Techniques of Securing Surgical Drain to Skin (Drain Fixation)

Choice of Suture: Non-absorbable (braided suture provides slightly superior grip on tubing than monofilament sutures)

Technique 1:

1. Create a series of knots around the drain.
2. The long end of the thread (attached to the needle) is passed through the skin directly next to the drain exit site, to create a loop, which is closed using a classic surgical knot.

Further reading: Mura S, Guarneri GF, Parodi PC. A modified technique for securing drains to the skin. JPRAS Open. 2018 Jun 23;17:21-23. doi: 10.1016/j.jpra.2018.06.002. PMID: 32158827; PMCID: PMC7061563.

Technique 2: Roman Gaiter Fixation Technique

1. Tie suture to the skin, leaving both tails long.
2. Wind each end around the tube once and tie again.
3. Assistant should hold the tube upwards.
4. Threads are wound around tubing, advancing along its length, ~1 mm with each wrap.
5. A single throw is placed each time the threads cross (i.e. at each turn).
6. Each throw should be tight enough to indent the tubing.
7. The tubing should be forced into a slightly tortuous shape; otherwise it is unlikely to have a firm enough grip and liable to slip.

Technique 3: Locking-Turns technique

1. Tie a suture to skin, leaving a tail (which will be used later to tie the knot).
2. Create multiple locking loops on tube using the needled-end.
3. Loops are drawn tight until the tubing is slightly waisted.
4. Live (Needle) end is now tied to the other, previously unused, tail of the original skin knot to anchor.

Further reading: Partridge, R., & Sabharwal, A. J. (2013). A31 Drains and Drain Fixation Techniques. Basic Techniques in Pediatric Surgery, 107–109. doi:10.1007/978-3-642-20641-2_31