Comparative Study On The Disposable Multifunctional Drainage Bag And The Self-made Drainage Bottle In The Drainage Of Pericardial Effusion

Pericardial effusion is a clinical manifestation of a variety ofcauses. With the continuous improvement of the diagnosis and treatmenttechnology, the risk factors resulting in cancer increases, and the incidenceand detection rates of the tumor continue to increase, causing the proportion ofmalignant pericardial effusion is rising. The rapid accumulation of largepericardial effusion in the pericardium can lead to cardiac tamponade, whichwill threaten the life. The most direct, effective treatment is the pericardialdecompression. And the pericardiocentesis catheter drainage has been widelyused because of its simplicity and safety. Now the drainage devices matchingwith the central venous catheter are lack in clinical. The clinicians often usematerials produce drainage devices, such as self-made drainage bottles andordinary drainage bags. However, the production process is time consuming,easy dropping off, easy to pollution, inconvenient to use as well as otherproblems. The one-time disposable multifunctional drainage bag (Patent No.:ZL200,920,255,142.7) developed by our department has resolved the aboveproblems, and the safety and efficacy in the process of draining the pericardialeffusion has improved remarkably.Objective: Through the comparative study on the traditional self-madedrainage bottle and the disposable multifunctional drainage bag connecting tothe central venous catheter to drain the pericardial effusion, evaluate the thesafety and efficacy of the disposable multifunctional drainage bag in theclinical application.Methods: In this experiment, we collected40patients who werehospitalized for malignant pericardial effusion in the Department RespiratoryMedicine of The Forth Hospital of Hebei Medical University(2010.9~2011.3), including11women and29men, aged from36to72, mean age (56.5±9.4)years. They were diagnosed as malignant pericardial effusion by find cancercells in pericardial effusion cytology. They were all confirmed by ultrasoundwith moderate or severe pericardial effusion. The pericardial effusion patientswho with aortic dissection, clotting disorders not be corrected, the patientsunder anticoagulant therapy, the pericardial effusion patients with bleedingtendency or thrombocytopenia below50×10~9/L, the pericardial effusion inthe posterior wall or of the limitations, transudate, the non-neoplastic effusioncaused by pericardial infection and the patients with Liver function failure andrenal failure are ruled out. The patients were randomly divided into twogroups, experimental and control groups. Experimental group: Through theultrasound, use the Seldinger technique to position ARROWpericardiocentesis catheter drainage, and connect the bag to drain thepericardial effusion. The whole process is under aseptic manipulation. Wedrainaged the pericardial effusion continully, keeping the speed in5-10ml/min, to be avoided acute right heart dilation by drainage a lot ofpericardial effusion in a short-term. Inject20mg/time of cisplatin (the totalamount of cisplatin does not exceed120mg) and40million units/time ofinterleukin-II to the pericardium, and clip the drainage tube for48-72hours. Then, drain the pericardial effusion until no effusion left. If thedrainage volume in the24-hour is less than25ml and through theidentification of B-ultrasound, there is small amount of pericardial effusion,you can pull out the drainage tube. Control group: Through the B-ultrasound,use the Seldinger technique to position ARROW pericardiocentesis catheterdrainage, and connect the self-made bottle to drain the pericardial effusion.The aseptic manipulation will be carried out strictly, and the process and thepericardial injection are the same with those of the experimentalgroup. Charge the disposable multifunctional drainage bag or the self-madedrainage bottle every eight days.Study the drainage tube expulsion rate, the incidence of blockage anddredging, the drainage efficacy, the incidence of air reflux, the disposable multifunctional drainage bags' infection, the operating time-consuming, thepatient satisfaction in the pericardial effusion drainage process of the twogroups comparatively.Results:1The expulsion rate,blockage rate and the dredging rate of the drainagetube:there were20cases of pericardial effusion in the experimental group, thedrainage tube connector loose had occurred0times, the expulsion rate was0%;the blockage of the drainage tube had occurred5times, all of them weredredged, the blockage rate was15%and the dredging rate was100%;therewere20cases of pericardial effusion in the control group, the drainage tubeconnector loose had occurred5times, the expulsion rate was25%; theblockage of the drainage tube had occurred10times,2of them were dredged,the blockage rate was50%and the dredging rate was20%, P<0.05, there weresignificant statistical difference between the two groups, The experimentalgroup was obviously less than the control group in the expulsion rate andblockage rate of the drainage tube, higher than the control group in thedredging rate of the drainage tube.2The effective rate of treatment: In the experimental group, there were15cases complete remission,4cases partial remission,the total cases were19,the effective rate was95%; In the control group, there were14cases completeremission,4cases partial remission,the total cases were18, the effective ratewas95%, P>0.05, There was no significant statistical difference between thetwo groups.3The incidence of air reflux: In the experimental group, the air refluxoccurred1time, the incidence of air reflux was5%, the reason was the brokenof central venous catheters in vitro; In the control group air reflux occurred7times, the incidence rate was35%. All of them were iatrogenic airregurgitation. The reasons were bottles slipped off the central venous catheter,There was significant statistical difference between the two groups, P<0.05.The experimental group was obviously less than the control group in theincidence of air reflux. 4The rate of fluid contamination in the drainage bag (bottle): Thegermiculture of the fluid in the drainage bag (bottle) was examinated everyeight days. In the experimental group, there were32times of the examinationof the germiculture, and none fluid contamination occured, the rate was0%,in the control group, there were39times of the examination of thegermiculture,there were6cases of fluid contamination.3cases of them werePseudomonas aeruginosa,2cases of them were S. aureus, and1cases was E.coli. The rate of fluid contamination was15%, There was significant statisticaldifference between the two groups, P<0.05. The experimental group wasobviously lower than the control group.5The operating time between the two groups:There were47times drainagein the experimental group, the average time was48.75±10.84s; in thecontrol group, there was49times drainage, the average time was270.95±44.76s, There was significant statistical difference between the two groups,P<0.0001. The experimental group was obviously lower than the controlgroup.6The satisfaction rate of the two groups: There were14cases in theexperimental group expressed satisfaction, the satisfaction rate was95%; therewere7cases in the control group expressed satisfaction,the satisfaction ratewas35%.There was significant statistical difference between the two groups,P <0.05. The experimental group was obviously higher than the control group.Conclusion: During the process of draining the pericardial effusion, theexpulsion rate, the blockage rate, the time consuming as well as the incidenceof air reflux in the clinical operations are less than those of the self-madedrainage bottle; the dredging rate and the patient satisfaction rate are higherthan those of self-made drainage bottle. The rate of fluid contamination in thedrainage bag is lower than that of the self-made drainage bottle.It isconfirmed that the effectiveness and safety of the disposable multifunctionaldrainage bag in the clinical applications is higher. This study shows that theapplication of the bag in the process of draining the pericardial effusion isbetter than that of self-made seal bottle. The clinical operation is convenient, simple, and the drainage system with good effectiveness and safety can bewidely used.