Br. J. Surg. Vol. 63 (1976) 141-142
Self-retaining chest drainage tubes L A U R E N C E F. T I N C K L E R * SUMMARY
A self-retaining chest drainage tube together with a special introducing trocar and cannula is described. The tube has been designed to overcome the disadvantages of existing conventional chest drainage tubes.
THE conventional method of draining the thoracic cavity for the treatment of empyema and pneumothorax and following chest operations is to insert tubes of either rubber or plastic in the pleural cavity via an intercostal space. Lacking any means of self-retention, the tubes are then held in position by means of a skin stitch or by being strapped to the chest wall. Both of these methods have their disadvantages. First, a skin stitch grasps the tube poorly, especially if the tube is made of plastic; secondly, such a stitch pulls on the patient’s skin and causes discomfort ; thirdly, strapping may cause a skin rash in sensitive patients, and, fourthly, strapping may become soiled and unstuck. To overcome these disadvantages, a chest drainage tube which is self-retaining by means of an inflatable balloon has been designed, together with an instrument for inserting it into the chest. The tubes The tubes are made of plastic and are 26 Ch. in size for adult patients (a smaller, appropriately sized tube is in preparation for use in paediatric chest surgery).
xT Fig. 3. Diagram showing positions of drainage tubes in use.
Fig. 1. The drainage tube.
At present they are not radio-opaque. They have two channels: one with a valve to inflate a latex rubber balloon cuff (10 ml) and the other for drainage. The balloon by which the tube is retained in position, is sited 20cm from the tip, which is open-ended. Over all, the tube is 200 cm long, enabling it to be attached directly to an underwater seal bottle (or vacuum suction container) at the bedside, the coupling being secured by means of a short length of rubber tubing, which is part of the drainage tube, of sufficient wall thickness to prevent it collapsing or kinking, which would obstruct the lumen (Fig. 1). Fig. 2. The drainage tube together with the cannula and trocar.
* Maelor General Hospital, Wrexham, North Wales. 141
Laurence F. Tinckler Proximal to the balloon the tube has a movable rubber collar to prevent the tube slipping into the chest, which it otherwise might do as the patient moves. Having positioned the tube as required in the chest and inflated the retaining balloon, this rubber collar is manipulated along the tube until it comes into juxtaposition with the chest wall, thus preventing any possible piston effect.
The introducer The drainage tubes are inserted into the closed chest by means of a stainless steel trocar and cannula. The trocar, which is bayonet pointed, is 20cm overall including the handle, and the cannula 6 cm long. In the wall of the cannula there is a linear gap through which the tube is passed when the cannula is disengaged from it (Fig. 2). Technique A small starting skin incision is made with a scalpel at the appropriate site in an intercostal space, and the assembled trocar and cannula pushed through into the pleural cavity; the trocar is removed and a drainage tube passed down the cannula, which is then disengaged from the chest wall; the drainage tube is stripped out of the cannula through the gap in its side and the cannula is removed. The retaining balloon is inflated in the pleural cavity by injecting sterile water through the valve of the inflating channel. At the end of open chest surgery the drainage tube can be inserted via a scalpel stab incision without using the special trocar and cannula.
When the drainage tube is used as an apical drain for the evacuation of air from the pleural cavity, its full length is utilized, and when used as a basal drain for drainage of fluid such as blood, serum or pus the terminal portion beyond the balloon may be trimmed, according to the length required (Fig. 3). Lateral drainage ports, if required, may be cut into the tube by the surgeon before the tube is inserted. Removal of the tube is simply accomplished, causing no discomfort to the patient. Without disturbing the dressings the retaining balloon is deflated and the tube slid out of the chest; as the tube is being withdrawn, a Vaseline gauze or similar dressing is applied firmly over the drainage site to prevent ingress of air. As these tubes are long enough to couple directly to an underwater seal bottle, intermediate connection and extension tubing is dispensed with, making them more convenient to use. The possibility of the tubing being accidentally disconnected during transit or in the ward is minimized. These self-retaining chest drainage tubes and the special trocar and cannula are available from Down Bros and Mayer & Phelps Ltd, Church Path, Mitcham, Surrey.
Acknowledgements The special trocar and cannula have been developed with the generous cooperation of Mr R. Pickering of Polymathics Ltd, Tamworth, Staffs.