title: How to secure the connection between thoracostomy tube and drainage system?
abstract: BACKGROUND
  Thoracostomy tube insertion is one of the common bedside procedures in emergency medicine and many acute specialties. Dislodgement of thoracostomy tube from the connection tube of chest drainage system is an important problem with potential complications such as contamination, infection and pneumothorax. Besides, mere loosening can also lead to malfunction. It is a common practice to tape the connection of the system. This study aimed to evaluate the materials and methods of connection of chest drain system to minimize drainage dislodgement.
  
  
  METHODS
  We conducted an experimental study to assess the tightness of the connection with various taping materials and methods. We selected three commonly used adhesive materials (3M™ Transpore™ Medical tape, 3M™ Micropore™ Medical tape, 3M™ Soft Cloth Tape on Liner) and three different methods (cross method, straight method, nylon band) to secure the junction between the thoracostomy tube and the bi-conical adaptor in the drainage system. The measured outcome was the weight causing visible loosening of the junction between thoracotomy tube and the adaptor.
  
  
  RESULTS
  For each taping material and taping method, 10 trials were performed. The median weight required to disconnect the junction is 26.22 lb for Transpore™, 31.29 lb for Micropore™ and 32.44 lb for Soft Cloth Tape on Liner. A smaller force was required to disconnect if Transpore™ is used (P<0.001). There was no statistical significant difference between Micropore™ and Soft Cloth Tape on Liner (P=0.98). The median disconnecting force is 32.44 lb for straight taping method, 40.55 lb for cross taping method and 21.15 lb for plastic band. The cross-taping method was the more secure method (P<0.0001 when compared with plastic band) (P=0.033 when compared with straight method).
  
  
  CONCLUSIONS
  Cross-taping is the most secure method among the tested varieties in connecting the thoracostomy tube to the chest drainage system. Transpore™ is not a recommended material for thoracostomy tube taping.
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.
authors.forename: Ka Ki Pat
authors.initials: KK
authors.lastname: Li
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.
authors.forename: Kit Shing John
authors.initials: KS
authors.lastname: Wong
authors.affiliation: Department of Accident and Emergency Medicine, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.
authors.forename: Yau Hang Henry
authors.initials: YH
authors.lastname: Wong
authors.affiliation: Clinical Skills Training Centre, Tuen Mun Hospital, Tuen Mun, Hong Kong, China.
authors.forename: Ka Lok
authors.initials: KL
authors.lastname: Cheng
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.
authors.forename: Fung Ling
authors.initials: FL
authors.lastname: So
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.
authors.forename: Chu Leung
authors.initials: CL
authors.lastname: Lau
authors.affiliation: Department of Accident and Emergency Medicine, Pok Oi Hospital, Au Tau, Yuen Long, Hong Kong, China.
authors.forename: Chak Wah
authors.initials: CW
authors.lastname: Kam
keywords: Cross-taping; Drainage system; Thoracostomy tube