Surgical drains: types, management and removal
I must thank Dr Brenda McEvoy who suggested this topic and requested me to write about it since it is not very well taught at medical school and house officers (especially surgical) then struggle when they begin their work. This is only a snap-shot view of surgical drains and I have provided links for further detailed information at the end of the blog.
There are different types of drains used in different surgical procedures and each has a specific role. However, in general, the main role of any drain is to decompress a cavity or to prevent accumulation of fluid (blood/pus/urine/lymph/etc) or air. To give a few common specific examples:
- Breast surgery: to prevent collection of blood/lymph.
- Chest drain: to drain blood/fluid/air.
- Biliary surgery: to prevent collection of bile.
- Infected cysts: to drain pus and prevent its reaccumulation.
- Thyroid surgery: to prevent haematoma around airway.
TYPES OF DRAINS
There are various ways of classifying drains.
Open v/s closed:
- Open drains e.g. corrugated drains allow drainage onto a gauze pad or bag. However, there is a disadvantage of increased risk of infection.
- Closed drains e.g. Redivac drains are basically tubes connected to bottles/bags. The advantage is that it reduces the risk of infection because it is a closed system.
Active drains are those that have suction, which may either be high pressure or low pressure depending on the need.
Passive drains have no suction and allow natural drainage.
Rubber drains have generally phased out as they used to cause intense tissue reaction. Silastic drains are inert and have the advantage of less tissue reaction.
When the drain is inserted, it is usually brought out via a separate stab incision and is placed in the most dependent part. The drain has to be secured with a stitch, usually silk suture. Care has to first of all taken when patient is transferred from operating table to bed to ensure that the drain is not dislodged.
Once the patient is on the ward, the following steps need to be taken which ensure that complications are minimised:
- Label all drains to ensure that documentation can be appropriate, easy, consistent and accurate.
- Documentation should include amount (ml), colour and consistency. Any changes should be noted as well. In specific cases, for example, bilious and urinary drainage should be noted and acted upon.
- The output should be counted as a part of input-output balance.
- Ensure that post-operative instructions of operating surgeon are followed.
As a general rule, the surgeon would decide when to remove a drain and will have mentioned that in his/her operation notes. However, drains can be removed when the drainage has stopped or has considerable reduced. Sometimes, if the drain is in a cavity, then the drain may be gently withdrawn by about 2 cm everyday to allow the cavity to collapse and heal.
Ensure that the drain stitch is cut and removed before removing the drain!
Make sure that the patient is warned about slight discomfort before removing the drain. Have a sterile field and don sterile gloves. Grasp the drain near the skin and gently pull out the drain with a steady, sustained traction. Do not yank or keep tugging. If it is difficult to remove the drain, then stop & call for senior help.
Once the drain is removed, cover the site with sterile gauze dressing and continue to monitor the output.
I hope this snap-shot review about surgical drains is useful to you. For more information, you could visit http://www.patient.co.uk/doctor/Surgical-Drains-Indications-Management-and-Removal.htm and http://rn.modernmedicine.com/rnweb/Hands-On+Help/Surgical-drains/ArticleStandard/Article/detail/388216. These sites provide more evidence-based information about surgical drains.