د.نشوان -سيمنارات واضافات

Surgical Drains:Indications, Types, & Principals of Use

Indications
The four indications for applying a surgical drain are: 1-To collapse surgical dead space in areas of redundant tissue (e.g., neck and axilla)2- To provide focused drainage of an abscess or grossly infected surgical site3- To provide early warning notice of a surgical leak (either bowel contents, secretions, urine, air, or blood)—the so called sentinel drain4- To control an established fistula leak

Drain Types

Open, Flat, Penrose Dependent on gravity and capillary action Drainage related to surface area Penrose - latex
AdvantagesAllow drainageHelp obliterate dead spaceSoft / malleable – less painfulDisadvantagesVery irritating Allow bacterial ingressCannot be connected to suctionGravity dependent

Drain Types

Tube Single lumen +/- side holes Silicone, polyvinyl chloride, red rubber
Advantages Drain from both within and outside of lumen Can be connected to suction Can be used with closed collection system Disadvantage Discomfort due to stiffness

Drain Types

Double lumenSump drains – open/open suctionDrainage of fluid via large lumenSump lumen – smaller and allows ingress of air AIR
AIR
FLUID
AdvantagesMore efficient than single lumenMaintain patency longer than single lumenDisadvantagesRisk of contamination of wound as environmental air drawn in – reduced with filter


Drain Types
Passive Active Continuous suction Intermittent suction

Passive Drains

PassiveDrain by means of pressure differentials, overflow, and gravityProvides a stent that keeps a draining tract / cloaca openAllow egress via a path of least resistanceFlat or with a lumenOpen or Closed – Closed preferred

Passive Drains

Passive closedAdvantagesAllow evaluation of volume and nature of fluidPrevent bacterial ascensionEliminate dead spaceHelp appose skin to wound bed – quicker wound healingDisadvantagesGravity dependent – affects location of drainDrain easily clogged

Active Drains

Vacuum pulls fluid / gas from the wound Closed to atmosphere = Closed suction Vacuum applied to a single lumen tube Not gravity dependent

Active Drains

Active Drains
AdvantagesKeep wound dry – efficient fluid removalCan be placed anywherePrevent bacterial ascensionHelp appose skin to wound bed – quicker wound healingAllows evaluation of volume and nature of fluidDisadvantagesHigh negative pressure may injure tissueDrain clogged by tissue

Principals of Ideal Use

Aseptic site preparation (clip, scrub, debride, lavage) Place to avoid anastomosis sites and major vessels Exit through separate stab incision, away from surgical incision Aseptic postoperative management (cover with sterile bandage, change before strike through, clean & dry cage)


Complications and Failure of Drains
Poor Drain Selection Poor Drain Placement Poor Post-operative Management

Complications and Failure of Drains

InfectionAscending bacterial invasionForeign body reactionDecreased local tissue resistanceBacterial hiding placesPoor placement – fluid accumulation, drain kinkedPoor postoperative management

Complications and Failure of Drains

Discomfort / PainThoracic Tubes – diameter too largeStiff tubingInefficient DrainageExiting in non-dependent locale (passive drains)Kinked tubeObstructedPoor drain selection – diameter too small to remove viscous fluid

Complications and Failure of Drains

Breakdown of anastomotic sites Erosion into hollow organs (firm drains) Incisional dehiscence / hernia Poor placement Premature Removal Accumulation of fluid Decreased Mobility DVT/PE Increased hospital stay