Nursing Care of Children with Chylothorax after Cardiac Surgery
Chylothorax is a rare diagnosis in which lymphatic fluid, specifically chyle, accumulates in the pleural space. Chyle is a milky-white fluid primarily composed of fat, but also contains electrolytes and lymphocytes. Although chylothorax may occur in neonates with congenital lymphatic malformations, it is most commonly seen in patients after cardiac surgery due to damage to the thoracic duct or high central venous pressures. It may be initially noticed as a pleural effusion on radiograph or through chest tube output. Diagnosis is based on analysis of the pleural fluid to determine the presence of chylomicrons. Initial treatment involves draining the pleural fluid and dietary modifications. Medications such as somatostatin and octreotide may be used to manage the lymphatic fluid. If medical management fails, surgical intervention may be needed. Treatment should focus on the sequelae, which includes malnutrition, electrolyte imbalances, respiratory compromise, and immunodeficiency. Understanding the pathophysiology of chylothorax following cardiac surgery, and the sequelae will help nurses effectively care for these patients.