Vasudeva Lam
Havering & Redbridge University Hospitals NHS Trust, United Kingdom
Scientific Tracks Abstracts: Surgery Current Research
Background: Intercostal tube drainage (ICD) is life-saving intervention in general surgery and emergency practice, used for trauma, pneumothorax, haemothorax, and postoperative thoracic complications. Standard ICD requires an underwater seal drainage system, which serves as a one-way valveâ??allowing air or fluid to escape the pleural cavity while preventing re-entry, thereby supporting lung re-expansion. Problem Statement: In todayâ??s world, marked by wars, disasters, and healthcare inequalities, access to conventional ICD equipment may be severely limited. Even when trained personnel are available, doctors often face challenges due to lack of standardized systems, particularly in developing countries, underdeveloped regions, war zones, and mass casualty incidents. In such environments, improvisation with available hospital materials can bridge critical gaps in patient care. Emergency Principle: In acute emergencies, a needle thoracostomy can immediately convert a tension pneumothorax into a simple pneumothorax, providing life-saving decompression. This should be the first step before tube thoracostomy when resources are scarce. Objective: This presentation describes a simple, rapid, and cost-effective method of converting a standard urine drainage bag (urobag) into an underwater seal system. The aim is to provide a safe improvised option for short-term use, transport, or when conventional underwater seal systems are unavailable for hours. Technique: â?¢ A side opening is created in the urobag tubing.â?¢ The tubing is inserted into the collection pouch and secured with silk suture. â?¢ The bag is filled with sterile fluid to create a 2 cm water seal (critical to avoid excess intrathoracic burden). â?¢ The intercostal tube is then connected, providing effective pleural drainage. â?¢ The improvised urobag system can be assembled in 2â??3 minutes using readily available materials. Key Principles for Safe Use: â?¢ Water level: Must be maintained at 2 cm. Higher levels increase intrathoracic work to push air out and hinder lung expansion. â?¢ Positioning: The urobag system must always remain below the level of the patientâ??s chest. â?¢ Continuity: The tube tip must remain underwater at all times, including during transport. â?¢ Vent: The system must allow for air exit from the collection chamber to prevent pressure buildup. Discussion: This innovation is not a replacement for standard underwater seal systems in tertiary hospitals. Rather, it is a desperate measure for short term use, particularly in transportation from war zones, primary health centres, and under-resourced facilities to higher centres. Previous case reports and publications have described similar improvisations, but this method provides a clear, practical, and reproducible technique that addresses key safety considerations.Conclusion: The urobag conversion method is a practical, life-saving alternative in resource constrained environments. It underscores the importance of surgical knowledge, improvisation, and adaptability in global emergency care. While it should only be used in desperate situations, maintaining the 2 cm water seal principle and correct system positioning ensures its safe function.
Dr. Vasudeva Lam is a General Surgery Registrar at Barking, Havering & Redbridge University Hospitals NHS Trust, UK. He completed his MBBS at Andhra Medical College and MS General Surgery at Lady Hardinge Medical College, New Delhi. He holds MRCS (England), with ATLS and Acute Critical Care certifications. He has presented at national conferences, published case reports, and led quality improvement audits. His clinical interests include emergency, colorectal, and breast surgery, with a focus on innovative, low-cost surgical solutions and surgical education.
