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A simple technique for securing tubes
METHODS & TECHNIQUES tubes, securing, technique
A Simple Technique for Securing Tubes The brief task of inserting a tube, such as a central venous catheter or a chest tube, is usually followed by the longer task of ensuring that the tube will not be inadvertently pulled out. Various methods for securing tubes have been described, and yet these tubes continue to be pulled out with frustrating predictability. The author describes a technique for securing tubes which is simple, effective, requires no special equipment or assistance, and which is applicable to any flexible tube or catheter inserted at a site suitable for placement of an anchoring suture. After the anchoring suture is secured to the skin, an easily mastered knot is performed which, because it ~qll not slip when tightened, allows an indentation to be made in the tube. Once this indentation is further secured with a square knot, it will not allow the tube to slip through it. [Frank M: A simple technique for securing tubes. Arm Emerg Med 12:25-27, January 1983.]
Michael Frank, MD Akron, Ohio From the Department of Emergency Medicine, Akron City Hospital, Akron, Ohio. Address for reprints: Michael Frank, MD, Associate Director, ACH EMS, Akron City Hospital, 525 East Market Street, Akron, Ohio 44309.
INTRODUCTION Surgical lore has it that the use of many different techniques to resolve the same problem usually means that none is particularly effective. The existence of a multitude of techniques for securing chest tubes, central lines, and so forth attests to this fact.l-4 These various techniques represent a constant struggle against the Murphy's Law certainty that insures that all these tubes will be pulled out sooner or later. A simple technique for securing tubes has been developed. While its simplicity alone makes it useful, its true value lies in its remarkable effectiveness.
TECHNIQUE After the tube or catheter is inserted, secure a suture to the skin close to the point of entry (Figures ] and 2). The illustration shows the suture being secured just beyond the point of entry, but the technique works just as well if the securing suture is placed under the tube or on either side. Each end of the anchored suture is brought around the tube and looped back through itself {Figures 3 and 4). The two ends are then pulled in opposite directions, which tightens the loops in a selfqocking fashion, so that the tube will be indented by the loops {Figure 5). This indentation will remain even after tension on the two ends is relaxed (Figure 6), and this assures that the tube cannot be pulled free from the suture. Avoid pulling too tightly when using a tube that is relatively flexible compared to the strength of the suture, because the tube can be completely occluded. (Sailors will recognize the technique thus far as an unorthodox method of producing a clove hitch. As every good sailor knows, a clove hitch tightens under strain: the harder the boat pulls on the line, the tighter the rope gets around the anchorinz stmcture.I Once the suture has been pulled tightly around the tube or catheter and locked in place, three square throws are laid down and the suture ends are cut (Figure 6). There is no need for additional loops around the tube or for any more distantly placed knots and loops to secure the tube at a point further away from the point of entry. The needle end can be used to place a purse-string, if desired, after which the ends are cut long. When the tube is removed, the ends can be tightened and tied. 12:1 January 1983
Annals of Emergency Medicine
25/59
SECURING TUBES Frank
"l
4
J4 60/26
Annals of Emergency Medicine
12:1 January 1983
Fig. 1. A suture is placed near the point where the tube enters the skin. Fig. 2. The suture is tied securely with three square throws. Fig. 3. One end is brought around the tube and passed through its own loop. Fig. 4. The other end is passed around the tube from the opposite direction and through its own loop. Fig. 5. The two ends are pulled in opposite directions until the tube is L~dented by the pressure. Fig. 6. The indentation remains even after tension on the suture is relaxed. A securing k n o t of three square throws is placed. In 1973 Voitk 1 described a technique for securing tubes which also used indentation to assure fixation. That technique involved grasping a soft tube b e t w e e n two h e m o s t a t s ,
12:1 January 1983
Stretching it apart, and then tying a suture down on the stretched segment before releasing tension. When the stretched segment returns to its normal caliber, the suture rests in an indentation, assuring that the tube will not slip. But the technique requires at least two operators and can only be used on soft, pliable catheters. Small intravenous catheters might be crushed by the hemostats, and large, relatively inflexible chest tubes could not be easily stretched. Our technique has the advantage of simplicity and effectiveness. No unusual equipment is needed, it only takes a few minutes to master, and it is suitable for any flexible tube or catheter, regardless of gauge, material, or location, the only restriction being that the insertion site must allow for placement of an anchoring suture. Use of this technique would therefore be somewhat radical for securing a Foley bladder catheter or nasogastric tube,
Annals of Emergency Medicine
but is suitable for securing chest tubes, intravenous catheters, soft rubber tube drains, suprapubic catheters, gastrostomy feeding tubes, and so on. The method of suture fixation assures that the tube will not slip in the suture. The suture m a y break or the tube m a y be pulled hard enough to tear the suture from the skin, but the tube will not slip in the suture.
REFERENCES 1. Voitk A: Technique for the secure suture of rubber tubes. Surg Gynecol Obstet 137: 283-284, 1973. 2. Morgan MG, Glasser SP: Fixation of IV catheters. N EngI J Med 291:1309-1310, 1974. ,3. Adams JM, Rudolph AJ: Simple method for stabilizing umbilical catheters. Arch Dis Child 54:563, 1979. 4. Hrabovsky E, Gutierrez K: A new technique for catheter fixation in the infant. Surg Gynecol Obstet 149:897-898, 1979.
