Title : Enhancing chest drain removal safety: The role of surgical knot-tying skills among nurses in a thoracic ward
Abstract:
Background: Limited evidence exists regarding the risk of air or fluid leakage following chest drain removal and the poten7al influence of knot-tying techniques. This study aims to evaluate the associa7on between surgical knot-tying methods and the incidence of air leaks or pneumothorax aKer chest drain removal.
Methods: This observa7onal study was conducted in a thoracic surgical ward between June and July 2022. Postopera7ve pa7ents with chest drains were recruited, excluding cases where drain sites had been closed using a purse-string suture. Only full-7me ward nurses were included. In the first cycle, standard prac7ce was observed. Prior to the second cycle, par7cipa7ng nurses received targeted training in surgical knot-tying techniques. A pre- and post-training survey assessed nurses’ confidence in their knot-tying abili7es. Drain sites were examined for air or fluid leakage at one- and four-hours post-removal. Chest X-ray reports, interpreted by radiologists, were used to assess for residual or increasing pneumothorax.
Results: In the first cycle, 12 pa7ents (mean age: 59.6 years) and 10 nurses were included. Prior to drain removal, 42% of pa7ents had residual pneumothorax. Post-removal imaging revealed persistent pneumothorax in 25% and increased pneumothorax in 17%. In the second cycle, involving 5 pa7ents (mean age: 62.8 years) and 5 nurses trained in surgical knot-tying, 60% had residual pneumothorax pre-removal, with no subsequent radiological worsening observed aKer drain removal.
Conclusion: Training nurses in surgical knot-tying techniques may reduce the incidence of post-removal air leaks and pneumothorax. Incorpora7ng transferable surgical skills into nursing prac7ce has the poten7al to enhance pa7ent safety in chest drain management within thoracic wards
