Drain Insertion
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A surgical drain is a tube used to remove
pus Pus is an exudate, typically white-yellow, yellow, or yellow-brown, formed at the site of inflammation during infections, regardless of cause. An accumulation of pus in an enclosed tissue space is known as an abscess, whereas a visible collect ...
,
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is com ...
or other fluids from a
wound A wound is any disruption of or damage to living tissue, such as skin, mucous membranes, or organs. Wounds can either be the sudden result of direct trauma (mechanical, thermal, chemical), or can develop slowly over time due to underlying diseas ...
, body cavity, or organ. They are commonly placed by
surgeon In medicine, a surgeon is a medical doctor who performs surgery. Even though there are different traditions in different times and places, a modern surgeon is a licensed physician and received the same medical training as physicians before spec ...
s or
interventional radiologist Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs both ...
s after procedures or some types of injuries, but they can also be used as an intervention for decompression. There are several types of drains, and selection of which to use often depends on the placement site and how long the drain is needed.


Use and Management

Drains help to remove contents, usually fluids, from inside the body. This is beneficial since fluid accumulation may cause distension and pressure, which can lead to pain. For example, nasogastric (NG) tubes inserted through the nose and into the stomach can help remove stomach contents for patients who have a blockage further along in their gastrointestinal tract. After surgery, drains can be placed to remove blood, lymph, or other fluids that accumulate in the wound bed. This helps to promote wound healing and allows healthcare providers to monitor the wound for any signs of internal infection or damage to surgically repaired structures. Drains may be classified as passive or active, open or closed, and external or internal. Passive drains rely on gravity or capillary action to remove fluid, whereas active drains rely on a suction/vacuum force, whether that be through connection to wall suction, a portable suction device, or a bulb that has been squeezed to create a vacuum. Open drains are commonly used for superficial wounds and drain into dressings or a stoma bag. Closed drains are tubes or other channel-like structures that are connected to a container, thereby creating a closed system. External drains go from inside the body to outside the body and can be seen, while internal drains are completely inside the body. An example of an internal drain is a ventriculo-peritoneal shunt, which is a tube that connects ventricles of the brain to the peritoneal cavity. This helps remove extra cerebrospinal fluid from the brain. 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. Drains will have protective dressings that will need to be changed daily/as needed. The routine use of drains for surgical procedures is diminishing as better radiological investigation and confidence in surgical technique have reduced their necessity. It is felt now that drains may hinder recovery by acting as an 'anchor' limiting mobility post surgery and the drain itself may allow infection into the wound. In certain situations their use is unavoidable.


Complications

Drains risk becoming occluded or clogged, resulting in retained fluid that can contribute to infection or other complications. Thus efforts must be made to maintain and assess patency (condition of being open) when they are in use. Once a drain becomes clogged or occluded, it should be removed, as it is no longer providing any benefit.


Types of drains

Surgical drains can be broadly classified into: *
Jackson-Pratt drain A Jackson-Pratt drain (also called a JP drain) is a Suction (medicine), closed-suction medical device that is commonly used as a drain (surgery), post-operative drain for collecting bodily fluids from surgical sites. The device consists of an in ...
– consists of a perforated round or flat tube connected to a negative pressure collection device. The collection device is typically a bulb with a drainage port which can be opened to remove fluid or air. After compressing the bulb to remove fluid or air, negative pressure is created as the bulb returns to its normal shape. * Blake drain – a round silicone tube with channels that carry fluid to a negative pressure collection device. Drainage is thought to be achieved by capillary action, allowing fluid to travel through the open grooves into a closed cross section, which contains the fluid and allows it to be suctioned through the tube. *
Penrose drain A Penrose drain is a soft, flexible rubber tube used as a surgical drain, to prevent the buildup of fluid in a surgical site. It belongs to the "passive" type of drain, the other broad type being "active". The Penrose drain is named after Ameri ...
– a soft rubber tube *
Negative pressure wound therapy Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess wound exudate and to promote healing in acute or chronic wounds and ...
– 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 Granulation is the process of forming grains or granules from a powdery or solid substance, producing a granular material. It is applied in several technological processes in the chemical and pharmaceutical industries. Typically, granulation inv ...
, often used for large surgical/trauma/non-healing wounds. * Redivac drain – a high negative pressure drain. Suction is applied through the drain to generate a vacuum and draw fluids into a bottle. *
Shirley drain The Shirley wound drain or sump drain is a suction Suction is the day-to-day term for the movement of gases or liquids along a pressure gradient with the implication that the movement occurs because the lower pressure pulls the gas or liquid ...
* Pigtail drain – has an exterior screw to release the internal "pigtail" before it can be removed * Davol *
Chest tube A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a drain (surgery), surgical drain that is inserted through the chest wall and into the pleural space or the Mediastinum. The insertion of the tube is som ...
– is a flexible plastic tube that is inserted through the chest wall and into the
pleural space The pleural cavity, or pleural space (or sometimes intrapleural space), is the potential space between the pulmonary pleurae, pleurae of the pleural sac that surrounds each lung. A small amount of serous fluid, serous pleural fluid is maintained ...
or
mediastinum The mediastinum (from ;: mediastina) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is a region that contains vital organs and structures within the thorax, mainly the heart and its vessels, the eso ...
* Wound manager


See also

*
Wound healing Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier again ...
*
Incision and drainage Incision and drainage (I&D), also known as clinical lancing, are minor surgical procedures to release pus or pressure built up under the skin, such as from an abscess, boil, or infected paranasal sinus. It is performed by treating the area wit ...
*
Instruments used in general surgery There are many different Surgery, surgical specialties, some of which require specific kinds of Surgical instrument, surgical instruments to perform. General surgery is a specialty focused on the abdomen; the Thyroid, thyroid gland; Disease, dis ...


References


External links

* {{Authority control Medical drains