Sumaya Mohd : Sumaya Mohd Surgical Drains Definition : A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains inserted after surgery do not result in faster wound healing or prevent infection but are sometimes necessary to drain body fluid which may accumulate and in itself become a focus of infection. Definition Slide 3: Drains may be hooked to wall suction,
a portable suction device,
or they may be left to drain naturally. Slide 4: Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for excessive bleeding. Depending on the amount of drainage, a patient may have the drain in place one day to weeks. Indication : Prophylactic
To remove excess blood and serum .
To remove pus, blood, serous exudates, chyle or bile .
To form a controlled fistula e.g. after common bile duct exploration Indication Indication : Therapeutic
1) To drain pus, blood, serous exudates, chyle or bile .
2) To drain air from the pleural cavity.
3) To drain ascites Classification Indication Slide 7: Signs of new infection or copious amounts of drainage should be reported immediately. Drains will have protective dressings that will need to be changed daily/as needed. classification : Closed system
Open system classification Types of drain : Jackson-Pratt drain -
Negative pressure wound therapy –
Pigtail drain - has an exterior screw to release the internal "pigtail" before it can be removed
Chest tube Types of drain Jackson-Pratt drain : Jackson-Pratt drain, JP drain, or Bulb drain, is a drainage device used to pull excess fluid from the body by constant suction.
The device consists of a flexible plastic bulb -- that connects to an internal plastic drainage tube. Jackson-Pratt drain Slide 11: The Jackson-Pratt drain used as negative pressure vacuum, which also collects fluid. As a low negative pressure suction system, it is designed so that intra abdominal contents such as the omentum or intestines are not sucked into the tube, minimizing the risk of bowel perforation or ischemia Continue Jackson drain : Removing the plug and squeezing the bulb removes air, which reduces air pressure within the drainage tubing. This is usually accomplished by folding the drain in half while it is uncapped, then while folded, recapping the drain. Continue Jackson drain A penrose drain : A Penrose drain is a surgical device placed in a wound to drain fluid. It consists of a soft rubber tube placed in a wound area, to prevent the build up of fluid. A penrose drain Negative pressure wound therapy : Negative pressure wound therapy - Involves the use of enclosed foam and a suction device attached; this is one of the newer types of wound healing/drain devices which promotes faster tissue granulation, often used for large surgical/trauma/non-healing wounds. Negative pressure wound therapy Removal of drains : A drain is removed as soon as it is no longer required. Hence it is necessary to know the purpose for which it was inserted and you should ascertain this from the surgeon at the time of operation. The following are general guidelines:
Drains put in to cover preoperative bleeding and hematoma formation, can come out after 24— 48 hours. Removal of drains Slide 16: Drains put in to cover serous collections can come out after 3—5 days.
Where a drain has been put in because the wound may later become infected, it should be left for 1-5 days. Continue… : Drains put in to cover intestinal anastomoses should not be removed until after 5—7 days.
A T-tube can be removed after 6— 10 days. Before this is done, a T-tube cholangiogram must be performed to make sure that there is distal patency in the common bile duct. Some surgeons clamp the T-tube for 24 hours before it is removed. Continue… Literature review : A Comparative Study of Closed-wound
Suction Drainage vs. No Drainage in Total
W. A. Hadden, FRCSEd, FRCSEd(Orth), and A. G. McFarlane, FRCS Literature review Slide 19: High-vacuum drains rival conventional underwater-seal drains after pediatric heart surgery☆
Andrew E.2004, Slide 20: Conclusions of the study : Redivac drains are as safe and effective as conventional drains in the pediatric setting, and resulted in a lower incidence of residual pleural effusions requiring drainage. Together with their ease of care, earlier mobilisation of patients and greater cost-effectiveness, the routine use of high-vacuum drains can be recommended following pediatric heart surgery. Thank you : Thank you