be derived from the change in the rate of air leakage and from the increase in fluctuation of pleural pressure.

Optimization of Chest Tube Management to Expedite Rehabilitation of Lung Cancer Patients After Video-Assisted Thoracic Surgery: A Meta-Analysis and Systematic Review.

The aim of this meta-analysis and systematic review of published evidence was to optimize chest tube management for fast-track rehabilitation of lung cancer patients after video-assisted thoracic surgery (VATS). The PubMed, Web of Science, and EMBASE databases were searched to identify all studies that addressed the issue of chest tube management after VATS for lung cancer. Finally, 35 articles were included for analysis, i.e., 29 randomized controlled trials and 6 clinical trials. After synthesis of the published evidence, the following protocol for chest tube drainage was formulated: (1) after VATS lung wedge resection, chest tube drainage can be omitted in selected cases; (2) normally, one 28Fr chest tube (or 19Fr Blake drain) is placed; (3) the use of a digital monitoring system is recommended; (4) in case of increasing pneumothorax or severe air leakage supported by digital recording system, the tube should be placed with active suction; and (5) the chest tube can be removed within 48h postoperatively when air leakage is resolved and fluid drainage is <400mL/day. Further multicenter studies are warranted based on the variations of body sizes among different ethnicities.

Radiographer workforce role expansion to improve patient safety related to nasogastric tube placement for feeding in adults

To determine whether the active involvement of radiographers in nasogastric tube (NGT) management at a large multisite healthcare institution can contribute to risk reduction regarding feeding through misplaced NGTs. Despite national guidance in the National Health Service advising on safe practice to confirm NGT position, a number of "never events" (feeding through misplaced NGT) continue to occur due to misinterpretation of the check radiograph. Practice change was introduced, including all plain film radiographers providing contemporaneous comments on NGT position on the check radiograph. The success of the system was assessed to determine the accuracy of radiographer comments against the reference standard of the radiologist report to see whether the system has helped reduce the number of "never events". During the first 27 months post-implementation, 4,675 check NGT radiography examinations were analysed. Two hundred and twenty-seven examinations were excluded due to absent or incomplete radiographer comments. The accuracy of the radiographer comments was 98.5% (95% confidence interval [CI]: 97.7-99.5%), sensitivity 97.4% (95% CI: 96.3-98.3%), specificity 98.9% (95% CI: 98.5-99.2%), positive predictive value 96.8% (95% CI: 95.6-97.7%), and negative predictive value 99.1% (95% CI: 98.8-99.4%). After focused training, radiographer comments are a safe, sustainable, and workable solution offering an effective solution for image misinterpretation issues relating to NGT "never events". This should be considered for wider implementation in healthcare.

Optimal primary management of bulky stage IIIC ovarian, fallopian tube and peritoneal carcinoma: Are the only options complete gross resection at primary debulking surgery or neoadjuvant chemotherapy?

ObjectiveTo explore the impact of primary debulking surgery (PDS) to minimal but gross residual disease (RD) in women with bulky stage IIIC ovarian, fallopian tube, or primary peritoneal cancer. MethodsWe retrospectively reviewed all patients with the aforementioned diagnosis who underwent PDS at our institution from 01/2001–12/2010. Those with disease of non-epithelial histology or borderline tumors were excluded. Clinicopathologic data were abstracted, and appropriate statistical tests were used. ResultsWe identified 496 eligible patients. Median age was 62years; 91% had disease of serous histology. Patients were grouped by RD status: no gross RD, 184 (37%); RD of 1–5mm, 127 (26%); RD of 6–10mm, 54 (11%); and RD >10mm, 131 (26%). With a median follow-up of 53months, the median progression-free survivals (PFS) were: 26.7, 20.7, 16.2, and 13.6months, respectively (p<0.001). The median overall survivals (OS) were 83.4, 54.5, 43.8, and 38.9months, respectively (p<0.001). Among patients with RD following PDS, those with RD of 1–10mm had improved PFS (p<0.001) and OS (p=0.001) compared with those with RD >10mm. Patients with RD 1–10mm who received intravenous/intraperitoneal (IV/IP) chemotherapy were younger and had prolonged OS compared with those solely exposed to IV chemotherapy (p<0.001 and p=0.002, respectively). ConclusionsPDS to no gross RD was associated with the longest PFS and OS. However, cytoreduction to 1–10mm of RD was also associated with better survival outcomes compared with cytoreduction to >10mm of RD. We conclude that PDS remains an appropriate option for patients with a high likelihood of achieving RD 1–10mm, especially for younger patients who can receive IV/IP chemotherapy after PDS.

