Trauma Tip: How to secure your intercostal catheter to the patient

I frequently get asked about the best way to secure a chest tube once it’s inserted.

So here’s a video demonstrating how I do it.

httpv://www.youtube.com/watch?v=v2y-g0RAImw

In summary:

  • Thick (1/0 or 2/0) silk sutures grip the tube better and are easier to tie, but as they are braided carry a theoretical increased wound infection risk, whereas nylon suture material is slippery and won’t grip the tube as well, but have a lower infection risk. I use silk.
  • Don’t use the old “roman sandal” winding of the suture material along the tube, instead wrap your sutures around the tube multiple times, close to the skin. This will prevent the tube sliding in & out of the wound, (which carries bacteria into the chest and is associated with increased empyema rates).
  • You can place a small square (5cm) of non-stick dressing (like “Melolin) or a gauze, with a cut into the centre, around the tube, under your adhesive dressing.
  • Use a see-through adhesive dressing, so you can see if there is any major blood or air leakage at the site, and you can tell if the tube insertion depth has changed.
  • Use sleek tape in a “mesentery” to secure the tube to the patient’s chest wall.

 

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