Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation

A Brunelli

A Sanni

Amy Bradley

B Deng

DA Waller

G Varela

JM Mier

K Papagiannopoulos

N Alphonso

Pala B Rajesh

RJ Cerfolio

Sridhar Rathinam

Teresa Cantlin

TW Rice

Journal of Cardiothoracic Surgery

English

PubMed

Background:

Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clear contents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may have variable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is not scientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with scientific digital flow recordings and an in built alarm system.
Methods:

We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regional thoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6 [1 Excellent to 6 Poor].
Results:

120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomy and lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it was more scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patients early. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patients and scientific removal of chest drain.
Conclusions:

Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation

Sridhar Rathinam (4607125)

A. Bradley (7039049)

T. Cantlin (7694498)

P. B. Rajesh (7694501)

Leicester Research Archive

Thopaz Portable Suction Systems in Thoracic Surgery: An end user assessment and feedback in a tertiary unit

Rathinam, Sridhar

Bradley, Amy

Cantlin, Teresa

Rajesh, Pala B

Heart of England: HEFT Repository

RESEARCH ARTICLE Open AccessThopaz Portable Suction Systems in ThoracicSurgery: An end user assessment and feedback ina tertiary unitSridhar Rathinam1,2, Amy Bradley1, Teresa Cantlin1 and Pala B Rajesh1*AbstractBackground: Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clearcontents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may havevariable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is notscientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of thepatient, with scientific digital flow recordings and an in built alarm system.Methods: We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regionalthoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6[1 Excellent to 6 Poor].Results: 120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomyand lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it wasmore scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patientsearly. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patientsand scientific removal of chest drain.Conclusions: Thopaz digital suction units were found to be user friendly and were liked by the staff and patients.The staff feedback stated the devices to be objective and scientific in making decisions about removal andenabled mobilisation.IntroductionThoracic surgical patients have chest drains placed inthe pleura to drain air and blood [1]. There are variousdevices which are connected to the chest drains withsome of the recent ones having digital flow metersincorporated in them [2]. In some circumstances thesedrains are placed on negative pressure suction to evac-uate the contents of the pleural cavity as well as tohelp re-expand the lungs [3]. Traditionally this hasbeen achieved by connecting the chest drain bottles tolow pressure wall suction. Though this achieves nega-tive suction this has limitations as it impairs patientmobility and the suction applied by the wall unit canbe variable. There is a potential infection risk particu-larly if patients disconnect themselves to mobilise leav-ing the suction tube on the floor and reattach to thedrain later.There are currently systems which generate the flowsby digital meters incorporated in the drainage portals[4]. However this still doesn’t solve the problem ofmobilisation of the patient as if the patient needs suc-tion they have to be connected to the wall.The Thopaz chest drain system (Medela Switzerland)is a portable suction unit with a drainage canister whichcomes with a mains charger and can be allowed tomobilise with the patient.We describe the user feedback from staff and patientsin our regional thoracic centre after trial evaluation ofthe device for a three month period.* Correspondence: p_rajesh51@yahoo.com1Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital,Bordesley Green East, Birmingham B9 5SS, UKFull list of author information is available at the end of the articleRathinam et al. Journal of Cardiothoracic Surgery 2011, 6:59http://www.cardiothoracicsurgery.org/content/6/1/59© 2011 Rathinam et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.Materials and methodsA pilot evaluation was performed in a regional thoracicunit over a period of two months to evaluate the utilityof the device in our thoracic practice.DeviceThopaz chest drain system is a portable suction unitwhich allows mobilization of the patient (Figures 1).This offers patients the benefit of suction and enablesearly mobility. It has scientific digital flow recordingswith an in built alarm system (Figure 2). There are var-ious alarms which alert the nurses regarding blocks,high volumes and battery status. The device also flushesthe collection tubing connected to the inter-costal drainpreventing blockage of drains.The clinicians can assess air-leak in a scientific andobjective manner as the data can be reviewed in a gra-phic format. Drain removal is performed when there isminimal flow and the graphs are stable.Evaluation15 devices were evaluated between August and October2008 on elective thoracic surgical patients undergoingvideo-assisted thoracic surgical procedures and electivelung resections. Patients undergoing pneumonectomyand those undergoing decortication were excluded fromthe trial evaluation.User FeedbackThe staff were trained about the use, assembly, alarmmanagement and care of the device in pre arranged ses-sions. After a few weeks to enable familiarity and estab-lish practice, the nursing staff were asked to fill astructured questionnaire addressing overall deviceassessment, device assembly, ease of management andsatisfaction rating them on a scale 1-6 ( 1:Excellent, 2:Very good, 3:Good, 4:Satisfactory, 5: Needs improve-ment and 6 Poor). Patients with pneumothoraces whohad chest drains and wall suction prior to surgery whohad Thopaz following