What is the most likely cause of blood gush through chest tube site following it's removal four days after CABG?
MOSTLY THE TUBE WAS NOT FUNCTIONNING WELL(BLOCKED)
however the possibility of injuring one of the grafts is still there
there may be many causes but common cause we see is collection of fluid .most of the times noactive intervention.it subsides by itself. generally we keep colostomy bag to that site so that whater remaining collection that comes for one or two days. later you can remove.
Above answers are good. However, don't overlook the possibility of injury to an intercostal artery that was tamponaded by the tube; removing the tube allowed it to bleed freely. First, chest exam & x-ray (fluid in chest?). second, if no fluid in chest and bleeding continues, tamponading the IC vessels with a Foley catheter may both clarify and treat the problem.
bleeding from one of the subcutaneous artery from the local site of entry of drains is a possibility which I have noted most commonly in my practice, next likelyhood I will suspect is collection which was not drained by the tube is coming out, in both the conditions hemodynamics is stable but if there is hypotension and tachycardia bleeding from grafts may be due to slipped clips may be suspected, but if there is sudden severe bleeding with hemodynamic collapse possibility of bleeding from proximal anastomosis is most likely
Two major options : Agree with above
Blood: Chest tube removal damaged graft, removed tamponade of artery (intercostal, subq vessel etc). If due to graft should see cardiac ischemia. Unlikely give 4 days out, but possible. Depends on chest tube path for possible structures that could be damaged.
Serosanguinous fluid: Most likely given 4 days out, Likely due to chest tube non functional (kinked, obstructed from clot/debris) and the chest tube tract if large/short would have low resistance to discharge fluid.
Either way can collect fluid and spin down to see RBC fraction if not clear which type of fluid.
tHANK YOU ALL. Dr Das gave the most likely answer.
It was large amount of bright red blood, the patient became hypotensive, pushed to OR. .The side hole pulled one of the clips on the vein graft close to the proximal anastomosis.
so the tube was too much in to reach near to the aorta which is unusual
Well, i agree with above.
In first place i want to ask, why chest tube kept so long after a CABG? Was there a high out put in post op days?
A rare but not uncommon possibility is Rt-heart failure, leading to hepatic congestion and deranged homeostasis. A high INR can also cause such bleeding.
The most likely cause would be a skin arterial bleeder which would have got infected.
1.COLLECTED BLOOD GUSHING WITH EACH HEART BEAT(MEDIASTINAL) OR EACH INSPIRATION(IF PLEURAL SITE)
2.RARELY AND DEADLY , WHEN PULLING TUBE ,GRAFT MAY GET CAUGHT IN ONE OF EYE OF TUBE AND PULLED ALONG
3. INTERCOSTAL VESSEL / SUPERIOR EPIGASTRIC VESSEL INJURY DURING INSERTION AND THEN INJURIED AGAIN WHILE PULLING TUBE OUT
36% of chest tubes clog off and stop draining, even though there is still blood to be evacuated. (Karimov, EJCTS, 2013). Perhaps there was a collection of retained blood that was not draining out of the clogged chest tube and then it spontaneously drained once the tube was removed. Was it dark blood?
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