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A Simple Technique for Securing Tubes The brief task of inserting a tube, such as a central venous catheter or a chest tube, is usually followed by the longer task of ensuring that the tube will not be inadvertently pulled out. Various methods for securing tubes have been described, and yet these tubes continue to be pulled out with frustrating predictability. The author describes a technique for securing tubes which is simple, effective, requires no special equipment or assistance, and which is applicable to any flexible tube or catheter inserted at a site suitable for placement of an anchoring suture. After the anchoring suture is secured to the skin, an easily mastered knot is performed which, because it ~qll not slip when tightened, allows an indentation to be made in the tube. Once this indentation is further secured with a square knot, it will not allow the tube to slip through it. [Frank M: A simple technique for securing tubes. Arm Emerg Med 12:25-27, January 1983.]
Michael Frank, MD Akron, Ohio From the Department of Emergency Medicine, Akron City Hospital, Akron, Ohio. Address for reprints: Michael Frank, MD, Associate Director, ACH EMS, Akron City Hospital, 525 East Market Street, Akron, Ohio 44309.
INTRODUCTION Surgical lore has it that the use of many different techniques to resolve the same problem usually means that none is particularly effective. The existence of a multitude of techniques for securing chest tubes, central lines, and so forth attests to this fact.l-4 These various techniques represent a constant struggle against the Murphy's Law certainty that insures that all these tubes will be pulled out sooner or later. A simple technique for securing tubes has been developed. While its simplicity alone makes it useful, its true value lies in its remarkable effectiveness.
TECHNIQUE After the tube or catheter is inserted, secure a suture to the skin close to the point of entry (Figures ] and 2). The illustration shows the suture being secured just beyond the point of entry, but the technique works just as well if the securing suture is placed under the tube or on either side. Each end of the anchored suture is brought around the tube and looped back through itself {Figures 3 and 4). The two ends are then pulled in opposite directions, which tightens the loops in a selfqocking fashion, so that the tube will be indented by the loops {Figure 5). This indentation will remain even after tension on the two ends is relaxed (Figure 6), and this assures that the tube cannot be pulled free from the suture. Avoid pulling too tightly when using a tube that is relatively flexible compared to the strength of the suture, because the tube can be completely occluded. (Sailors will recognize the technique thus far as an unorthodox method of producing a clove hitch. As every good sailor knows, a clove hitch tightens under strain: the harder the boat pulls on the line, the tighter the rope gets around the anchorinz stmcture.I Once the suture has been pulled tightly around the tube or catheter and locked in place, three square throws are laid down and the suture ends are cut (Figure 6). There is no need for additional loops around the tube or for any more distantly placed knots and loops to secure the tube at a point further away from the point of entry. The needle end can be used to place a purse-string, if desired, after which the ends are cut long. When the tube is removed, the ends can be tightened and tied. 12:1 January 1983
Annals of Emergency Medicine
25/59
SECURING TUBES Frank
"l
4
J4 60/26
Annals of Emergency Medicine
12:1 January 1983
Fig. 1. A suture is placed near the point where the tube enters the skin. Fig. 2. The suture is tied securely with three square throws. Fig. 3. One end is brought around the tube and passed through its own loop. Fig. 4. The other end is passed around the tube from the opposite direction and through its own loop. Fig. 5. The two ends are pulled in opposite directions until the tube is L~dented by the pressure. Fig. 6. The indentation remains even after tension on the suture is relaxed. A securing k n o t of three square throws is placed. In 1973 Voitk 1 described a technique for securing tubes which also used indentation to assure fixation. That technique involved grasping a soft tube b e t w e e n two h e m o s t a t s ,
12:1 January 1983
Stretching it apart, and then tying a suture down on the stretched segment before releasing tension. When the stretched segment returns to its normal caliber, the suture rests in an indentation, assuring that the tube will not slip. But the technique requires at least two operators and can only be used on soft, pliable catheters. Small intravenous catheters might be crushed by the hemostats, and large, relatively inflexible chest tubes could not be easily stretched. Our technique has the advantage of simplicity and effectiveness. No unusual equipment is needed, it only takes a few minutes to master, and it is suitable for any flexible tube or catheter, regardless of gauge, material, or location, the only restriction being that the insertion site must allow for placement of an anchoring suture. Use of this technique would therefore be somewhat radical for securing a Foley bladder catheter or nasogastric tube,
Annals of Emergency Medicine
but is suitable for securing chest tubes, intravenous catheters, soft rubber tube drains, suprapubic catheters, gastrostomy feeding tubes, and so on. The method of suture fixation assures that the tube will not slip in the suture. The suture m a y break or the tube m a y be pulled hard enough to tear the suture from the skin, but the tube will not slip in the suture.
REFERENCES 1. Voitk A: Technique for the secure suture of rubber tubes. Surg Gynecol Obstet 137: 283-284, 1973. 2. Morgan MG, Glasser SP: Fixation of IV catheters. N EngI J Med 291:1309-1310, 1974. ,3. Adams JM, Rudolph AJ: Simple method for stabilizing umbilical catheters. Arch Dis Child 54:563, 1979. 4. Hrabovsky E, Gutierrez K: A new technique for catheter fixation in the infant. Surg Gynecol Obstet 149:897-898, 1979.
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