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PubMed1992

Passive tube and suction drainage after elective cholecystectomy--a comparison using ultrasonography.

Daily ultrasonography of the gallbladder bed was performed in patients with suction or passive tube drains after elective cholecystectomy. A total of 19 patients was randomized to suction drainage and 17 to passive tube drainage. A policy of early drain removal was followed. No significant difference was found between the volume drained and the size of collection detected in either group. Significant bile leaks were detected and were adequately drained by suction and passive tube drains. There were no complications from drains. In view of these findings, we advocate short-term drainage of the gallbladder bed after both open and laparoscopic cholecystectomy using the drain of the surgeon's choice.

Abdomen↗

PubMed2006

[High-pressure suction drainage for poststernotomy mediastinitis].

We present a case of high-pressure suction drainage for poststernotomy mediastinitis. A 67-year-old man who underwent coronary artery bypass grafting because of angina pectoris was noted massive dirty exudate fluid (putrid secretions) from median sternal wound on the 6th postoperative day. The sternal wounds were completely reopened and all sternal wires removed. Thorough debridement was performed. The mediastinum was then washed out with warn normal saline. The polyurethane foam was shaped to fit the resulting sternal defect and placed within the cavity just below the skin edge. The suction tube was inserted inside the foam and the area was covered with the adhesive drape. After 45 days suction drainage the sternal wound was closed, after which he was discharged.

Aged↗

PubMed2006

Fibrin glue in thyroid and parathyroid surgery: is under-flap suction still necessary?

The introduction of fibrin sealants has brought into question the necessity of routinely placing suction drains. We conducted a retrospective study to determine whether fibrin sealants are comparable to traditional drains in terms of length of hospital stay and hematoma prevention. We evaluated 124 patients who had undergone thyroidectomy and 47 patients who had undergone parathyroidectomy. Of these, 22 thyroid surgery patients and 10 parathyroid surgery patients had their incisions closed without a drain after the application of fibrin glue. We found that the use of fibrin glue resulted in a statistically significant decrease in the length of hospital stay following both types of surgery (p = 0.033 and p = 0.022, respectively). Two hematomas in the drain group required immediate surgical evacuation; in both of these patients, the suction was clotted and ineffective. One minor hematoma occurred in the fibrin glue group, and it was opened at the bedside 24 hours after surgery. We conclude that fibrin sealants offer a comparative advantage over under-flap suction in both thyroid and parathyroid surgery. Also, fibrin glue is less expensive, and its use obviates the discomfort felt by patients when a drain is removed.

Adolescent↗

PubMed2006

[The use of a closed-suction drain in total knee arthroplasty: a prospective, randomized study].

OBJECTIVE: To determine the value of using a closed-suction drain in cemented knee arthroplasty. METHODS: One hundred patients were prospectively randomized into two groups, one group underwent cemented total knee replacement with a single deep closed-suction drain, and the other group (n = 50) no drain. RESULTS: The total blood loss was significantly greater in those with a drain although those without lost more blood into the dressings. There was no statistical difference in the postoperative swelling or pain score, ecchymosis, deep vein thromboses (DVT), time at which flexion was regained or the incidence of infection at a minimum of two years after surgery in the two groups. CONCLUSION: There is no evidence to support the use of a closed-suction drain in cemented knee arthroplasty.

Aged↗

PubMed1991

Bronchial suction by minitracheotomy as an effective measure against sputum retention.

Bronchial suction by means of a minitracheostomy is a new method for treatment of sputum retention and related pulmonary diseases. Through a small coniotomy, a specially designed cannula is inserted into the trachea, allowing frequent bronchial suction. The effectiveness of this method was prospectively analyzed in 74 consecutive patients and the results were compared with those reported in the literature. The operative procedure for insertion of the Minitracheotomy cannula caused nonlethal bleeding in three patients who were receiving anticoagulant medications. Thirty-eight of 43 patients treated on the intensive care ward were detubated and dismissed at an earlier stage than usual because of a minitracheostomy. The method failed in two comatose patients and in one patient with a laryngeal tumor. The method was effective in 18 patients who had serious pulmonary disease postoperatively. Thirteen patients at high risk for pulmonary infections, in whom the cannula had been prophylactically applied after extensive operations, did not have postoperative pulmonary complications. Over-all, the median period for bronchial suction was 4.0 days; decannulation followed on average 4.7 days later. No complications were caused by the presence of the cannula and the device was well tolerated by the patients.

Adolescent↗

PubMedDate not supplied

The effect of lung hyperinflation and endotracheal suctioning on cardiopulmonary hemodynamics.

