Use of ‘Romodrain’ for intercostal drainage in infants

Sir,

I have been using the ‘Romodrain’ marketed by Romsons for intercostal drainage in infants as well as older children. I conducted a telephonic survey with 28 colleagues, who also use it for infants. I have noticed that there is a holdup of the draining fluid in the drainage tube, and hence the lung expansion is delayed. This was reported by 16 colleagues. This needed evacuation frequently by disconnection with the chest tube. As the fluid in the bag collected, and the level rose, the drainage was even slower.

The survey revealed that the diameter of the catheters commonly used for insertion into the chest, that is, suction catheter, trocar catheter, and Nelaton's catheter varied depending on the size of the intercostal space. The bag is hung at an average height of 20-50 cm below the level of the baby's chest by all colleagues.

In clinical practice when we compare an infant to an older child, or an adult, with anintercostal drain we have to accept that, in infants:

1. The involuntary respiratory effort during sleep, coughing, and sneezing is less. There is no voluntary effort and cooperation.

2. The expiratory pressure during sleep, sneezing, and coughing which forces the fluid (blood, air, or pus) out of the chest is much less in an infant; especially when it is ill or having a painful operation wound on the chest. It varies from patient to patient.

3. The flow rate, flow velocity of the draining fluid, and the expiratory pressure is variable at all times. During recovery as more and more fluid collects in the bag, the infant has to work under increased pressure to push the fluid out. The average rise in the fluid level in the bag for every 100 ml of fluid collected is 1.4 cm.

We will divide the intercostal drainage apparatus into four parts as follows:

1. Chest drainage tube (tube ‘A’).

2. Wide bore tube of the ‘Romodrain’(tube ‘B’).

3. Tube inside the bag (tube ‘C’).

4. Portion of tube under water/saline (tube ‘D’).

Applying the standard physical principles of ‘flow rate’, ‘flow velocity’,[1,2] and pressure under a fluid increases with the depth,[3] the following changes in the standard ‘Romodrain’ would ensure better drainage of chest fluid in infants:

1. Tube ‘A’ — A12 Fr‘Romsons‘Trocarcath’ is short (21 cm), and hence better than Nelaton's or suction catheter(> 40 cm)

2. Tube ‘B’ should be shortened to 45 cm (normal 105 cm) so that the bag can be hung about 15 cm from the level of the chest.

3. Length of Tube ‘D’ can be reduced by dipping it for 2 cm instead of the usual 4 cm as marked on the bag.