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Modern medicine
Surgical drains
December 01,
By Sally Beattie, RN, MS, CNS, GNP
2006
If you plan on transferring to critical care or med/surg, you'll quickly learn that drains come
with the territory. In fact, postop patients who undergo orthopedic, cardiac, or general
surgery often come back from the OR with more than one. That's because drains serve a
necessary function postop: They promote healthy wound healing, prevent infection, and
reduce pain.
But don't be fooled. While drains are helpful, they're not innocuous. In this review, we'll
cover some of the most common postop drains and how to properly manage patients who
have them.
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Drains remove blood, serum, lymph, and other fluids that accumulate in the wound bed
after a procedure. If allowed to build, these fluids put pressure on the surgical site as well
as adjacent organs, vessels, and nerves. The decreased perfusion delays healing; the
increased pressure causes pain. In addition, a buildup of fluid serves as a breeding ground
for bacteria.
Fluid can be removed from a wound using either a passive or active surgical drain. Passive
drains rely on gravity to evacuate fluid, while active drains are attached to a vacuum device
or wall suction. A surgeon chooses a drain that both fits the operative site and can handle
the type and amount of drainage expected. For instance a T-tube is a fairly large passive
drain that's typically placed during a cholecystectomy to accommodate the 200 500 ml of
bile that's expected to accumulate in the early postop period.
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The Penrose is another passive drain. But it's usually placed to manage much smaller
amounts of drainage. That's good, because it's typically left open, meaning its free end,
which protrudes a mere inch above the skin, isn't usually attached to a bag or pouch to
collect the drainage. Instead, fluid from the wounds seeps out onto a gauze pad.
Active drains like the Jackson-Pratt (JP) and Hemovac always have a drainage collection
reservoir attached. Drains that have some type of pouch are often called closed systems.
Unlike the Penrose, which looks like a large limp straw, the tubing on a JP or Hemovac is a
little stiffer so that it won't flatten under the pressure exerted by suction. The tips of these
drains are fenestrated, meaning they have multiple holes to facilitate draining.
In any case, a drain may exit a wound through the suture line or from a small opening near
the incision.
Complications: Anticipate and limit them
The downside of a drain is that it can be painful going in and coming out. For that matter, it
can be painful just sitting in the wound. That's because the drain destroys nearby tissue
that it rubs up against. A drain also provides a pathway for bacteria to get into the wound.
In fact, the risk of infection from a drain rises significantly by the third or fourth day postop,
and so does the degree of mechanical damage to local tissue. To minimize these
problems, the surgeon will place a drain so that it reaches the skin by the shortest, safest
route. That way the drain exerts the least amount of pressure on adjacent tissue.
However, to be effective, a drain also has to reach the deepest, most dependent area of a
wound to adequately evacuate excess fluid. Unfortunately, the deeper a drain goes, the
greater the risk of complications.
And because the drain is foreign, the body quickly starts to wall it off by encasing it in
granulation tissue. This can hamper the drain's ability to function, so making sure that it's
patent is part of basic care.
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A systematic approach to drain care can limit complications and ensure the best outcome
for the patient. It helps to first label each drain with a number for easy identification, and
consistency in documentation. Note the location and type of fluid that ought to be draining
from each.
Next, you will need to monitor drainage for color, consistency, and quantity of drainage.
During the initial postop period, drainage tends to be sanguineous, which is dark red and
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If you're successful, cover the site with a dry, sterile dressing and document the outcome.
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Continue to record the type and amount of any ongoing drainage, which should be minimal
and stop within 24 hours. If a site
more than expected, it may be a sign that fluid is
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continuing to accumulate, and a new drain may have to be placed.
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Managing drains is an important part of the postop healing process. With your knowledge
and skill, you'll contribute to the best possible outcome.
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CEESS
1. Patton, R. M. (2006). Interventions for postoperative clients. In Ignatavicius, D. D. &
Workman, M. L. (Eds.). Medical-Surgical Nursing (5th ed), (pp. 346-347). St. Louis:
Elsevier/Saunders.
2. Pudner, R. (2005). Wound healing in the surgical patient. In Pudner, R. Nursing the
Surgical Patient (2nd ed.), (pp. 56 58). Edinburgh: Elsevier.
3. Makic, M. F. (2005). Dressing wounds with drains. In AACN Procedure Manual for
Critical Care (5th ed), (pp.1118 1122). St. Louis: Elsevier/Saunders.
4. Makic, M. F. (2005). Drain removal. In AACN Procedure Manual for Critical Care (5th
ed), (pp. 1123 1124). St. Louis: Elsevier/Saunders.
5. Ngo, Q. D., Lam, V. T., Deane, S. A. "Drowning in Drainage." 2004.
www.esechealth.com/drains/online.asp (8 Aug. 2006).
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