Construction of a low-cost,improvised,negative-pressure,closed tube surgical drain for low resource settings: A preliminary report

Sir,

Surgical practitioners in resource-limited environments, such as sub-Saharan Africa, have surmounted challenges of scarcity and cost through improvization. ¹ We have used negative-pressure, closed-tube surgical drains at our institution following thyroidectomies and mastectomies requiring drainage for twenty years. This drain has, however, to the best of our knowledge, not been previously described in the literature nor documented. The two-piece drain comprises a controllable drainage tube fashioned from a shortened and slit infusion giving set, and a closed 500 mL receptacle improvised from an empty, semi-rigid saline infusion bag. Serial folding of the bag results in a calculated maximum opening negative pressure of 15.4 kPa if there is no loss from the system. ² Costing 1.1 US$, the drain is a low-cost alternative and does not require sterilization by end users. Randomized controlled trials are ongoing to validate its bio-mechanical efficiency and to compare its complications relative to readymade negative-pressure drains.

The improvised drain is constructed using a sterile, unused intravenous fluid giving set and an empty, used, 500 ml collapsible plastic intravenous fluid container. First, the fluid giving set is shortened from the patient end leaving about a 30 cm length distal to the drip chamber incorporating the control valve. An even, 10–15 cm longitudinal slit is then made from the distal end long using stitch scissors. The slit end is the intra-wound portion. After positioning and securing the drain, an empty fluid bag is collapsed by serial folding from the base to produce a visual concertina-like effect and generate a negative pressure. The end of the fluid giving set with the drip chamber is inserted into the empty collapsed fluid bag to produce a closed, negative-pressure system.

The efficacy of the system may be limited by the quality of plastic saline bottles, leakage from the system, and the need to recharge it regularly to maintain pressure. It may not effectively deal with clots or fat globules. Simple, affordable, improvised technology is key to successful rural practice; however, bio-mechanical efficiency and cost effectiveness must be validated against standards. Drains are not a substitute for adequate haemostasis. ³ Preliminary results of a randomized control trial comparing the use of this drain with a standard ready-made closed tube drain in thyroidectomy suggests equivalent efficacy and significant savings in direct costs. A randomized control trial describing its use in draining mastectomy wounds is underway.