Place Atrium™ to Waterseal (PAWS): A quality improvement project to assess wall suction versus no suction in chest tubes after open-heart surgery

This quasi-experimental study was conducted as part of an interprofessional clinical scholar program in which I served as the coordinator support for a staff nurse's evidence-based practice study, using evidence to solve a relevant clinical problem and improve the quality of care being provided to open heart surgery patients. The study included the comparison of two care approaches for managing chest tubes post open heart surgery, using a quasi-experimental design.  The new approach of placing the chest tube to waterseal 12 hours post open heart was compared with the standard practice of keeping the chest connected to wall suction until removal of the tube. The comparison was made to ensure the safety of the new approach and the rate of complications, chest tube output, and time to removal were the outcomes. My role included assistance with the design of the study, statistical analysis, and writing the results section of the paper and serving as the overall editor of the publication.


Background:  Traditionally chest tubes are placed to -20 cm wall suction until removal to facilitate draining blood, fluid, and air in the pleural or mediastinal space for open-heart surgery patients (OHS).  However, there is no clear evidence to support using wall suction in OHS patients and there is some evidence in pulmonary surgical patients that placing chest tubes to water seal is a safer practice and results in decreased chest tube dwell time and eliminates air leaks.   

Objective: The primary objective was to demonstrate that placing chest tubes of OHS patients to water seal after 12 hours of wall suction (intervention) is a safe alternative to placing chest tubes to wall suction until removal (usual care).  

Methods: A quasi-experimental (pre/post) design assisted in evaluating the two chest tube management approaches regarding chest tube complications, output, and dwell time to determine whether changing approaches would add to the quality of care. . 

Results: No significant differences in complications (0 versus 2 events, Fisher’s Exact Test, p = 0.23), chest tube output (H(1) = 0.001, p = .97), and dwell times (median of 47 hours both pre and post) occurred between (n = 48) intervention and usual care (n = 52) patients. 

Conclusion: Placing chest tubes to water seal after 12 hours of wall suction was a safe alternative to using wall suction until removal. 



This publication has been peer reviewed.
Publication Type: 
Journal Article
Tamara Kruse, RN, BSN, CCRN-CSC. Sharon Wahl, RN, MS Patricia Finch Guthrie, PhD, RN Sue Sendelbach, PhD, RN, CCNS
Year of Publication: 
Journal, Book, Magazine or Other Publication Title: 
Critical Care Nurse
American Association of Critical Care Nurses
Date Published: 
Tuesday, August 1, 2017
Publication Language: 
JoAnn Grif Alspach
Boyer's Domain: 



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