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TECHNICAL SECTION
Ann R Coll Surg Engl 2010; 92: 353–356
354
ureteric stents, but is probably only suitable in women where the
distal coil is more readily accessible. In conclusion, this mini-
mally invasive technique appears safe and definitive.
References
1. Bultitude MF, Tiptaft RC, Glass JM, Dasgupta P. Management of encrusted
ureteral stents impacted in upper tract. Urology 2003; 62: 622–6.
2. Lam JS, Gupta M. Tips and tricks for the management of retained ureteral
stents. J Endourol 2002; 16: 733–41.
3. Canby-Hagino ED, Caballero RD, Harmon WJ. Intraluminal pneumatic lithotripsy
for the removal of encrusted urinary catheters. J Urol 1999; 162: 2058–60.
BACKGROUND
Seroma formation is a common complication of any surgery produc-
ing a significant dead space or causing disruption of the lymphatic
drainage. Traditionally, large seromas require multiple aspirations
using a 60-ml syringe with the contents dispensed into a kidney
bowl. This method can introduce infection, which is of particular sig-
nificance when the seroma cavity is associated with a biomedical
A closed vacuum drainage system for the
management of postoperative seromas
CHARLES J BAIN, SAMER SAOUR, PARI-NAZ MOHANNA
GKT Cancer Reconstruction Service, St Thomas’ Hospital,
London, UK
CORRESPONDENCE TO
Charles J Bain, GKT Cancer Reconstruction Service, St
Thomas’ Hospital, Westminster Bridge Road, London SE1
7EH, UK. E: bainage@hotmail.com
Figure 1 The lithoclast probe (white arrow) beside the nephrostomy tube
(black arrow).
Figure 2 Intraluminal insertion of lithoclast probe into nephrostomy tube.
Figure 3 The potential for the lithoclast probe to exit the nephrostomy
tube side holes (white arrow).
Figure 1 A white (14-G) needle is connected to a 3-way tap and the exten-
sion of the latter is attached to the suction tubing of a 600-ml Redovac®drain.
Figure 2 Aspiration of a large abdominal seroma using the closed vacu-
um drainage system.
TECHNICAL SECTION
Ann R Coll Surg Engl 2010; 92: 353–356 355
device such as an implant or mesh. In addition, multiple aspirations
can dislodge the needle causing pain and also increasing the likeli-
hood of exposure to bodily fluids. The use of a calibrated drainage
bag to maintain a closed system has been described previously.1We
have developed a closed drainage system which utilises the negative
pressure from a Redovac®drain (B. Braun, PO Box 1120, D-34209
Melsungen, Germany).
TECHNIQUE
Under aseptic conditions, a white (14-G) needle is connected to a 3-way
tap and the extension of the latter is attached to the suction tubing of a
600-ml Redovac®drain (Fig. 1). With the needle inserted into the most
dependent part of the seroma, the negative pressure of the Redovac®
drain is applied by releasing the clamp, resulting in rapid aspiration of
the collection (Fig. 2). The Redovac®bottle can be changed whilst main-
taining a closed system thereby avoiding fluid spillage.
DISCUSSION
We have described a safe, simple and efficient technique using a
closed vacuum drainage system for aspiration of large seromas.
This method allows rapid aspiration of large seroma volumes,
whilst reducing the possibility of introducing infection and the
spillage of bodily fluids.
Reference
1. Ashraf O, Donnelly PK. A safe closed seroma aspiration system. Ann R Coll
Surg Engl 2007; 88: 412.
BACKGROUND
Correct handling and manipulation of a needle is not only a basic sur-
gical skill and principle but it is also an important component of the-
atre etiquette as well as surgical safety. Scrub nurses are vital to safe
and successful surgery. The surgeon and the scrub nurse should have
a mutual respect for one another. It is the scrub nurse’s duty to hand
the surgeon the correct needle on the correct suture on the correct nee-
dle holder. Similarly, it is the surgeon’s responsibility to hand back the
needle and suture in a safe manner as demonstrated below. Junior sur-
gical trainees in particular would benefit from getting into good habits
early in their surgical careers.
TECHNIQUE
Traditionally, the suture is handed back to the scrub nurse as soon as
the final throw has been placed, the suture has been cut and the nee-
dle remounted. Often, little attention is paid to how the needle is
mounted when being handed back to the scrub nurse, which can
potentially cause needle-stick injuries.1–3 Needle-stick injuries are an
occupational hazard; however, they can be minimised by simple and
safe measures as shown below. This technique involves reverse
mounting the needle in the jaws of the needle holder thereby pre-
venting exposure of the sharp needle tip which could leave the sur-
geon, scrub nurse or patient’s skin prone to inadvertent injury.
DISCUSSION
This technique is now standard surgical practice for the first
author after the senior author introduced this concept when oper-
ating together. He had picked it up 20 years before from a New
Zealand cardiac surgeon. We advocate this simple and easily
Impressing the scrub nurse
Z AHMAD, RP COLE
Department of Plastic and Reconstructive Surgery, Salisbury
General Hospital, Salisbury, UK
CORRESPONDENCE TO
Z Ahmad, Department of Plastic & Reconstructive Surgery,
Salisbury General Hospital, Odstock Road, Salisbury SP2 8BJ, UK
E: zeeshan.ahmad@doctors.org.uk
Figure 1 The exposed sharp mounted on the needle holder as it is usually passed
from surgeon to scrub nurse.
Figure 2 The needle re-mounted with the tip securely locked in the jaws
of the needle holder together with the swage thereby making it impossible
to suffer a sharps injury from the tip.
