Suture Techniques in Securing Percutaneous Drains in Interventional Radiology: Review and Pictorial Essay

Monday, March 31, 2025

4:50 PM – 4:55 PM CT

Location: Music City Center, 204

Abstract Presenter(s)

Manisha Naganatanahalli, MD

Medical Student
Case Western Reserve University School of Medicine, United States

Author/Co-author(s)

Edwin F. Chou, MD

Fellow Physician
Cleveland Clinic Foundation, United States
AK

Annabelle Kwok

Lake Highland Preparatory School, United States
KB

Kunaal Bafna, MD

Resident Physician
Johns Hopkins University School of Medicine, United States
Charles Martin, III, MD, FSIR, MBA (he/him/his)

Staff Physician
Cleveland Clinic Foundation, United States
GL

Gray R. Lyons, MD

Attending
Johns Hopkins Medicine, United States
Justin J. Guan, MD

Associate Staff Physician
Cleveland Clinic, United States

Learning Objectives:

List the most used suture options in IR and discuss how their material characteristics influence suture selection when securing percutaneous drains.

Review basic suturing principles including 1) local anesthetic administration with buffering options, anesthetic pharmacokinetics/pharmacodynamics, 2) fundamental suturing techniques including placement of air-knot, tying surgeon’s and square knots using single-handed and two-handed techniques, and 3) biomechanical considerations in suturing

Describe the most common variations of suture securement techniques, including Roman Sandle, Purse-String, Half-Hitch, Reverse Stitch, Bumper Stitch, and Hub Suture, illustrating how each is performed via hand-drawn pictorial essay

Discuss the roles of each suture securement technique by comparing/contrasting their strengths/weaknesses.

Background: Percutaneous drain securement is a critical aspect of interventional radiology procedures, as drain dislodgement can result in a subtherapeutic drainage, repeat interventions, and in the worst-case scenarios cause complications such as bleeding or sepsis. IR trainees and even practicing staff are often uninformed about the various suture types and suture techniques available for drain securement. This education exhibit aims to discuss basic suture principles and present the most common drain securement suturing techniques, illustrating the suture steps via pictorial essay of hand-drawn images, contrasting the strengths and weaknesses of each technique, and discussing situations where each technique may be considered for best clinical outcomes.

Clinical Findings/Procedure Details:
1. General Suturing Principles

2. Securement Techniques: each with discussion of strengths/ weaknesses, situations of use, and hand-illustrated steps in tying

-Roman Sandle

-Half hitch technique

-Modified drain stitch

-Reverse Stitch

-Bumper stitch

-Hub suture

-Purse string and Z-stitch

3. Additional Considerations

4. Self-retaining mechanism inherent of drains and tubes.

5. Adhesive devices as adjunct stabilization options

Conclusion and/or Teaching Points: Percutaneous drains can be secured using various suture techniques. Practicing interventional radiologists may have different preferences, but understanding the techniques, strengths, and weaknesses of various suture securement methods is vital for situations where certain securement methods fail.