A simple, novel, cost-effective technique for the management of chest drains

BACKGROUND

Chest drain insertion is regular practice in cardiothoracic surgery; it also forms part of emergency medical care.^1,2 Effective fixation is essential following a time-sensitive emergency procedure.^1,3 Resulting complications are well known and, whilst there are many factors which contribute to the failure of chest drains,^2,4,5 no standard method to secure, identify, adjust and remove surgical drains has ever been described.⁴ We describe a novel technique using a braided device to address these issues in a series of 50 patients admitted to Great Ormond Street Hospital's Cardiothoracic Unit.

TECHNIQUE

The device was developed to secure size 16-Fr chest drains using a simple braided sleeve with anchoring points for suturing (Fig. 1). The sleeve is loaded on to the drain and pushed down to the skin surface and secured with sutures (Fig. 2). Adjustments and or removal can be performed easily by longitudinal compression of the device or by cutting the sutures (Fig. 3). In piloting, tape was recommended at the distal end of the device to prevent patient interference; however, in practice, this was deemed unnecessary. A barium thread, braided into the device, allows easy identification on X-ray (Fig. 4).

Figure 1.

Braided sleeve with anchoring points for suturing.

Figure 2.

Loading sleeve on to the drain, pushing down to the skin surface and securing with sutures.

Figure 3.

Adjustment.

Figure 4.

Barium thread, braided into the device, allows identification on X-ray.

DISCUSSION

This device managed simultaneously to save time and simplify the securement, identification, adjustment and removal of drains secured. Braidlock® (Biw Ltd, Unit 5 Churcham Business Park, Churcham, Gloucester GL2 8AX,UK) has now been developed further with the introduction of an adhesive back as well as Velcro strapping. This development has a wide application for all medical lines and is now in use in a variety of clinical settings.