Felis ISSN 2398-2950

Drain: surgical wounds

Contributor(s): Andrew Gardiner, Joseph Harari, 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 compromises 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 graft: 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 systems.
  • Fluid or gas removed via internal lumen.
  • Continuous low level suction, eg wound management:
    • Closed system.
    • Vacuum used - approximately 80 mmHg.
  •  ​Greater pressures damage tissue and cause drain obstruction
  • Intermittent suction, eg thoracocentesis Drainage: thorax.

Suction systems

  • Compressible plastic containers:
    • Concertina or grenade shaped containers.
    • Simple and cheap.
    • Continuous, relatively even suction pressure for up to 24 hours 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 cerival tissue planes or peritoneal drainage Peritoneal drainage technique.
  • 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.

Aftercare

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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 L (1985) Principles of surgical drains and drainage. JAAHA 21 (1), 21-28 VetMedResource.


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