the operation were requested togive their feedback. The medical staff were requested tostate their opinion regarding the device.Results120 patients were evaluated over 2.5 months. The pro-cedures were lobectomy, wedge resection, VATS lungbiopsy, VATS pleural biopsy and VATS bullectomypleurectomy.15 staff nurses evaluated the device and made theirassessments on the following factors: overall deviceassessment, device setup and completeness, alarm man-agement and instructions for use.The staff feedback evaluation rated the device as verygood or good in most categories. The Median scoresand range are as follows with the following figures illus-trating the median scores.Overall: 2 (2-3) Efficacy: 2 (2-3)Vacuum adjustment: 2 (1-4) Flow Readings: 3 (1-5)Display: 3 (2-4) Alarm System: 3 (1-5)Setup: 2 (1-3) Canister Change: 2 (1-3)InstructionsThe staff feedback on the instructions which accompa-nied the system including the error message and alarmmanagement was rated as excellent by 13%, very goodby 54%, good by 20% and satisfactory by 13% (Figure 3).Device SetupThe Staff were pleased that there was no need for prim-ing which reduced the risk of spilling and infection riskas the canisters were sealed dry units. 4 rated the canis-ter and canister setup as excellent with 7 and 4 ratingthem as very good and good respectively. The onlynegative feedback was the text marking on the canisterwhich made it difficult to read in the night.The tubing was rated as excellent by 6, very good by 6and good by 3. The feature of constant flushing wasperceived to be a positive attribute.Figure 1 Thopaz Chest Drain System.Figure 2 Digital display and graphs of air-leak.Rathinam et al. Journal of Cardiothoracic Surgery 2011, 6:59http://www.cardiothoracicsurgery.org/content/6/1/59Page 2 of 5Changing the canister and tubing was felt to be excel-lent by 4, very good by 8 and good by 3 staff (Figure 4).Device CharacteristicsThe assessments made on the device characteristicswere assessed in various sections as vacuum setup andadjustment, flow rates and graphs, legibility of displayand alarm system. The vacuum setup and adjustmentwas assessed to be excellent by 4, very good by 6, goodby 4 and satisfactory by 1.The flow rates and the graphical display were rated asfollows: excellent (1), very good (5), good (5), satisfac-tory (1) and room for improvement (1). The legibility ofdisplay was felt to be very good by 5, good by 6, satis-factory by 3 and room for improvement by 1.The alarm warning and alarm system received mixedreviews as the feedback was influenced by the high sen-sitivity of the alarm systems. It was rated excellent (1),very good (1), good (7), satisfactory (3) and room forimprovement (3) (Figure 5).Overall Device performanceThe overall device performance had positive feedbackwith 13 rating it as very good and 2 rating it as good.The general utility of the device received similar assess-ment with 9 rating it as very good and 6 rating it asgood.The device efficacy was felt to be very good by 11,good by 3 and satisfactory by 1 and similarly the overalldevice completeness was assessed as very good by 11,good by 2 and satisfactory by 2 (Figure 6).Doctors’ feedback stated that the drain managementwas more objective and scientific with the Thopaz.Patients appreciated that it was portable and lightwhich meant they could mobilise on suction givingthem more independence. They preferred the lack ofbubbling noise and the compactness over conventionaldrains and suction.DiscussionChest drains are an integral part of thoracic surgerywith patients having at least one drain after most thor-acic surgical procedures. Closed chest drain systemshave evolved from the time they were introduced inFigure 3 Assessment on Instructions for use.Figure 4 Assessment on Setting up the device.Figure 5 Assessment on Device Specifics.Figure 6 Assessment on Overall device assessment.Rathinam et al. Journal of Cardiothoracic Surgery 2011, 6:59http://www.cardiothoracicsurgery.org/content/6/1/59Page 3 of 5thoracic surgical practice. The three bottle underwaterseal chest drainage has now progressed to single cham-ber devices with the liquid column acting as the oneway valve to enable fluid and air to escape from thethoracic cavity.Suction is applied to the chest drain systems in thepresence of continuous air-leak or when the lung is notfully expanded [3,5,6]. There is a continuing debate onthe role of suction in thoracic surgery [7,8]. Some sur-geons practice includes continuous suction followingpleurectomy and talc insufflations to enable adequatepleurodesis.Currently suction is applied from the wall suctionports in the ward which are connected to the chestdrain bottles. This has a logistical problem in wardswithout wall suction port. The flow in the wall suctionports can be variable and the suction delivered to thepatient is influenced by a variety of factors like thelength of the tubing from the wall suction port, the fluidin the chamber, the length of the tubing between thepatient and drain bottle.Thoracic surgical patients need to mobilise and havephysiotherapy as a part of their post-operative care, con-stant suction can impede mobility. Continuous suctionalso poses privacy problems to young patients who haveto stay in bed while having to use convenience facilities.Patients sometimes are allowed to mobilise off suctionand on suction when resting; this poses the potentialinfection risk as most patients tend to disconnect thetubing from the drain bottle, leave it on the floor andconnect it back to the drain bottle.There is an alternative option in patients with persis-tent air-leaks when the lungs are up which are notsuction dependant. The drains can be connected toflutter-bags with Heimlich valves to enable mobilisa-tion and even discharge home to remove the drainslater [9]. There are various devises which measure digi-tal air leak this has reduced inter-observer error indecision making in drain management in patients withair-leak [10].In an ideal world the chest drainage system should bereliable, simple, safe, portable, cost efficient and offerobjective real time data to help clinicians in the decisionmaking of chest drain management. The device whichwe evaluated, the Thopaz portable chest drain and suc-tion unit helps