Exploration and practice of clinical nursing information construction

Objective To achieve the information management in clinical nursing work. Methods Clinical nursing information system has been developed and applied based on data of nursing information system (HIS) . Results The information record of nursing work included vital signs collection, nursing assessment, medical order implementing, documentations, tube management. Clinical nursing information system could optimize clinical workflow and improve the quality and efficiency of clinical nursing work, which reflected the scientificity and timeliness of clinical workload statistics. Conclusions The construction, application and development of clinical nursing information system bring the nursing work to a new level. As a result, clinical nursing work will gradually become standardized, scientific and informationalized. Key words: Nursing administration research; Information construction; Personal digital assistant

Kinetic separation of cobalt from zirconium by cation exchange process

ABSTRACTZirconium-tin alloys are used as pressure tubes in Indian pressurized heavy water reactors (PHWRs). Used pressure tubes contain neutron activation products of the constituent elements. 60Co is one of the long-lived radioisotopes of concern, for both radioactive waste management and recycling of pressure tubes. This article describes a facile cation exchange separation of Co(II) from Zr(IV) in HCl medium. Co(II) could be preferentially sorbed on the gel resin by utilizing its faster kinetics. Higher flow rates and shallow resin bed were the key steps, which prevented the loading of Zr(IV) on the resin phase.

No chest tube protocol in video-assisted thoracic surgery procedures

The urge for less pain, earlier mobility, low financial cost, and better cosmetic outcome has driven the everlasting pursuit of thoracic surgeons for smaller incisions, low port number, and shorter hospital stay. Management of chest tubes is pivotal in the postoperative care of patients submitted to thoracic surgeries. However, thoracic surgeons have traditionally managed chest tubes based more on their experience and personal preference rather than guided by an evidenced-based approach. Chest tubes increase the rate of postoperative pain and hospital stay, and the removal of a chest tube improves ventilator function and reduces chest pain after pulmonary resection. Removing a chest tube sooner not only has financial benefits but also has beneficial functional effects for the patient. Upon witnessing the benefits of early removal of chest tubes after video-assisted thoracic surgery procedures, some surgeons are starting to adopt a no chest tube protocol especially in thoracic procedures, in which the lung is left untouched. Upon reviewing the papers published on avoiding chest tubes in video-assisted thoracic surgery procedures, it showed that such a technique can be safely used without affecting the quality of the procedures. Moreover, it can lead to a more favorable postoperative course.

Are Internal or External Pancreatic Duct Stents the Preferred Choice for Patients Undergoing Pancreaticoduodenectomy? A Meta-Analysis.

The technique of pancreatic duct stenting during pancreatic anastomosis can markedly reduce the incidence of postoperative pancreatic fistula (PF) after pancreaticoduodenectomy (PD). The method of drainage includes using either an external or an internal stent; the meta-analysis result shows us that there were no differences in the rates of postoperative complications between PD using internal stents and PD using external stents; internal stents may be more favorable during postoperative management of drainage tube. What is more, internal stents could reduce the digestive fluid loss and benefit the digestive function.

