Surgical Drains Flashcards
What actions do penrose drains rely on? (4)
- Capillary action
- Gravity
- Overflow
- Fluctuations in pressure of space
What wound is a penrose drain best suited for?
Smaller, superficial wounds with low to moderate exudate.
Where does the drainage occur with a penrose drain?
Along outside of tube
What ratio does a penrose drain provide?
High SA:Vol
Penrose drain:
A) Where does it exit?
B) Exit wound size?
C) Where does the proximal end of the drain lie?
D) How much of the drain should exit?
A) Dependent part of wound
B) exit hole slightly wider than circumference of drain
C) Deep tissues
D) 2-3 cm
How is a penrose drain secured?
To exit point with simple interrupted monofilament nylon
Why should a penrose drain not exit at both ends?
It precludes having the drain in the deep tissues and creates an entry point for bacteria
What is the exception to the rule that penrose drains shouldn’t exit both ends of wounds?
- inguinal
- axillary
(1 exit = acts as a 1 way valve)
Vaccuum drain:
= Where does the tube exit?
= is it dependent?
The tube exits the skin adjacent to the wound and does not have to be dependent.
Vacuum drain:
- Where is the fenestrated portion placed?
in the wound. It should be placed in the deepest part of the wound and can extend along the length of the wound.
How is a vacuum drain secured?
The tube is secured to the skin with a purse-string suture and Chinese fingertrap suture.
How is a vacuum created after placing the drain?
A compressible silicone grenade is attached to the tube. The grenade is squeezed to evacuate air then the vent hole is closed to establish a vacuum.
Penrose or vacuum:
This drain mechanism results in a higher risk of contamination
Penrose
Penrose or vacuum:
This drain mechanism results in a lower risk of excoriation
Vacuum
Penrose or vacuum:
This drain mechanism allows the volume of fluid produced to be quantified
Vacuum
Penrose or vacuum:
This drain mechanism results in negative pressure being created
Vacuum
What law describes laminar flow through a drain? What does this mean practically?
Poiseuille’s law
This means that doubling the diameter of the drain increases flow 16 times, and halving the length doubles the flow.
When should compressible grenades be emptied?
- every 6 hours
- When they fil to 20-30%
When is a peritoneal drain indicated?
Manage septic peritonitis
Why is a closed gravity dependent drain not effective for peritoneum?
Closed, gravity-dependent drainage is ineffective because of the creation of a vacuum that collapses the drain.
Sump-tube drainage overcomes the vacuum phenomenon but why should they not be used in peritoneal drainage?
Allows airborne bacterial access to the peritoneal cavity.
What drain should be used for peritoneal drainage?
Closed-suction drainage with the previously described Jackson Pratt fenestrated drains and silicone grenades provides effective peritoneal drainage. Multiple drains can be placed evenly throughout the abdominal cavity, exiting lateral to the linea alba.
What may occlude peritoneal drains?
Omentum
Where is the skin incision for a thoracotomy tube?
A skin incision is made over the dorsal tenth or eleventh intercostal space.
Where is a thoractomoy tube tunneled and therefore inserted?
7-8 intercostal
What does the tunnelling for chest drain reduce?
Tunnelling offsets the skin and pleural entry points, creating a flap valve that limits entry of air into the pleural space along the drain.
How to secure a chest drain?
Chinese finger trap
When is intermittent chest drainage used?
Non-life-threatening fluid or air accumulation and for post-operative monitoring.
When is continuous chest drainage used?
For evacuation of fluid or air from the chest.
What are the 3 chambers for in continuous chest drainage?
- Bottle one is the collection chamber; this collects fluid from the thoracic cavity.
- Bottle two is the water seal. Air leakage from the pleural space is detected as bubbles.
- Bottle three is the suction control. The water height in this chamber dictates the negative pressure in cmH20 (usually set between 5-20).
With the 3 chamber continuous chest drain; How is the amount of negative pressure applied measured?
The difference between the height of water in the chamber three and two.
True or false?
Passive drains must be dependent; active drains to not need to be.
True
True or False?
The proximal end of the drain should be placed in the deepest part of the cavity to be drained.
True
How to minimise contamination of the wound by external flora when placing a drain?
Place inside to out
How to create exit incision for drain?
After tunneling with forceps; stab incision made at exit
True or False
The exit hole in the skin should be the same width as an active suction drain and slightly narrower than a passive drain.
False :
The exit hole in the skin should be the same width as an active suction drain and slightly wider than a passive drain.
Post placement
How to reduce the risk of ascending infection and to absorb exudate from the drain.
Exit site covered with a dressing
When to remove a drain?
should be removed as soon as possible. All drains induce fluid production (2 ml/kg/day), so zero fluid is unlikely.
How to remove a drain/what to do with exit hole?
Drains should be removed in a single smooth motion after removal of any anchoring sutures. The exit hole is left to heal by second intention.
Possible complications of a drain? (4)
Infection
Tumour seeding
Vessel erosion
Seroma
Is the following complication found with passive or vacuum drains?
Poor positioning
Passive
Is the following complication found with passive or vacuum drains?
Blockage
Vacuum
Is the following complication found with passive or vacuum drains?
Retrograde contamination
Both
Is the following complication found with passive or vacuum drains?
Loss of negative pressure
Vacuum
Is the following complication found with passive or vacuum drains?
Dislodgement
Both
How to reduce drain complications? (4)
- using the smallest effective drain size.
- using a flexible drain.
- using a closed drain.
- removing the drain as soon as it is safe to do so.
