Introduction and Objectives Dislodgement of intercostal chest drains (ICDs) is common, affecting up to 21% of ICDs.1 Why ICDs dislodge is not well understood. The optimum technique for securing ICDs has never been the subject of a randomised trial.
Current BTS guidelines recommend ‘0’ or ‘1’ sutures and caution against excessive adhesive dressings. Adhesive dressings are nevertheless widely used, sometimes instead of sutures. This study aims to identify the best technique for securing ICDs.
Methods A chest wall model was developed using 7mm medium-density fibreboard with one hole for a 12-French ICD and four smaller holes for sutures. Appropriately qualified doctors secured ICDs to the model with their usual sutures and technique. Some doctors who used small sutures repeated the experiment using larger sutures. The force required to remove the ICD from the model was measured with a Newton metre. A maximum force of 100N was applied, as ICDs snapped at forces over 110N. The force needed to detach ICDs fixed to the experimenter’s chest using adhesive dressings was also measured.
Results Using ‘1’ sutures, ICDs remained attached even at 100N ‘0’ sutures snapped at 86N ‘2/0’ sutures were most commonly used, but snapped at 57N ‘3/0’ and ‘4/0’ sutures were the least effective; the drain slipped at 25N and 20N respectively.
Individual doctors using the same technique with larger sutures (‘1’ or ‘0’ instead of ‘2/0’) attached ICDs more securely (92N vs 57N, p=0.03) though the number of sutures, technique and doctor’s experience had no effect. ICDs detached painlessly from Rocket© dressings at 47N. An improvised tegaderm© dressing was more secure but detached painfully from the skin at 73N (p=0.03). The force required didn’t diminish over 48 hours.
Conclusions ‘1’ sutures may be the best way to secure an ICD however the force required to pull sutures from the skin is unknown and knots may loosen over time. Using larger sutures improved ICD fixation. Adhesive dressings secure ICDs with similar strength to sutures and may represent an important alternative or adjunct, particularly in patients with fragile skin.
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