The purpose of this study was to examine the effect of sequential lung hyperinflation breaths followed by suction on mean arterial pressure (MAP), cardiac output (CO), pulmonary artery pressure (PAP), and pulmonary airway pressure (Paw) to elucidate the mechanism for the increase in MAP seen with lung hyperinflation and suction. Thirty-four postoperative coronary artery bypass graft patients were randomly exposed to three lung hyperinflation breaths at one of five volumes (tidal volume, 12cc/kg, 14cc/kg, 16cc/kg, and 18cc/kg of lean body weight) using a ventilator followed by 10 s of suctioning repeated for a total of three times. There was a mean increase in MAP (13.71 torr), CO (12.2%), PAP (4 torr), and Paw (23.5 torr) above baseline over the three sequences. The mechanism for the increase in MAP with lung hyperinflation may be attributed to transient increases in intrathoracic pressure, resulting in increased left ventricular preload and CO.

Adult↗

PubMed1990

[Complications and risks of suction drainage].

After the introduction of Redon high-vacuum drainage, a considerable decrease in post-operative haematomas has been noted. But some of the complications could not be prevented by using the Redon system. They were in fact the result of it. The Redon system cannot be classified as a "closed" wound drainage. During bottle replacement, the system must be disconnected. An effective closed system must remain absolutely tight from application to removal of the drain so no possibility exists of contamination infection from the outside. After introduction of a continuously absolutely closed system in a prospective study with 3 different systems the influence after hip joint arthroplasty operations on wound healing was investigated. The wounds were drained with the Redon high-vacuum system or the newly developed, permanently closed drainage system with maximum obtainable low pressure of 80% vacuum and 50% vacuum. Here the maximum obtainable vacuum builds up slowly in relation to the accumulated amount of wound fluids. The loss of low pressure in Redon systems differs between the drains. In the intra-articular drains the mixture of air and blood results in a linear decrease and follows not a hyperbola like in subcutaneous drains. Because of the high suction at the beginning of the Redon drainage necrotic muscle cells adhere to the outside of the drain openings and clogs them up mechanically. The stronger the suction effect on the tissue, the more fatty live cells and small vessels enter the lumen of the drain in the Redon system and 80% vacuum. This mechanisms result in bleeding from the drain canal after removal of the drain and "secondary" haematomas. In the absolutely continuously closed system with maximum obtainable low pressure of 50% vacuum increased suction, lowered bleeding after removal of the drain and best healing results were observed. The 9.8% Cfu occurrence on Redon drains after removal found in the study is within the lower average figures given in literature while the 0.9% figure with both closed systems was never reached before.

Equipment Failure↗

PubMed1987

A suction blister method that gives epidermal biopsies from mice of different ages, suitable for histologic studies of Langerhans cells.

A modified suction blister device has been developed. It allows in vivo retrieval of 3 x 3 mm2 mouse epidermis biopsies. Separation takes place exactly at the epidermal-dermal junction. Young skin and iso-grafted skin require suction with a lower bar value than skin from young and old non-grafted animals. Langerhans cells in biopsies were identified both with ATPase staining and with monoclonal antibody. Suction blisters produce Langerhans cell counts similar to those obtained on EDTA-separated epidermis.

Aging↗

PubMed1989

Prophylactic closed suction drainage of femoral wounds in patients undergoing vascular reconstruction.

Prophylactic closed suction drainage has been advocated in a variety of surgical wounds, but its use in wounds involving vascular anastomoses has not been studied. Fifty patients undergoing lower extremity revascularization that required bilateral groin incisions were randomly assigned to have either the right or left side of the groin drained with a closed suction catheter. The contralateral wound was closed without drainage. Statistically there was no difference between wound closed with drains and undrained wounds in the occurrence of hematomas, seromas, lymphoceles, superficial infections, subcutaneous infections, or graft infections; although serious complications were more frequent in the drained wounds. Prophylactic closed suction drainage appears to offer no advantage over closure without drainage in wounds of the groin resulting from elective vascular operations.

Anastomosis, Surgical↗

PubMed1989

Effectiveness of oxygen concentrations of less than 100% before and after endotracheal suction in patients with chronic obstructive pulmonary disease.

This within-subject study compared the effects of hyperinflations with 20% above maintenance oxygen (O2) level and 100% O2 hyperinflations before and after endotracheal suction in 11 acutely ill patients with chronic obstructive pulmonary disease. Four hyperinflations were delivered at 1.5 times the calculated tidal volume (10 ml/kg) with 100% O2 or 20% above maintenance O2 level via resuscitator bag, followed by 10 seconds of continuous endotracheal suctioning. This sequence was repeated three times. No statistically significant differences (p less than 0.05) were found between the two protocols for arterial oxygen saturation, blood pressure, or heart rate (analysis of variance for repeated measures). There was no change in heart rhythm for any of the subjects. The results of this study suggest that hyperinflation with 20% above maintenance O2 level can be used for oxygenation in patients with chronic obstructive pulmonary disease before and after endotracheal suctioning. Replication is needed before clinical implementation.

