What is the best way to secure a chest drain? A scoping review.

Abstract

Each year, around 30,000 intercostal chest drains (ICDs) are inserted in the UK, with complications like displacement being a common concern. Various fixation techniques have been proposed to secure ICDs, but there is no consensus on a gold standard. A scoping review was conducted to identify publications describing ICD fixation methods and frequency with which they become dislodged. Three databases were reviewed: MEDLINE from 1946 to 17th October 2024 through the Ovid^® website portal, PubMed^®, and the Cochrane Central Register of Controlled Trials (CENTRAL). Appropriate search terms and synonyms were applied with Boolean operators and from 5275 identified records 63 were included for review. Nine ICD fixation principles were identified to classify fixation methods: kinking; Poisson-effect ("Roman Sandal"); suture "through" the tube; tube fixation points (cuffs or wings); friction/adhesion (from ties or dressings); external coiling/locking/flattening; internal balloons; internal coiling (pigtails); subcutaneous tunnelling. Many fixation methods combined more than one principle. Although no definitive conclusions on the best fixation method can be drawn from this review, trends suggest that incorporating sutures or using combined techniques, such as sutures paired with dressings, cable ties or balloon catheters, may enhance ICD security. In laboratory conditions, the highest pull force was associated with the modified Jo'berg knot. Further robust studies are needed to compare the effectiveness of different fixation methods superior in terms of displacement rate, but also taking into account pain, skin integrity, wound leakage/infection, or ease of use.