What type of suture can be used for securing an external surgical drain?

From the Guidelines

For securing an external surgical drain, a non-absorbable suture should be used to narrow the linear incision around the edge of the chest drain. When deciding on the type of suture, it is essential to consider the morbidity, mortality, and quality of life outcomes. According to the study by 1, the use of a non-absorbable suture is recommended to secure the drain in place. The following key points should be considered when securing an external surgical drain:

• The chest drain incision should be closed by a non-absorbable suture to prevent the drain from falling out.
• A stay suture can be placed through the skin and then criss-crossed up the drain to ensure it is not too tight or it can occlude a soft drain.
• Special dressings/fixation devices are available to hold small catheters and drains in place.
• Steristrips may be useful and a transparent adhesive dressing is often used to allow inspection of the drain site. It is crucial to ensure the suture is tight enough to hold the drain in place but not so tight that it compresses or occludes the drain lumen, as this can lead to complications and affect patient outcomes. The study by 1 provides guidance on securing the drain, but it is essential to prioritize the patient's morbidity, mortality, and quality of life when making decisions about drain fixation. In real-life clinical practice, it is vital to consider the potential risks and benefits of different suture types and techniques to ensure the best possible outcome for the patient. By using a non-absorbable suture and following proper fixation techniques, healthcare providers can minimize the risk of complications and improve patient outcomes. The use of a non-absorbable suture, such as nylon or silk, is a widely accepted practice in clinical medicine, and its effectiveness has been supported by various studies, including 1. Ultimately, the choice of suture type and fixation technique should be based on the individual patient's needs and the clinical context, with the goal of minimizing morbidity, mortality, and improving quality of life.

From the Research

Suture Types for Securing External Surgical Drains

• The type of suture that can be used for securing an external surgical drain is not explicitly stated in the provided studies, but several methods for securing drains are described 2, 3, 4, 5, 6.
• A study published in 2019 compared different methods of drain fixation, including suturing through the tubing versus around it, and found that manual traction was a reasonable first-line approach to address tethered drains 5.
• The study also found that the use of 4-0 vicryl suture resulted in no instances of drain retention, while 0 vicryl and 2-0 vicryl sutures had a 25% drain retention rate 5.
• Another study published in 2018 described a modified technique for securing drains to the skin, which involves tying knots that do not constrict the skin, thereby avoiding tissue damage or scarring 3.
• A technique for securing external ventricular drains to the scalp using hydrocolloid dressings and staples was also described, with a reported EVD pullout complication rate of 0.4% 6.

Drain Fixation Methods

• Several methods for securing drains are described in the provided studies, including:
  • Using knots made from two half-hitches to secure drain tubing 4
  • Suturing through the tubing versus around it 5
  • Using 4-0 vicryl suture to secure the drain 5
  • Fixing the drain between two hydrocolloid dressings and securing it with staples 6
  • Tying knots that do not constrict the skin to avoid tissue damage or scarring 3