experience at LHRC

1. Management of drains
.

2. classification
drain
Open(penrose
drain)
Closed(Jackson-
pratt drain)
drain
Active(suction)
Passive(gravity,over
flow)

3. Types of drain
1.Jackson-pratt drain
2.Hemovac drain
3.Pigtail drain
4.Penrose drain
5.t-tube
6.Chest tube
7.Negative pressure wound therapy
8.RT/NJ/FJ
9.Urinary catheter

4. .
DRAIN
assessment
Volume content

5. Post operative care
DEPENDS ON THE TYPE,PURPOSE AND LOCATION OF THE DRAIN.
• SKIN AROUND THE WOUND MUST BE KEPT CLEAN,AND DRY TO PREVENT
INFECTION AND SKIN IRRITATION.
• METICULOUS SKIN CARE AND ASEPTIC TECHNIQUES MUST BE OBSERED
DURING APPLICATION AND CHANGE OF DRESSING OVER DRAIN.
• GAUZE DRESSING ARE USED AROUND AND OVER DRAINAGE TUBES.
• TO PROTECT THE TUBE
• ABSORB SOME AMOUNT OF DRAINAGE.
• ASSIST WITH THE STABILIZATION OF THE TUBES.
• PROTECT FROM EXTERNAL CONTAMINATION.
• AN ACCURATE MEASUREMENT AND RECORD KEEPING OF DRAINAGE
OUTPUT.
• DRAIN CONTAINER SHOULD BE EMPTIED AT LEAST ONCE A DAY.

6. When to remove…?
• ONCE THE DRAINAGE HAS STOPED.
• ITS OUT PUT HAS BECOME <20 ML/DAY.
• THE DRAIN HAS STOPPED SERVING THE DESIRED FUNCTION.

7. Inadvertent removal/drain dislodgement
1.if the drain suspected to have been moved,it should be secured and
inform the treating team
2.in the event a drain has been dislodged , sterile dressing/insert
smaller drain after informing the treating team
3.if drain suspected to have receded into the patient , imaging & the
treating team should be notified

8. Educate the patient
• Daily charting (if discharging with drain)
• Regarding content of drain(pus/blood/bile/PF)
• Take care when moving

9. Removal of drain in pancreatic surgery
• What is the drain fluid amylase(POD1,3,5,7,9..?.......low/high
• How much daily drain out put?
• What is the content?...PF/chylous/bile/haemorrhagic/purulent/ascites
• If PF grade >A,do not remove drain,can be discharged with drain, later on
down sizing drain and removal in follow up visits
• If content is haemorrhagic in drain (minimal or large
volume),immediately inform treating teammay require
CT/angio/exploration

10. Removal of drain in total gastrectomy
• What was the oral dye study(POD 5th)….?
• How much daily drain out put….?
• What is the
content….?purulent/ascites/chylous/haemorrhagic/PF/bile
• Oral diet started or not….?

11. Drain removal in LAR/ULAR
• Oral diet started or not…?
• What is the content..? …serous/ascetic/purulent/faecal/haemorrhagic
• How much volume..?

12. Drain removal in post
cholecystectomy/HJ/hepatectomy
• What is the content…?bile/serous/haemorrhagic
• How much daily volume…?
• In post hepatectomy,if its high volume ascetic and c/s no
growthremove and stich drain site

14. Drain removal after esophagectomy
• Neck corrugated draindaily dressings,remove if dry on POD2/3
• Abdominal drain-look for volume/content—remove after oral diet
starting
• Chest drain—look for volume/content,
do fluid triglyceride to r/ o chylothorax if high volume
• If TG value >110,start MCT oil based feed
• During removal of ICD, take help of fellow colleague as purse string
suture require at the time of ICD removal.do check x ray also after
removal

15. Drain(romovac) removal in post incisional
hernioplasty
• How much Daily Drain out put in both suction bag…..?(if two
seprately placed)
• If mesh is there and still not able to temove drain due to
volumesend fluid for c/s to r/o infection
• Remove drain if <20cc/day on day 2/3/4

16. For ascitic high drain output
• Start Diuretics low dose and increase dose if require
• If low s.albumin causing high ascitic drain out put,then iv h.albumin
/oral high protein supplement
• Do drain fluid c/s to r/o infectionremove drain if no growth

17. Post removal
• Monitor the site (for bleeding/discharge)
• Put stoma bag if more soakage
• If its ascetic fluid and send for c/s  close the drain site if no
growth.

18. For urinary catheter removal
• In LAR/ULAR may require for 6/7 days , see the operative notes for
any bladder repair before removing.do not clamp it if any bladder
suture have taken during surgery
• In AR/hemicolectomy early removal if possible , no need to even
clamp it.
• If delayed removal  better to clamp and remove it on sensation

19. For rectal catheter removal
• When placed for LAR/ULAR4/5th day ,if stool + ,inform operating
team

20. For Ryle’s tube removal
• In total or extended gastrectomy,do not remove till oral dye
study(pod5th)
• In post Whipple’ssee volume,usually 4th /5th day removal
• If Ryle’s accidently dislodged early ,DO NOT put it back in case of
esophagectomy /gastrectomy patient
• If colostomy closure/left hemicolectomyremove 1st POD after
informing operating team

21. conclusions
THE ESSENTIAL QUESTIONS A SURGEON NEEDS TO ANSWER WHEN DECIDING ON
THE VALUE OF SURGICAL DRAINS ARE..
• WHAT PURPOSE WOULD A DRAIN SERVE IF PLACED?
• WHAT TYPE OF DRAIN SHOULD BE USED?
• HOW LONG SHOULD THE DRAIN BE LEFT IN PLACE?
ONCE THESE QUESTIONS ARE CAREFULLY AND ADEQUATELY ANSWERED EACH TIME
A DRAIN IS USED, THE EFFECTIVENESS AND ADVANTAGE CAN BE MAXIMIZED WITH
MINIMAL PROBLEMS.