Reasons for using drains
• To remove unwanted fluid/exudates/gas o May serve as a breeding ground for infection or cause discomfort • To promote tissue apposition/Eliminate dead space o Facilitates cavity closure and wound healing and ↓ bleeding and exudates production. • To monitor leakage eg. Bile leak after biliary operations • To divert body fluids from a particular surgical site eg. T-tube in CBD operations • To facilitate subsequent access to a cavity eg. Irrigation of pancreatic bed after resection of pancreatic necrosis or abscess. • To allow injection of contrast for radiographic studies eg. T-tube cholangiogram
Prophylaxis vs therapy
• Therapeutic - Evacuate an existing collection • Prophylactic - Prevent the accumulation of fluid
Types of drains
• Open vs closed system
Open drains
o Penrose drain, Yeates drain, Corrugated drain o Advantages - Possibly less pain - Easier for patient as no container attached, therefore less bulky. o Disadvantages - ↑ infection secondary to migration of organisms
Closed system
o Suction vs Passive o Suction - Sump suction vs Closed suction o Closed passive drains - Pig-tail catheters, urinary catheter - Work by pressure gradient, gravity, capillary action o Closed suction drains - Bellovac drian, BLAKE® drain, Jackson-Pratt drain - Advantages • Effective evacuation of effluent even when pressure gradient may not otherwise favour the exit of effluent (eg. Negative pressure in pleural space) • Promotion of tissue apposition – less bleeding and seroma? • Suction force helps to keep drains clear from debris - Disadvantages • Can lead to tissue collapse around a drain and obstruct • Tissue erosion, especially if applied suction is high • May promote anastomotic leaks and retard healing of an existing fistula o Closed Sump suction - Salem sump drain (NGT) • Has a main drainage lumen and a smaller vent lumen • Advantages o Improved drainage due to air flow around the drain preventing surrounding tissues from collapsing into drain holes o ↓ risk of mechanical erosion of tissues • Disadvantages o ↑ risk of airborne bacteria entering via vent o Higher risk of mechanical trauma as these drains are usually larger and stiffer than most closed suction drains o ↓ patient mobility as attached to wall suction o Advantages § ↓ infection as it is a closed system § Less nursing time needed potentially if high output as don’t need to change dressings § ↓ risk of contaminating staff and other patients § Allow more accurate measurement of drainage output § Protect surrounding skin from irritating discharge
Complications
Immediate
o Pain/irritation
o Bleeding
o Perforation or injury to surrounding structures
Early
o Infection
o Occlusion
o Migration/Dislodgement
o Leaking
Late
o Fistula
o Pressure or suction necrosis
o Hernia