A Cross-Sectional Study: Chest Tube Drainage Practice Patterns among Canadian Thoracic Surgeons Following Pulmonary Surgery

Background: High chest tube drainage following lung surgery is a rate-limiting step to discharge, increasing length of hospital stay. There is a paucity of evidence-based clinical research on safe maximal daily chest tube drainage prior to removal. Objectives: To describe the practice patterns of Canadian thoracic surgeons with respect to daily chest tube drainage after routine pulmonary surgery. Methods: A self-reported electronic questionnaire was administered to members of the Canadian Association of Thoracic Surgeons (CATS). Data was tabulated on the primary outcome of acceptable maximal daily pleural output prior to chest tube removal, and secondary outcomes of: years in clinical practice, academic versus community setting and rational for chest tube management. Descriptive and univariate analysis was conducted for each response by maximal daily pleural drainage category. Results: A total of 124 surveys were distributed. Response rate was 56%, with a 93% completion rate. Acceptable maximal pleural drainage among surgeons was highly variable. Rationale for tube removal was also variable, including individual clinical experiences (n = 23, 33%), evidence based guidelines (n = 18, 26%), and group practice pattern (n = 12, 17%). Academic surgeons comprised 72% of respondents. Community based surgeons were more likely to remove tubes at a lower mean volume. Years in clinical practice did not influence acceptable daily pleural drainage. Conclusion: There is great variability in post-operative management of chest tube fluid output among Canadian thoracic surgeons. Future research on this topic is warranted, with the aim of developing an evidence-based chest tube management algorithm incorporating daily chest tube drainage volumes as a key variable.

A Simple Shunt Tube Management Technique during Beating-Heart Coronary Artery Bypass Grafting

A Simple Shunt Tube Management Technique during Beating-Heart Coronary Artery Bypass Grafting

A Population Intervention to Improve Outcomes in Children With Medical Complexity.

Children with medical complexity experience frequent interactions with the medical system and often receive care that is costly, duplicative, and inefficient. The growth of value-based contracting creates incentives for systems to improve their care. This project was designed to improve the health, health care value, and utilization for a population-based cohort of children with neurologic impairment and feeding tubes. A freestanding children's hospital and affiliated accountable care organization jointly developed a quality improvement initiative. Children with a percutaneous feeding tube, a neurologic diagnosis, and Medicaid, were targeted for intervention within a catchment area of >300 000 children receiving Medicaid. Initiatives included standardizing feeding tube management, improving family education, and implementing a care coordination program. Between January 2011 and December 2014, there was an 18.0% decrease (P < .001) in admissions and a 31.9% decrease (P < .001) in the average length of stay for children in the cohort. Total inpatient charges were reduced by $11 764 856. There was an 8.2% increase (P < .001) in the percentage of children with weights between the fifth and 95th percentiles. The care coordination program enrolled 58.3% of the cohort. This population-based initiative to improve the care of children with medical complexity showed promising results, including a reduction in charges while improving weight status and implementing a care coordination program. A concerted institutional initiative, in the context of an accountable care organization, can be part of the solution for improving outcomes and health care value for children with medical complexity.

P3.04-031 Intermittent Chest Tube Clamping May Shorten Chest Tube Duration and Postoperative Hospital Stay of Lung Cancer Surgery: Topic: Miscellaneous II

