Abstract No. 255: The bumper stitch: A better way to secure tubes?

Abstract

Drainage tube dislodgement is a common complication of a commonly performed procedure. Dislodgement of drains secured using the traditional “air knot” technique (in which a suture in placed into the skin near the drain exit site and knotted, with the free ends of the knot wrapped around the tube and again tied to secure it) usually occurs due to suture erosion through the skin, requiring additional visits for resuturing or drain replacement. This technique also results in a moderate amount of “play” or to-and-fro motion in the tract. Biliary drains in particular are sensitive to subtle changes in position, because even minor side hole malposition may result in peri-catheter leakage or bleeding. In the “bumper stitch” technique, the suture is protected from erosion by a short piece of plastic tubing, and the knot securing the suture to the skin is inside the tube tract. Theoretically, the bumper stitch results in less “play” and is more resistant to skin erosion and subsequent tube dislodgement. We sought to establish baseline data regarding these two techniques in anticipation of a randomized trial. 61 patients presenting for drain change/removal were enrolled into this IRB-approved study. Data collected included tube type and diameter, suture type, skin status and “play” and were analyzed using Fisher's Exact test and the Wilcoxon rank sum test. 12 bumper stitches and 54 air knots were studied. All were 2-0 nylon material. There was no significant difference in the average days since placement (p = 0.23). In total, 3 tubes were dislodged (6%), 3 had skin ulceration (6%), and 1 had suture erosion (2%); all were secured by air knots. Data concerning tube dwell time, size and “play” are shown in the Table.Tabled 1TypeMean dwell (days)Mean (range) \“play\” (cm)% of tubes with any \“play\”Mean tube diameter (F)Bumper130.04 (0-0.3)1712Air knot220.47 (0-1.5)5912pNS0.0070.02NS Open table in a new tab The bumper stitch had significantly less “play” than the traditional air knot technique. Neither erosion nor dislodgement were observed with bumper stitches.