The modified 'Jo'burg' technique for securing intercostal chest drains

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Medical Device Fixation

Background:

• Intercostal chest drain (ICD) insertion is crucial for thoracic trauma but has a high complication rate (approx. 20%).
• Inadequate fixation leading to dislodgement accounts for 7% of ICD complications, especially during casualty movement in military settings.
• Current ICD securing methods lack standardization within the Defence Medical Services (DMS).

Purpose of the Study:

• To propose a modified, robust, and easily teachable technique for securing ICDs.
• To present pilot validation results of this technique among trauma surgical skills course candidates.
• To advocate for the standardization of this ICD securing technique across the DMS.

Main Methods:

• A modified, tried-and-tested technique for securing ICDs was developed, including alternative steps for those unfamiliar with surgical knot tying.
• A pilot validation study was conducted with candidates on a trauma surgical skills course.
• The technique's robustness, teachability, and reproducibility were assessed.

Main Results:

• The proposed technique was demonstrated to be robust, easily teachable, and reproducible.
• Pilot study participants successfully learned and applied the technique.
• The technique offers a standardized approach to ICD fixation, potentially reducing dislodgement.

Conclusions:

• A standardized, easily teachable technique for securing intercostal chest drains has been developed and validated.
• This technique should be adopted across the Defence Medical Services to improve patient safety and reduce complications.
• Implementation via military trauma courses can ensure widespread adoption among medical personnel.