address most of these problems.It enables the patients to mobilise, observing andrecording the flows of the drainage through the patientin a digitally retrievable format. The manufacturers statethe device provides suction only when required until thepleural pressure reaches the physiological limit. Hencethe patient is not harmed by continuous suction. TheThopaz system has been shown to reduce the durationof chest drainage, delivers objective information in chestdrain management, reduces the number of radiographsand is cost effective [11-13]. Our study focussed on theend users assessment of the device as it would be theusers and patients who will be the proof of an effectivesystem.The Nurses were pleased that there was no need forpriming which reduced the risk of spilling and infectionrisk as the canisters were sealed dry units. The onscreengraphs and alarms made management more safe whichmade air leak assessment accurate. The setting up wasuser friendly and the product could be cleaned with anyalcohol group detergent.The initial learning period had difficulties with alarmsensitivities, the difficulty with reading the letters on thecanisters and some leakage from the canister during dis-posal. However these have been addressed in the newerversion.Patients appreciated that it was portable and lightwhich meant they could mobilise on suction givingthem more independence. They preferred the lack ofbubbling noise and the compactness over conventionaldrains and suction. This comment was prominent inparticularly the patients that were transferred withpneumothoraces on the standard under water seal bottleon continuous wall suction.In our study the clinicians found the system to be userfriendly and enabled effective decision making in theremoval of chest drains. The perceived benefits alsoincluded utility in wards without wall suction, reductionin portable x-rays, decreased infection risk and betterphysiotherapy.ConclusionThopaz digital suction units were found to be userfriendly and were liked by the staff and patients. Thestaff feedback stated the devices to be objective andscientific in making decisions about removal andenabled mobilisation.AcknowledgementsThis work was presented in the Cardiothoracic Forum in the Annual Meetingof the Society for Cardiothoracic Surgery in Great Britain and Ireland inLiverpool, UK in March 2010 and 18th European conference on GeneralThoracic Surgery in Valladolid, Spain in June 2010Figures 1 and 2 are courtesy of Medela AG Switzerland.Author details1Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital,Bordesley Green East, Birmingham B9 5SS, UK. 2Consultant Thoracic Surgeon,University Hospitals of Leicester, Leicester LE3 9QP, UK.Authors’ contributionsSR was involved with study design, collected the data, performed the dataanalysis and authored the manuscript, AB was involved in data collectionand coauthored manuscript and TC collected data and co-authoredmanuscript. PBR is the principal investigator, devised the study and coauthored the manuscript. All authors have read and approved themanuscript.Rathinam et al. Journal of Cardiothoracic Surgery 2011, 6:59http://www.cardiothoracicsurgery.org/content/6/1/59Page 4 of 5Competing interestsThe authors declare that they have no competing interests.Received: 3 February 2011 Accepted: 21 April 2011Published: 21 April 2011References1. Cerfolio RJ, Tummala RP, Holman WL, Zorn GL, Kirklin JK, McGiffin DC,Naftel DC, Pacifico AD: A prospective algorithm for the management ofair leaks after pulmonary resection. Ann Thorac Surg 1998, 66(5):1726-31.2. Cerfolio RJ, Bryant AS: The benefits of continuous and digital air leakassessment after elective pulmonary resection: a prospective study. AnnThorac Surg 2008, 86(2):396-401.3. Brunelli A, Monteverde M, Borri A, Salati M, Marasco RD, Al Refai M,Fianchini A: Comparison of water seal and suction after pulmonarylobectomy: a prospective, randomized trial. Ann Thorac Surg 2004,77(6):1932-7.4. Varela G, Jimenez MF, Novoa NM, Aranda JL: Postoperative chest tubemanagement: measuring air leak using an electronic device decreasesvariability in the clinical practice. Eur J Cardiothorac Surg 2009, 35(1):28-31.5. Alphonso N, Tan C, Utley M, Cameron R, Dussek J, Lang-Lazdunski L,Treasure T: A prospective randomized controlled trial of suction versusnon-suction to the under-water seal drains following lung resection. EurJ Cardiothorac Surg 2005, 27:391-394.6. Rice TW, Okereke IC, Blackstone EH: Persistent air-leak followingpulmonary resection. Chest Surg Clin N Am 2002, 12(3):529-39.7. Sanni A, Critchley A, Dunning J: Should chest drains be put on suction ornot following pulmonary lobectomy? Interactive CardioVascular andThoracic Surgery 2006, 5(3):275-8.8. Deng B, Tan QY, Zhao YP, Wang RW, Jiang YG: Suction or non-suction tothe underwater seal drains following pulmonary operation: meta-analysis of randomised controlled trials. Eur J Cardiothorac Surg 2010.9. Waller DA, Edwards JG, Rajesh PB: A physiological comparison of fluttervalve drainage bags and underwater seal systems for postoperative airleaks. Thorax 1999, 54(5):442-3.10. Varela G, Jimenez MF, Novoa NM, Aranda JL: Postoperative chest tubemanagement: measuring air leak using an electronic device decreasesvariability in the clinical practice. Eur J Cardiothorac Surg 2009, 35(1):28-31.11. Cerfolio RJ, Bryant A: Quantification of postoperative airleaks. MMCTS2009.12. Mier JM, Molins L, Fibla JJ: The benefits of digital air leak assessmentafter pulmonary resection: prospective and comparative study. Cir Esp2010, 87(6):385-9.13. Papagiannopoulos K, Kuppusami M, Kefaloyannis EM: The use of Thopazpump in the management of air leaks. A transition from analogue tostandardised digital scoring. Experience of first 100 cases from a singleinstitution. Interactive CardioVascular and Thoracic Surgery 2009,9(Supplement 1):S31.doi:10.1186/1749-8090-6-59Cite this article as: Rathinam et al.: Thopaz Portable Suction Systems inThoracic Surgery: An end user assessment and feedback in a tertiaryunit. Journal of Cardiothoracic Surgery 2011 6:59.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitRathinam et al. Journal of Cardiothoracic Surgery 2011, 6:59http://www.cardiothoracicsurgery.org/content/6/1/59Page 5 of 5

