J Thorac Cardiovasc Surg 2008;136:236
© 2008 The American Association for Thoracic Surgery
Redon drains and underwater seal: The better of two worlds?
Nawwar Al-Attar, FRCS, FETCS, PhD,
Richard Raffoul, MD,
Patrick Nataf, MD
Bichat Hospital, Paris, France
To the Editor:
We read with interest the recent article of Gwozdziewicz, N
mec, and Steriovsky1
describing a technique of chest drainage after cardiac surgery with Redon drains (B. Braun Melsungen AG, Melsungen, Germany) .
Five Redon drains are placed in an elaborate fashion into the pericardial space and further drains are added if the pleura are opened and require drainage. The drains are attached to a reservoir under suction of –800 mbar (816 cm H2O).
On one hand, we fully agree with the advantages of using Redon drains and add the following to those already cited by the authors: (1) the ease with which these drains are removed, being less painful and requiring minimal or no analgesia, and (2) the fact that only one suture is needed to fix them and no closure is necessary after removal as compared with standard chest tubes. On the other hand, we use only two Redon drains, which correspond to drains 2 and 5 according to Gwozdziewicz's scheme, with number 5 being placed more toward the right ventricle. Occasionally, a third mediastinal Redon drain is added if the patient is at a particular risk for bleeding complications. It is often placed in regard to the culprit site, for example, the left atrium in mitral valve surgery. In case of pleural space drainage, one Redon drain is placed into each pleura as necessary. Moreover, in one of our patients, suction necrosis developed on a venous graft that was in direct contact with one of these Redon drains. This was attributed to the high suction pressure attained by connecting these drains to the reservoir as described in the article. We, therefore, connect the Redon drains to a sterile underwater valve seal system, Pleur-evac chest drainage unit or Pleur-evac Sahara chest drainage dual tube (Teleflex Inc, Research Triangle Park, NC) when the pleura are intact or open, respectively (
Figure 1). These systems are completely silent and produce no bubbling sound. They evidently require an external source of suction but control the suction pressure of the Redon drains to around –20 cm H2O, minimizing considerably the risk of a suction lesion on the heart or coronary grafts. We have not encountered such a lesion in our experience with more than 2000 patients in whom this system was applied.
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Figure 1. Redon drains attached to an underwater seal system. The suction pressure is regulated at –20 cm H2O. Inset shows connection of drains to system tubing.
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We congratulate the authors on their work and look forward to their feedback on the points we raised.
References
- Gwozdziewicz M, Nmec P, Steriovsky A. An alternative approach for chest drainage after cardiac surgery: Redon drains. J Thorac Cardiovasc Surg 2008;135:216-217.[Free Full Text]
