1. Securing chest drains

2. This technique requires separate sutures to secure the drain and to close the incision made for the drain. Since the needle will be handled a fresh suture should be used for this, not one with a needle that has already passed through patient tissue.

3. 1. Insert the chest drain (the gap between thumb and index finger represents the incision for the drain).

4. 2. Pass a loop (not quite in the centre of the suture – have the end with the needle slightly longer) behind the tube.

5. 3. Pass the free ends (one of which has the needle attached) through the loop TWICE. Then pull snug.

7. 4. Now pass the needle through the skin close to where the knot on the tube is (take a pretty decent bite of tissue – local anaesthetic first in conscious patient). In the photo below the suture passing under the middle and ring fingers represent the bite through the skin. Then knot the end with the needle and the free end (standard surgical knot)

9. Because of the qualities of the knot on the tube if tension is relaxed the drain can be moved (e.g. to withdraw slightly if the tube is too far in initially) but any traction on the tube will cause the knot to tighten.