What can a nurse do to manage chest tube clogging after heart surgery?

Regardless of diameter size, any tube used to drain the chest after surgery can become clogged. This usually happens in the setting of bleeding. Bleeding and clotting in the tube in this circumstance can be life threatening for two reasons. First, the amount of blood that comes out is very carefully monitored as a measure of the seriousness of the bleeding. If blood pools in the chest, for example, unnoticed because it is not coming out of the tubes, the patient can loose a large volume of blood. This can have severe consequences, including circulatory collapse and death. Second, if blood pools in the pericardial space, it can compress the heart, impairing the return of blood to the heart, and thus the ability of the ventricle to fill and empty. This condition, known as pericardial tamponade, likewise results in shock and can be fatal. In the setting of an air leak from the lung, clogging of the chest tube can lead to a pneumothorax, subcutaneous emphysema, or even death when the air builds up under pressure in the pleural space. When clinicians (mainly nurses and doctors) caring for patients in the perioperative period following chest surgery and trauma notice that there is clot forming in the tube, they often undertake measures to try to remove the clot. When clogging occurs in the visible portion of a chest tube, the options to clear the obstructed tube are limited. Even if the visible portion of the chest tube where it exits the skin appears patese, obstructing clot can occur in the tube inside the chest where it is not visible. Options to address clogging are limited, but often include squeezing, stripping and "milking" the tubes, or applying open suctioning - all of which undesirable for nurses and often dangerous activities for patients. The fact is that the options are limited once a tube starts to clog, especially in the setting of ongoing bleeding. Chest tube stripping, and milking, are not very effective.