Skip to main content
Log in

Development and validation of a measurement system for continuously monitoring postoperative reservoir levels

  • Scientific Note
  • Published:
Australasian Physical & Engineering Sciences in Medicine Aims and scope Submit manuscript

Abstract

Following cardiac surgical procedures, multiple drainage systems remain in place inside the patient’s chest to prevent the development of pericardial effusion or pneumothorax. Therefore, postoperative bleeding must be diligently observed. Currently, observation of the exudate rate is performed through periodical visual inspection of the reservoir. To improve postoperative monitoring, a measurement system based on load cells was developed to automatically detect bleeding rates. A reservoir retaining bracket was instrumented with a load cell. The signal was digitized by a microcontroller and then processed and displayed on customized software written in LabView. In cases where bleeding rates reach critical levels, the device will automatically sound an alarm. Additionally, the bleeding rate is displayed on the screen with the status of the alarm, as well as the fluid level of the reservoir. These data are all logged to a file. The measurement system has been validated for gain stability and drift, as well as for sensor accuracy, with different in vitro examinations. Additionally, performance of the measurement device was tested in a clinical pilot study on patients recovering from cardiac surgical procedures. The in vitro investigation showed that the monitoring device had excellent gain and drift stability, as well as sensor accuracy, with a resolution of 2.6 mL/h for the bleeding rate. During the clinical examination, bleeding rates of all patients were correctly measured. Continuously recording drainage volume using the developed system was comparable to manual measurements performed every 30 min by a nurse. Implementation of continuous digital measurements could improve patient safety and reduce the workload of medical professionals working in intensive care units.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Christensen MC, Dziewior F, Kempel A, von Heymann C (2012) Increased chest tube drainage is independently associated with adverse outcome after cardiac surgery. J Cardiothorac Vasc Anesth 26(1):46–51. https://doi.org/10.1053/j.jvca.2011.09.021

    Article  PubMed  Google Scholar 

  2. Dacey LJ, Munoz JJ, Baribeau YR, Johnson ER, Lahey SJ, Leavitt BJ, Quinn RD, Nugent WC, Birkmeyer JD, O’Connor GT (1998) Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England Cardiovascular Disease Study Group. Arch Surg 133(4):442–447

    Article  CAS  PubMed  Google Scholar 

  3. Karkouti K, Wijeysundera DN, Yau TM, Beattie WS, Abdelnaem E, McCluskey SA, Ghannam M, Yeo E, Djaiani G, Karski J (2004) The independent association of massive blood loss with mortality in cardiac surgery. Transfusion 44(10):1453–1462. https://doi.org/10.1111/j.1537-2995.2004.04144.x

    Article  PubMed  Google Scholar 

  4. Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ (2004) Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg 78(2):527–534. https://doi.org/10.1016/j.athoracsur.2004.02.088 discussion 534.

    Article  PubMed  Google Scholar 

  5. Ranucci M, Bozzetti G, Ditta A, Cotza M, Carboni G, Ballotta A (2008) Surgical reexploration after cardiac operations: why a worse outcome? Ann Thorac Surg 86(5):1557–1562. https://doi.org/10.1016/j.athoracsur.2008.07.114

    Article  PubMed  Google Scholar 

  6. Vivacqua A, Koch CG, Yousuf AM, Nowicki ER, Houghtaling PL, Blackstone EH, Sabik JF (2011) Morbidity of bleeding after cardiac surgery: is it blood transfusion, reoperation for bleeding, or both? Ann Thorac Surg 91(6):1780–1790. https://doi.org/10.1016/j.athoracsur.2011.03.105

    Article  PubMed  Google Scholar 

  7. Biancari F, Mikkola R, Heikkinen J, Lahtinen J, Airaksinen KE, Juvonen T (2012) Estimating the risk of complications related to re-exploration for bleeding after adult cardiac surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 41(1):50–55. https://doi.org/10.1016/j.ejcts.2011.04.023

    Article  PubMed  Google Scholar 

  8. Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M, Murphy GJ, Sellke FW, Shore-Lesserson L, von Heymann C, Ranucci M (2014) Universal definition of perioperative bleeding in adult cardiac surgery. J Thorac Cardiovasc Surg 147(5):1458–1463 e1451. https://doi.org/10.1016/j.jtcvs.2013.10.070

    Article  PubMed  Google Scholar 

  9. Magruder JT, Belmustakov S, Ohkuma R, Collica S, Grimm JC, Crawford T, Conte JV, Baumgartner WA, Shah AS, Whitman GR (2017) Attributable harm of severe bleeding after cardiac surgery in hemodynamically stable patients. Gen Thorac Cardiovasc Surg 65(2):102–109. https://doi.org/10.1007/s11748-016-0714-4