Thopaz Portable Suction Systems in Thoracic Surgery: an end user assessment and feedback in a tertiary unit.

Springer - Publisher Connector

HEFT Repository

Abstract
          
            Background
            Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clear contents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may have variable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is not scientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with scientific digital flow recordings and an in built alarm system.
          
          
            Methods
            We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regional thoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6 [1 Excellent to 6 Poor].
          
          
            Results
            120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomy and lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it was more scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patients early. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patients and scientific removal of chest drain.
          
          
            Conclusions
            Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation.
          </jats:sec

Crossref

A: Quantification of postoperative airleaks.

AD: A prospective algorithm for the management of air leaks after pulmonary resection. Ann Thorac Surg

Aranda JL: Postoperative chest tube management: measuring air leak using an electronic device decreases variability in the clinical practice. Eur J Cardiothorac Surg

AS: The benefits of continuous and digital air leak assessment after elective pulmonary resection: a prospective study. Ann Thorac Surg

Fianchini A: Comparison of water seal and suction after pulmonary lobectomy: a prospective, randomized trial. Ann Thorac Surg

Okereke IC, Blackstone EH: Persistent air-leak following pulmonary resection.

PB: A physiological comparison of flutter valve drainage bags and underwater seal systems for postoperative air leaks. Thorax

Should chest drains be put on suction or not following pulmonary lobectomy? Interactive CardioVascular and Thoracic Surgery

The benefits of digital air leak assessment after pulmonary resection: prospective and comparative study. Cir Esp

Treasure T: A prospective randomized controlled trial of suction versus non-suction to the under-water seal drains following lung resection. Eur J Cardiothorac Surg

YG: Suction or non-suction to the underwater seal drains following pulmonary operation: metaanalysis of randomised controlled trials.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3094380

Thopaz Portable Suction Systems in Thoracic Surgery: An end user assessment and feedback in a tertiary unit

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Leicester Research Archive

Heart of England: HEFT Repository

Springer - Publisher Connector

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