Canis ISSN: 2398-2942

Drain: surgical wounds

Synonym(s): Drain: active (tube)

Contributor(s): Dick White, Zoe Halfacree

Introduction

  • Temporary surgical implant.
  • Used as active or passive drain for removal of fluid and/or gases.

Uses

Assists wound healing

  • Eliminates potential tissue dead space (eg following tumor resection) which compromised vascular supply, phagocytic cell access and bacterial opsonization.

Provides exit route for accumulated fluid and gases

  • Serous exudate beneath a wound, eg pedicle skin flap Skin flap: pedicle.
  • Drainage of contaminated fluid following wound closure.
  • Drainage of septic exudate in septic peritonitis Peritonitis.
  • Irritant fluids, eg bile, urine, pancreatic secretions.
  • Restoration of negative intrathoracic pressure following thoracotomy Thorax: thoracotomy (intercostal).

Prophylaxis

  • Prevention of fluid accumulation in wounds.

Passive drainage

Active drainage

  • Used in conjunction with suction system.
  • Fluid or gas removed via internal lumen.
  • Intermittent suction, eg thoracocentesis Drainage: thorax.
  • Continuous low level suction, eg wound management :
    • Closed system.
    • Vacuum used - approximately 80 mmHg.
Greater pressures damage tissue and cause drain collapse and obstruction.

Suction systems

  • Compressible plastic containers:
    • Concertina or grenade shaped containers.
    • Simple and cheap.
    • Continuous, relatively even suction pressure for up to 24 h under aseptic conditions. 
    • Can be taped to ambulatory patient.
    • Silicon grenade drains (Jackson Pratt ) exert a continuous low level of negative pressure during filling and are most appropriate to use in wounds with proximity to delicate tissues (eg cervical tissue planes or peritoneal drainage).
  • Rigid pre-evacuated container:
    • Clear recording of volume drained.
    • Can be taped to ambulatory patient.
    • Some drains may exert higher than necessary pressure, extending drainage.
  • Syringe:
    • Simple and very cheap.
    • Combined with butterfly scalp needle: remove the needle and fenestrate the tube; insert into wound; connect syringe adaptor to syringe; apply suction and fix plunger at desired degree of withdrawal from syringe barrel.
  • Wall mounted or mobile suction generators:
    • Provide wide range of accurately controlled suction pressures.
    • Essential where large quantities of fluid or gas need rapid removal.
    • Can measure volume of fluid exiting wound.
    • Sophisticated negative pressure wound therapy devices can improve wound healing environment Wound: vacuum-assisted closure.

Advantages

Closed system

  • Uninterrupted flow of fluid from wound.
  • Wound can be covered with dry dressing.
  • Minimal bacterial contamination.
  • Can measure volume of fluid exiting wound.

Disadvantages

  • Greater rigidity causes more tissue irritation.
  • Single lumen tube drain less efficient than multiple lumen tube drain.
  • Not all active drains suitable for ambulatory patients, eg wall mounted or mobile suction generators.

Requirements

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Aftercare

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Outcomes

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Prognosis

  • Generally good if drain well monitored.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Roush J K (1990) Use and misuse of drains in surgical practice. Prob Vet Med (3), 482-493 PubMed.
  • Hampel N (1985) Principles of surgical drains and drainage. JAAHA 21 (1), 21-28 VetMedResource.


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