Aged↗

PubMed1989

Suction cup ground and reference electrodes in electrodiagnosis.

An alternative to the taped-disc surface electrodes typically used during monopolar and concentric needle electromyographic studies has been investigated. The use of suction cup surface electrodes in place of the taped metal disc surface electrodes increases patient and operator safety and enhances patient comfort and operator efficiency. A two-channel EMG, with a single active needle and two reference electrodes, was done on patients routinely referred for electromyographic studies. The motor units were stored and compared. Similarly, baseline noise was stored and compared. This study shows that no distortion of motor unit potentials in typically measured parameters, nor alteration in baseline "noise" occurs when using the suction cup electrode in place of the taped metal discs. The safer, more comfortable suction cup surface electrodes do not distort the motor unit potentials that electromyographers are accustomed to interpreting.

Action Potentials↗

PubMed1985

Extracellular K+ and Ca2+ activities measured during the action of negative pressure under a suction electrode placed on the surface of frog heart ventricle.

The application of negative pressure of -40 kPa (-300 mm Hg) for 10 min under a suction electrode placed on the surface of the spontaneously beating frog ventricle changed the extracellular potassium activity (aoK+) in three phases: a phase of rapidly rising aoK+, a slowly decaying phase and a phase of slowly rising aoK+. The changes reversed when suction was discontinued during the rapidly rising and decaying phase, but were not reversed during the slowly rising phase. Calcium extra-cellular activity (aoCa2+) decreased between -5 and -13 kPa, but increased during the higher pressures. The results indicated that injury of the ventricular tissue caused by a suction electrode elevated aoK+ and altered aoCa2+.

Action Potentials↗

PubMed1986

The effect of hyperinflation, inspiratory hold, and oxygenation on cardiopulmonary status during suctioning in a lung-injured model.

This study determined the effects of a 5-second inspiratory hold during ventilatory maneuvers on cardiopulmonary status before, during, and after endotracheal suctioning in an acute lung-injured model. Eight mongrel dogs were anesthetized, paralyzed, mechanically ventilated, and given intravenous oleic acid to produce pulmonary edema. Four protocols were tested in alternate order in which either tidal volume inflations or hyperinflations at an FiO2 of 0.6 were given with and without an inspiratory hold of 5 seconds before and after each of three sequential suctioning passes. In those protocols in which an inspiratory hold was used, statistically significant changes occurred in right atrial, pulmonary arterial, and aortic systolic and diastolic pressures (p less than 0.04). The use of an inspiratory hold with hyperinflation maintained PaO2 during suctioning (range of 81 to 91 mm Hg), but had the greatest decrease in PaO2 (8%) after return to the ventilator. In all protocols, with the exception of the one in which hyperinflations without an inspiratory hold were used, there was a cumulative increase in PaCO2 with tidal volume inflation protocols reaching peak PaCO2 values of 49 (+/- 7.5) mm Hg. In protocol 4 in which hyperinflation without inspiratory hold was used, PaO2 ranged from 75 (+/- 16) to 92 (+/- 34) mm Hg, and PaCO2 ranged from 37 (+/- 7) to 42 (+/- 6) mm Hg. In conclusion, the use of hyperinflation without an inspiratory hold resulted in the least undesirable changes in the variables studied. However, this protocol needs to be replicated in an acutely ill clinical population before recommended for practice.

Animals↗

PubMed1988

Airway pressures during closed system suctioning.

Closed system suctioning (CSS) is a method of removing secretions from the tracheobronchial tree of patients with mechanical ventilation without disconnecting the mechanical ventilator. The putative benefits of CSS include the maintenance of positive pressure ventilation, oxygen supply, and positive end-expiratory pressure (PEEP). However, some evidence indicates that negative airway pressure may develop during CSS if inappropriate ventilator settings are selected. The purpose of this in vitro, descriptive study was to delineate the airway pressures obtained during CSS with use of different ventilators and combinations of ventilator settings. Each ventilator was connected to a Vent Aid Training Test Lung and set at a ventilatory rate of 12/min and a tidal volume of 800 ml. For each ventilator, CSS was performed at peak inspiratory flow rates of 25, 40, 50, and 60 L/min, at sensitivities of 0.5, 1.0, 2.0, and 3.0 cm H2O, with and without PEEP of 10 cm H2O, and in modes of intermittent mandatory ventilation, assist control, and control. Airway pressure was measured at the Y-connector of the ventilator tubing. Two CSS trials were performed at each ventilator setting with the Ballard Trach Care System, a 14F in-line suction catheter, at a flow rate of 20 L/min for 10 seconds. During each suctioning trial, the peak positive and negative airway pressures were recorded. The negative airway pressure was above -10 cm H2O in most situations. In the control mode at all flow rates with or without PEEP, the Bennett MA1 and the Bourns-Bear 1 and 2 produced sustained peak negative airway pressure of less than -50 cm H2O.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗

PubMed1987

[What is the benefit of subglottic suction?].