Postoperative pleural drainage markedly influences the length of postoperative hospital stay and financial costs of medical care. Previous report documented the safety of chest tube clamping before removal. This study aims to see if intermittent chest tube clamping might shorten tube duration and hospital stay of lung cancer surgery. From July 2012 to June 2016, 285 consecutive cases of operable lung cancer patients undergoing lobectomy and systematic mediastinal lymphadenectomy were retrospectively analyzed. Chest tube management protocol was modified since January 2014 according to the literature. Before that time, patients (Group control, n=63) were managed with gravity drainage (water seal only and without suction). After that, patients (Group clamping, n=222) were managed with gravity drainage during first 24 hours after surgery (water seal only and without suction). Once a radiograph confirmed the reexpansion of the lung and no air leak detected, the tube would then be clamped intermittently at 24 hours after surgery and nurses checked the patients every 6 hours. If no abnormal symptoms developed (such as severe dyspnea, pneumothorax, subcutaneous emphysema), then unclamped 30 minutes to record drainage volume every 24 hours. The tube would be removed if drainage was normal and its volume was less than 200 ml in both group. All clinical data were recorded. Propensity score matching at 1:1 ratio was applied to balance variables potentially affecting chest tube duration between Group Clamping and Group Control. Analyses were performed to compare chest tube duration and postoperative hospital stay between the two groups. Variables linked with chest tube duration were gender, operation side, VATS and chylothorax, which were assessed using multivariable logistic regression analysis in whole cohort. The rate of thoracocentesis after chest tube removal did not increase in Group Clamping compared with Group Control in whole cohort (0.5% vs. 1.5%, P=0.386). The rates of pyrexia were also comparable in two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Group Clamping showed shorter chest tube duration (4.0 days vs. 4.8 days, P=0.001) and shorter postoperative stay (5.7 days vs. 6.4 days, P=0.025) compared with Group Control. Factors significantly associated with shorter chest tube duration were being female, left lobectomy, chest tube clamping, VATS and absence of chylothorax (P<0.05). This study suggests that chest tube clamping may decrease the length of chest tube duration and postoperative hospital stay while maintaining patient safety.

Improvement of the supply mode of reusable metal tracheal tube

Objective To improve the supply mode of reusable metal tracheal tube, enhance the centralized management of sterilized serving center, reduce the risk of contagion of tracheotomy and improve the clinical service quality. Methods We changed the setting of the reusable metal tracheal tube, and the number of endotracheal tube were increased from 1 to 5. After clinical use, the tubes would be cleaned and sterilized by sterilization and supply center according to standard operating procedure, and then be sent to clinical departments. The sterility, function integrity, operating convenience and supply timeliness of metal trachea cannula shoule be tracked and evaluated, and be compared with the traditional method. Results Totally 1 296 sets of reusable metal tracheal tube were centralized managed by the sterilization and supply center, and 8 732 sets of endotracheal tubes had been changed. The qualified rate of bacteria cultivation in improved metal trachea casing tube increased from 93.65% to 100%; the function integrity increased from 98.24% to 99.23%; the operating convenience increased from 74.29% to 100%, the supply timely increased from 93.33% to 98.57% (χ2=9.56, 4.36, 61.97, 7.42; P<0.01). Conclusions The practice of centralized management of reusing metal tracheal tube in the sterilization and supply center can normalize the cleaning and sterilization operation mode of the hospital; improve the sterilization quality, functional integrity, operation convenience and supply timely; reduce the occurrence of hospital infection; improve work efficiency; and made clinical operation more convenient. These actions give full play to the functions and professional advantages of steralization and supply center. Key words: Innovation and promotion; Reusable metal tracheal tube; Supply mode

Nursing critically ill patients in the intensive care unit

Critically ill patients present a challenge to the whole veterinary team because they require invasive diagnostic tests, advanced procedures and intensive nursing care. It is important to start with an...

Hidden Markov Model-Based Detection and Classification of Foreign Objects in Heat-Exchanger Tubes

In recent years, there has been significant interest in prognosis and health management of heat exchanger tubes in steam generators (SG) using eddy current (EC) non-destructive evaluation (NDE) techniques. One of the recent challenges encountered in SG tube inspection is the presence of foreign objects lodged outside the tubes. Extreme vibrations cause these loose parts to rub against the tube wall and form wears on their outer surfaces which can be dangerous in the high pressure environment. Hence, there is a strong need for reliable automated signal analysis systems for early detection of foreign objects and prevention of harmful radioactive leaks at nuclear facilities. In this paper, a hidden Markov model (HMM) based classifier is proposed which can estimate the material of the foreign object from EC inspection signal. Unknown loose part material interferes with EC analysis results and lead to errors in signal processing parameters which in turn can degrade performance and reliability of automated detection systems. The proposed algorithm implements a continuous HMM classifier by using magnitude and phase based measurements obtained from the foreign object. Results of applying the algorithm on experimental data from SG tube inspection is presented, demonstrating its benefits in increasing the robustness and performance of automated signal analysis systems in detecting loose parts.