The end for the ‘Roman Sandal’: an observational study of methods of securing chest drains in a deployed military setting

Abstract

There is ongoing debate regarding the optimal method of securing chest drains in trauma patients. Various courses describe methods for chest drain insertion, but little has been published to identify the best method to secure the drain. This article aims to examine differences in approach to securing chest drains and the security of the methods used. Whilst in a deployed medical treatment facility, 26 clinicians from various specialties and nationalities were asked to secure a pre-placed drain. A 32F drain was placed in a manikin and the clinicians were given a chance to prepare their equipment. They were given a choice of suture and their attempts were observed by one of the researchers. The attempts were timed and photographed. A second researcher, who had not observed the technique, then assessed the security of the drain. 15/26 clinicians used a 'Roman Sandal' technique with 5/26 proving to be insecure. Other techniques used showed no failure. The rate of consultant-secured failure was 12.5% compared to 40% for registrars and 33% for General Duties Medical Officers. The type of suture used made no difference, but the traditional 'Roman Sandal' method was insecure. Knots tied close to the skin and those that bit into the drain were shown to be most effective.