While it may seem to be a very simple thing, suturing a tube or drain in place is a very important technique. If done properly it can secure the positioning of the tube/drain in question, and prevent it from moving. If done incorrectly however, the sutured tube/drain may be susceptible to migration, and even may fall out of the patient. This page is dedicated to explaining one method of securely suturing a tube/drain in place so that it is secured to the patient, and will not be easily removed.
BEFORE YOU BEGIN
There are a few considerations to keep in mind before you start the process of suturing a tube in place.
This page assumes that the viewers know the basics of suturing. Make sure to review these on this page before reading on if more information on this topic is needed.
To suture a tube in place all that is needed are some:
- Suture material. Silk suture with a tapered needle is often used (often in a larger size such as 2-0)
- Needle drivers
Ideal positioning of the tube:
Make sure to have an idea of exactly how you (or the patient) would like the tube positioned after it is secured in place. This can dictate exactly how you suture the tube in place (shown more in the video below). Briefly, you would like to anchor the tube to the skin in such a way that the suture does not “fight against” the natural/desired resting place of the tube in question. Once the patient leaves, you do not want them have the weight of their tube constantly pulling agains their sutured skin.
HOW IT IS DONE
This video below shows one technique on how to suture a tube in place. The base principle is a simple one: an air knot is tied on the skin of the patient, and then the tube is secured to this airpot using a roman sandling technique of suturing. There are however some nuances to keep in mind that can make the difference between a tube that stays in place, and one that migrates.
- Make sure your initial knot on the skin of the patient is an air knot
- Make sure to tie a surgeons knot each time you start suturing around the tube
- Tie your knots around the tube tight enough to create an visible divot/impression in the tube (so as to ensure that the suture can not slide).
- Do not tie your knots so tight that the lumen of the tube is occluded (flush the tube at the end to ensure it is patent if you are concerned this may be an issue).
- Continue roman sandling around the tube 4 times, so that you have 4 separate knots along the length of the tube that are holding it in place. Feel free to do more if you feel the need to do so.
- Consider adding a second suture (with a second air knot on the skin) if want to further secure the tube in place
THE END RESULT
In the end you hopefully will have created a secure suture that runs along the length of the tube, and will keep it firmly in place. It is important to make sure that the suture can NOT slide along the length of the tube. If this is the case…the tube has not been properly sutured in place and can more easily be pulled out of place. Consider adding another suture to secure to the tube if you notice that your previous attempt has resulted in a tube that is free to slide through the suture knots that you have just placed.
ALTERNATIVE SUTURING TECHNIQUE: SUTURING TUBES IN PLACE WITH THE HALF-HITCH TECHNIQUE
While the above system is a very legitimate way to suture a tube in place, there is an alternative technique (called the half-hitch method) that is also a valid way to suture a tube in place. Watch the video below to learn this technique.
Page Updated: 03.24.2019