Thunderbolt Technique: Novel Hemostatic Technique for Hemorrhage Related to Venous Infusion Catheter Drains

1 Sir: F its usefulness, cheapness, and scarless healing, drainage with a venous infusion catheter1,2 is used worldwide with some modifications. In our institute, this kind of drain is routinely used during implant-based breast reconstruction on patients with low risk of hematomas. Our method of preparation is very simple: peeling off one side of the outer plastic cannula of a 16-gauge venous infusion catheter with a no. 15 scalpel blade (Fig. 1). Patients with hematomas have a high risk for infection during implant-based breast reconstruction. Even though drains are placed to prevent hematomas, sometimes this unfortunately leads to blood vessel puncture caused by insertion of the drain. Finding the damaged blood vessels and approaching them from the inside is very time consuming. With our modified drainage using a venous infusion catheter, it is easy to coagulate the bleeding point from the outside using the thunderbolt technique (Fig. 2). This novel technique is composed of 3 steps: first is the reinsertion of the inner needle into the middle of the outer plastic cannula; second is coagulation by touching the outer part of the inner needle with an active monopolar coagulation device; and finally, rotating the outer plastic cannula slowly while the monopolar coagulation device is in contact with the inner needle. Only 5–10 seconds are needed to perform this technique. With this technique, it is possible to coagulate the damaged vessels without missing. Adjusting the placement of the outer plastic cannula can prevent the epidermis from burning. In conclusion, for hemorrhage due to insertion of a drain made from a venous infusion catheter, the thunderbolt technique can easily and effectively achieve hemostasis by electrocoagulation from the outside.