Tutorial

“ Surgical Drains”

Why use Drains ?
Haematoma Other Fluids (serous, chyle, pus, etc)

Drain…. Indications : Life saving measure : Tension pneumothorax . Therapeutic benefit : Chest drainage : haem\ pneumothorax , empyema . Thoracotomy , cardiothoracic procedure , oesophegeal resection and perforation . Drainage of abscess and infected cyst . Drainage gastrointestinal , biliary and pancreatic fistula . Drainage after extensive dissection and elevation of skin flaps . After operation for injury to solid organs and partial excision of these organs . After pancreatic necrosectomy .

DRAINS

What kind of drain you need and which size ?The drain should be :Soft to avoid tissue injury .Non-irritating . Firm….incompressible .Resistant to decomposition .Smooth for easy removal .

The Perfect Product

Greater tissue contact Inert material. Slides smoothly past any tissue Promotes ease of movement and deep breathing Minimal pain on removal Comes in various sizes

Drain material

Latex rubber ( red rubber)…soft , but excites a profound inflammatory reaction within 24 H. .Polyvinyl chloride (PVC) …less reactive and incompressible , however , tend to harden and splite with prolonged use, especially when in contact with bile .Silicon ( best drain material ) least reactive and the most pliable, and show no tendency to harden with prolonged use .

Drainage systems

Open ( static) drainage ;Penrose , multitubular ,corrugateClosed siphon drainage :Closed suction drainage :Low negative-pressure ( -100 to –150 mmHg ) e,g, Portovac , Reliavac .High negative-pressure ( -300 to –500 mmHg )e,g. Redivac , .Sump suction drainage : for irritant discharge .Underwater seal drainage .


Type of Drains
Suction Non - Suction Via wound Separate site

Principles of Drain Placement

Maximum area Minimal trauma (nerves, vessel repair ) Gravitational Patient comfort Ease of removal

Packs

Abscess cavity Infected wound Must contain an anti septic must be replaced frequently.

wicks

Fistulae. Discharging sinuses. Same principles of packs.

Corrugated rubber drain

Sheet drainage Simple insertion, care and removal . Not expensive. Tissue irritant.

Tube drain

Most effective method of drainage. Closed drainage.


Suction machines can be connected intermittently.

Problems with Drains

Obstruction Suction system Diameter vs Fluid Patient mobility Removal

Wound principles

Skin Placement

Suction Channels

Drain Length

Placement

Trochar removal

Fixation

Suction “Tip”

Suction adaption

Skin Closure

Drain “Organiser”

Patient issues Post Op