Bronchopulmonary infections are the main cause of morbidity and mortality in intensive care wards. Since the usual anatomical and physiological barrier is missing in the intubated patient, oropharyngeal secretion will reach the subglottic space between glottis and upper rim of the low-pressure cuff. Starting from there, continuous microaspiration between cuff and tracheal mucosa leads to bacterial contamination of the upper respiratory tract. In patients with a disturbed immune system from that point on colonization and infection may follow. Therefore one is called upon to search for measures to prevent infection in ventilated patients. Selective decontamination of oropharynx and gastrointestinal tract has been described as an effective method. Others are recommending the application of aminoglycosides in the tracheobroncheal system. Removing retained secreted material is a general surgical principle. Therefore we tested the practicability and effectiveness of a continuous subglottic drainage. At this point we are mainly interested in its clinical aspects and in the method. We investigated the subglottic drainage in 10 intensive care patients who were on long-term mechanical ventilation and had undergone tracheostomy. All patients had an Ultratracheoflex cannula Nr. 9-11 (Rüsch Company, West Germany). It was modified by a suction catheter Ch. 12 (Uno Plast Company, West Germany): We cut two additional small holes in the curved catheter tip and attached the catheter with this part above the cuff at the dorsal convexity to the tracheoflex cannula (see illustration 1). An infusion pump was used for suctioning secretion from the subglottic space by an ordinary infusion set and at a suction flow of 100-125 ml/h.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical Care↗

PubMed1987

Gynecomastia: suction lipectomy as a contemporary solution.

Suction lipectomy is adapted for the correction of gynecomastia. Previous attempts using suction lipectomy for gynecomastia still required the use of sharp dissection for removal of the glandular breast tissue as well as excision of redundant skin. With this new technique, gynecomastia is corrected solely with the use of suction lipectomy. The technique is successful if the gynecomastia is due to excess fat or parenchymal hypertrophy. A 7-mm cannula is inserted first, to remove the adipose tissue. Then a 2.4-mm cannula is used to remove the glandular and ductal tissue. The 7-mm cannula is then reinserted to remove subareolar parenchyma and to make final contour adjustments. The surrounding subcutaneous tissue is easily undermined to avoid a saucer deformity and to allow for skin contraction. Patients return to full activities in 48 hours. A compressive garment is worn for 4 to 6 weeks. The results of 10 patients are discussed.

Adipose Tissue↗

PubMed1987

The effect of head and neck suction on G tolerance.

A device was constructed which allowed subatomospheric pressures of up to -50 mm Hg to be applied to the neck, or to the head plus neck, of volunteer subjects riding on the USAFSAM centrifuge. Breathing pressures were always atmospheric. The G tolerance was measured during gradual (0.1 G.s-1) and rapid onset (1.0 G.s-1) runs and heart rate was monitored. Neck suction decreased tolerance to an extent explicable by carotid sinus activation (about -0.8 G at -50 mm Hg), while combined head and neck suction of -25 mm Hg increased tolerance to an extent greater than predicted from pressure effects on the eye and carotid sinus. Neck suction of -50 mm Hg induced less bradycardia when applied at +3 Gz than under 1-G conditions. These results were discussed in relation to intraocular tension, baroreceptor responsiveness, and jugular venous siphon effect.

Acceleration↗

PubMed1979

[Results of continuous suction drainage in the treatment of pleural empyema (author's transl)].

201 adults with non-specific pleural empyema (58 women, 143 men) had suction drainage. Most of the patients were aged 61-70 years. In the 47 patients who had not had antibiotic therapy before admission the main causal micro-organisms were staphylococci, pneumococci and streptococci; in the 149, who had had antibiotic therapy outside, micro-organisms such as Pseudomonas, Esch. coli and Proteus predominated. Suction drainage had to be kept up for a remarkably long time: for 4-8 weeks in 36% of the cases and for more than 8 weeks in 8%. 31 patients died, but only 17 of them as a direct result of the pleural empyema. They had all been "high risk" cases on account of age (average 67.7 years), type of bacteria (59%), serious primary or complicating disease (59%), duration of the pleural empyema (76%). Suction drainage succeeded in 140 patients in clearing the infection; but marked adhesions were demonstrable in 27% of the patients when they were discharged from hospital.

Adult↗