Drains in Surgery Flashcards
Discuss drainage
Drainage can be established operatively by channeling the contents of internal organs externally (e.g ileostomy, colostomy) or by diverting the visceral contents internally (e.g cholecysto-jejunostomy)
Drainage can be established mechanically by means of a drain, which is a device used to direct the effluent/contents from a body cavity to another cavity or to the exterior.
What is a drain?
A drain can also be said to be a created channel which allows any fluid collected in a surgical wound, to come out after closure of the main wound.
An appliance or piece of material that acts as a channel for the escape (or exit) of gases, fluids or other matter from a cavity, wound, infected area or focus of suppuration.
What are the qualities of an ideal drain?
Must not be too rigid as to damage viscera
Must not be too soft as to kink or block
Should be made of non-irritant material
Should be wide enough for the expected effluent.
Should remain patent and left in situ for an adequate period until drainage is minimal.
Should be non-degradable.
Should be non-allergenic.
What is the classification of drain?
Location: Internal / External
Time: Temporary / Permanent
Mode of placement: Surgical / Non-Surgical
Exposure : Closed / Open
Pressure type : Passive / Active
Materials : Inert / irritant
Classification of drain systems?
What is an open (static) drain?
- OPEN (STATIC) DRAINS
- CLOSED SIPHON DRAIN
- CLOSED SUCTION DRAIN
- SUMP SUCTION DRAIN
OPEN (STATIC) DRAINS: eg Corrugated drain, Penrose, Ragnall etc.
- Exteriorized either through the op-wound or a separate stab wound.
- Contributes significantly to wound infection and to general dissemination of bacteria, esp. MRSA.
What is a CLOSED SIPHON DRAIN?
- Tube drain is used, connected to a sterile bag with or without a one-way valve.
- Some Systems incorporate bacteriological filters
- Reduces Infection.
What is a CLOSED SIPHON DRAIN?
- Firm Polyethylene tubes connected to portable and disposable suction flasks.
- Low Pressure vacuum (-100 to -150mmHg) e.g. Portovac, Reliavac.
- High Pressure vacuum (-300 to -500mmHg) e.g. Redivac, Sterimed.
What is SUMP SUCTION DRAIN?
- The most efficient system of drainage.
- Suited for the collection of irritant discharges e.g. small bowel and pancreatic fistulae.
- Has a parallel air vent that prevents the adjacent soft tissues from being sucked into the lumen of the drain when –ve pressure is applied.
- Some incorporate bacterial filter in the air vent.
What is a UNDER WATER SEAL DRAIN?
- Essential for drainage of the pleural space
- Straight or angulated near the tip
- Made from PVC or Silicone
- Water seal prevents equation of atmospheric with intrathoracic pressure
What are the materials required for a drain?
Latex Rubber (irritant): Soft, exites profound infl. Rxn within 24hrs, which encases the drain and renders it ineffective.
PVC (semi-irritant): Less reactive, Firm and unyielding. Hardens and splits with prolonged use esp in contact with bile.
Silicon (inert): Best material.
Least reactive, Most pliable.
No tendency to harden with prolonged use
What are uses of a drain?
Removal of material foreign or harmful to a particular location, e.g. potential nidus for infection.
Obliteration of dead space.
Monitoring and prevention of operative complications e.g. delayed haemorrhage or anastomotic leak
Therapeutic value of fibrous tract after drain removal. e.g. T-tube track for retrieval of residual biliary stone.
What are the indications for drain?
Prophylactically: e.g. Thoracic surgery.
Therapeutically: To permit escape of material which has already accumulated.
Diagnostically: e.g. MCUG, T-Tube Cholangiogram.
Monitoring; urinary output.
What are the uses of drains by surgical specialties?
Neurosurgery; Shunts, etc
GIT surgery; Biliary, Pancreatic, bowel, etc
Ortho; Joint, etc
General surg; Mastectomy, Thyroidectomy, etc
ENT
How long is a female and male urethra?
F: 4cm
M: 14-20cm
What are the Types of Drains?
CORRUGATED RUBBER DRAIN.
- Drains by capillary action and gravity.
- Cheaper and Technically easier.
- Disadv; Soaking of dressing.
GAUZE PACKS & RIBBON GAUZE WICK
- Act by capillary action
- Soaked in EUSOL-Paraffin to prevent adhesions to raw surface.
TUBE DRAINS.
- Malecot, Foley’s catheter,
- Penrose soft latex rubber tubes,
- Multiple Perforated tubes.
Adv.
- Quantity of effluent can be measured.
- Can be retained for long time.
- No skin excoriation.
- Less Infection rate.
- Removal is easy.
- Dye can be injected.
CLOSED SUCTION TUBE DRAIN.
- In the abdomen, connected to bag.
- In the thorax, to underwater seal.
- Multiple holes to be ensured.
- Simple Closed, Suction or Vaccum.
Other Drain Types:
- Glove drain
- Twisted Nylon suture threads; e.g. after breast mass excision.
