Intercostal chest drain clamping.

Sir,

Once the security measures have been taken, temporary clamping of an intercostal chest drain (ICD) is indicated during the change of the water seal unit and before removing the drain in patients with pneumothorax or pulmonary resection surgery. It is also used in other situations such as to prevent pulmonary re-expansion edema by draining a large amount of fluid or air, or as a hemostatic measure in the accidental bleeding caused by the ICD. Furthermore, clamping is very useful in the search for the site of an air leak at along the pleural drainage system and also for the intrapleural retaining of some fibrinolytic, antimicrobial, and sclerosing agents or normal saline solution, the latter for pleural lavage in cases of accidental hypothermia. The ICD clamping does not appear to have any adverse effect on patient safety when performed judiciously with appropriate supervision, just as is needed after removal of an ICD completely.[1] In the case of pneumothorax, the use of a clamp may allow the identification of possible complications related to an air leak but with the ability to solve the problem simply by unclamping the ICD instead of reinserting it. Conventionally, with the hospitalized patient, the clamping of an ICD is done with the help of forceps covered with rubber or simply by folding the ICD and securing it with some medical adhesive tape or ligation. Whatever the method used, it has not been given greater importance in the literature.

Depending on the case and the internal diameter of chest drain required, we use a personalized clamping technique with various disposable devices available in the hospital ward, with the aim of avoiding excessive manipulation with instruments that could damage or perforate an ICD. Standard intravenous infusion sets, enema, urinary or peritoneal dialysis bags, all of them have some clamping system that could be applied to an ICD [Figure 1]. Depending on the internal diameter of the ICD, we reserve the roller clamps of the intravenous infusion sets for 14–16 French (Fr) diameter drains, the slider clamps of the urinary bag outlet tube for 16–20 Fr drains, the on/off clamps used for enema bags in 20–28 Fr drains, and the clamp used in peritoneal dialysis bags for those >30 Fr. The patient does not necessarily have to be hospitalized, and occasionally, we use the clamping with any of them in ambulatory patients with malignant pleural effusion associated to pulmonary entrapment that merit pleural drainage more than twice a week by means of an indwelling catheter, only reserving drainage by thoracentesis for those with less symptomatic pleural effusions and with a periodicity of each one to 2 months.[2] The ICD usually used is a multipurpose one (Nelaton catheter) that due to its elastic characteristic can hardly be fragmented with any of these clamps; further, it is more comfortable for the patient and allows milking maneuvers.

Figure 1

Type of intercostal drain according to the required clamp: (a) clamp used in peritoneal dialysis bags; (b) on/off clamps used for enema bags; (c) slider clamps of a urinary collection bag; (d) roller clamps of intravenous infusion sets. It should be noted, some of these clamps have to be placed in the tube before insertion since if it were done later, the distal end of the tube, having a slightly larger caliber, would prevent it from being introduced through the clamp

Our environment is endemic to malignant pleural mesothelioma[34] which, associated with the high costs and the need for personnel training that involves the use of tunneled catheters and vacuum bottle drainages commercially available, has pushed us to the search for cheaper alternatives, safe, and easy to implement.

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Conflicts of interest

There are no conflicts of interest.