    Article  PubMed  Google Scholar 

  10. Hersch M, Einav S, Izbicki G (2009) Accuracy and ease of use of a novel electronic urine output monitoring device compared with standard manual urinometer in the intensive care unit. J Crit Care 24(4):629 e613–e627. https://doi.org/10.1016/j.jcrc.2008.12.008

    Article  Google Scholar 

  11. Otero A, Fernandez R, Apalkov A, Armada M (2012) An automatic critical care urine meter. Sensors 12(10):13109–13125. https://doi.org/10.3390/s121013109

    Article  CAS  PubMed  Google Scholar 

  12. Bartl C, Senftl M, Eichhorn S, Holzapfel K, Imhoff A, Salzmann G (2012) Combined tears of the subscapularis and supraspinatus tendon: clinical outcome, rotator cuff strength and structural integrity following open repair. Arch Orthop Trauma Surg 132(1):41–50. https://doi.org/10.1007/s00402-011-1400-8

    Article  PubMed  Google Scholar 

  13. Bruser C, Kortelainen JM, Winter S, Tenhunen M, Parkka J, Leonhardt S (2015) Improvement of force-sensor-based heart rate estimation using multichannel data fusion. IEEE J Biomed Health Inform 19(1):227–235. https://doi.org/10.1109/JBHI.2014.2311582

    Article  PubMed  Google Scholar 

  14. Fastier-Wooller J, Phan HP, Dinh T, Nguyen TK, Cameron A, Ochsner A, Dao DV (2016) Novel low-cost sensor for human bite force measurement. Sensors. https://doi.org/10.3390/s16081244

    Article  PubMed  Google Scholar 

  15. Hoyer C, Sandermann J, Paludan JP, Pavar S, Petersen LJ (2013) Diagnostic accuracy of laser Doppler flowmetry versus strain gauge plethysmography for segmental pressure measurement. J Vasc Surg 58(6):1563–1570. https://doi.org/10.1016/j.jvs.2013.06.057

    Article  PubMed  Google Scholar 

  16. Montano SR, Morris RW, Pybus DA (1996) The use of a load cell for continuous cardiotomy reservoir level measurement during cardiopulmonary bypass. Perfusion 11(4):319–325. https://doi.org/10.1177/026765919601100404

    Article  CAS  PubMed  Google Scholar 

  17. Heimisch WGB, Mendler N, Sebening F (1976) Kontinuierliche Messung und Aufzeichnung von Urinausscheidung und Drainagevolumen am Krankenbett. Biomedical Engineering/Biomedizinische Technik 21(1):13–14

    Article  Google Scholar 

  18. Hinghofer-Szalkay H, Greenleaf JE (1987) Continuous monitoring of blood volume changes in humans. J Appl Physiol 63(3):1003–1007

    Article  CAS  PubMed  Google Scholar 

  19. Hinghofer-Szalkay H (1986) Method of high-precision microsample blood and plasma mass densitometry. J Appl Physiol 60(3):1082–1088

    Article  CAS  PubMed  Google Scholar 

  20. Vitello DJ, Ripper RM, Fettiplace MR, Weinberg GL, Vitello JM (2015) Blood density is nearly equal to water density: a validation study of the gravimetric method of measuring intraoperative blood loss. J Vet Med. https://doi.org/10.1155/2015/152730

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fergusson DA, Hebert PC, Mazer CD, Fremes S, MacAdams C, Murkin JM, Teoh K, Duke PC, Arellano R, Blajchman MA, Bussieres JS, Cote D, Karski J, Martineau R, Robblee JA, Rodger M, Wells G, Clinch J, Pretorius R, Investigators B (2008) A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med 358(22):2319–2331. https://doi.org/10.1056/NEJMoa0802395

    Article  CAS  PubMed  Google Scholar 

  22. Diprose P, Herbertson MJ, O’Shaughnessy D, Gill RS (2005) Activated recombinant factor VII after cardiopulmonary bypass reduces allogeneic transfusion in complex non-coronary cardiac surgery: randomized double-blind placebo-controlled pilot study. Br J Anaesth 95(5):596–602. https://doi.org/10.1093/bja/aei244

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This study was funded by budget funds from the German Heart Center Munich (Munich, Germany).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Eichhorn.

Ethics declarations

Conflict of interest

All authors declare no conflict of interest.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee (the Committee for Medical Ethics of the medical faculty at the Technische Universität München / No. 517/16K) and with the Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals participating in this study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eichhorn, S., Reisinger, T., Böhm, J. et al. Development and validation of a measurement system for continuously monitoring postoperative reservoir levels. Australas Phys Eng Sci Med 42, 611–617 (2019). https://doi.org/10.1007/s13246-019-00746-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13246-019-00746-5

Keywords

Navigation