Lung Injury Resulting from Fluted Silastic Soft Drain Extraction under Negative Pressure Suction*

Susumu Isoda, Tamizo Kimura, Kenji Nishimura, Nozomu Yamanaka, Shingo Nakamura, Tadaaki Maehara

Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan.
Department of Cardiovascular Surgery, National Defense Medical College, Tokorozawa, Japan..

DOI: 10.4236/ojts.2013.33015                

Abstract

We experienced two cases of lung injury resulting from fluted silastic drain extraction under reservoir-generated negative pressure suction. In the first case, a 67-year-old man underwent coronary artery bypass grafting. A 19 Fr BLAKE drain was placed at the pericardial cavity, the mediastinum, and the left thoracic cavity. All three drains were connected to J-VAC reservoirs. After removing the drains (which maintained the negative pressure), subcutaneous emphysema and hemopneumothorax occur. A trocar catheter was inserted. Bleeding and the air leak terminated within a day. In the second case, a 73-year-old man underwent aortic valve replacement. Right pneumothorax occurred after the removal of the pleural cavity drain, which maintained the negative pressure generated by the reservoir. We inserted a trocar catheter, and the air leak terminated within a day. We hypothesized that the reservoir-generated negative pressure causes the pleura to enter the groove of the drain and become damaged during extraction. We stopped using a reservoir to connect to the fluted silastic drain placed at the pleural cavity and removed the negative pressure when extracting the pleural cavity drain. Since implementing this change, we have not experienced a similar lung injury in more than 500 cardiac surgery patients.

Keywords

Complication; Extraction; Lung Injury; Negative Pressure; Silastic Drain

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. A. Obney, M. J. Barrnes, P. G. Lisagor and D. J. Cohen, “A Method for Mediastinal Drainage after Cardiac Procedure Using Small Silastic Drains,” The Annals of Thoracic Surgery, Vol. 70, No. 3, 2000, pp. 1109-1110. doi:10.1016/S0003-4975(00)01800-2
[2]	M. Payne, G. J. Magovern Jr., D. H. Benckart, A. Vasilakis, G. W. Szydlowski, J. C. Cardone, et al., “Left pleural effusion after coronary artery bypass decreases with a supplemental pleural drain,” The Annals of Thoracic Surgery, Vol. 73, No. 1, 2002, pp. 149-152. doi:10.1016/S0003-4975(01)03327-6
[3]	T. L. Frankel, P. C. Hill, S. C. Stamou, R. C. Lowery, A. J. Pfister, A. Jain and P. J. Corso, “Silastic Drains vs Conventional Chest Tubes after Coronary Artery Bypass,” Chest, Vol. 124, No. 1, 2003, pp. 108-113. doi:10.1378/chest.124.1.108
[4]	E. R. Munnel and E. K. Thomas, “Current Concepts in Thoracic Drainage Systems,” The Annals of Thoracic Surgery, Vol. 19, No. 3, 1975, pp. 261-268. doi:10.1016/S0003-4975(10)64016-7
[5]	H. Niinami, M. Tabata, Y. Takeuchi and M. Umezu, “Experimental Assessment of the Drainage Capacity of Small Silastic Chest Drains,” Asian Cardiovascular and Thoracic Annals, Vol. 14, No. 3, 2006, pp. 223-226. doi:10.1177/021849230601400311
[6]	H. Ishikawa and S. Kimura, “The Flexible Silastic Drain after Chest Surgery: Novel Thoracic Drainage,” The Annals of Thoracic Surgery, Vol. 81, No. 1, 2006, pp. 331-334. doi:10.1016/j.athoracsur.2005.05.102
[7]	N. Sakakura, T. Fukui, S. Mori, S. Hatooka, K. Yokoi and T. Mitsudomi, “Fluid Drainage and Air Evacuation Characteristics of Blake and Conventional Drains after Pulmonary Resection,” The Annals of Thoracic Surgery, Vol. 87, No. 5, 2009, pp. 1539-1545. doi:10.1016/j.athoracsur.2009.02.013
[8]	H. Nakamura, Y. Taniguchi, Y. Adachi, S. Fujioka and T. Haruki, “The Use of Blake Drains Following General Thoracic Surgery: Is It an Acceptable Option?” Interactive Cardio Vascular and Thoracic Surgery, Vol. 8, No. 1, 2009, pp. 58-61. doi:10.1510/icvts.2008.188086