Surgical drains Flashcards
What are some indications of drains
help healing process by removing inflammatory mediators, bacteria, foreign material & necrotic tissue
relieve pressure that can impair perfusion & cause pain & thus reduce inflammation & morbidity
enable monitoring of potential complications
- e.g. measurement & sampling of fluid/gas within cavity that drain has been placed
elimination of dead space
removal of existing fluid/gas
prevention of accumulation of fluid/gas within wound
What is a surgical drain
implants that allow removal of fluid/gas from wound or body cavity
can be:
- open or closed
- passive or active
Describe passive drains
rely on gravity, body movement, pressure differentials or overflow to move fluid/gas
e.g. penrose drain
Describe penrose drains
Soft, tubular radiopaque latex
used in wounds after surgery where dead space is present or accumulation of fluid is anticipated
work by capillary action, gravity, overflow or fluctuations of pressure gradients caused by body movements
- fluid moves along external surface of drain, not through lumen
drainage efficiency is directly proportional to surface area of drain
common mistake is to create fenestrations, which decreases functional surface area & thus decreases efficiency of drain
Describe penrose drain placement
- drain placed in dead space
- passive drain should exit through single stab incision, away from primary incision, in most dependent portion of wound
- drain anchored with single interrupted suture
- drain should then be covered with sterile absorbent bandage
- change aseptically before strike-through is present
What mistake was made in this drain placement
2 stab incisions were made (dorsal & ventral) & the drain is exiting through both incisions
Increases risk for infection & decreases drain efficiency
gravity enables contaminants to move into the wound
What can happen if a penrose drain is placed without a bandage covering it?
egressing fluid can lead to skin irritation, excoriation & increases risk for ascending infection
uncovered drains are also accessible for patient to bite off, leaving buried portion within wound & requiring surgery to remove
bandages over drain also provide way to roughly estimate fluid production which helps clinician determine when to remove drain
Describe active drains
closed systems that collect fluid into a reservoir
- prevents saturation of bandage material
- decreases risk for ascending infection
- limits exposure of staff/other patients to contaminated fluid
apply artificial pressure gradient to pull fluid/gas from wound/body cavity
must be able to maintain patent lumen to function properly
e.g.:
- Jackson-Pratt drain (grenade drain)
- Thoracostomy (chest) drain
What is the purpose of negative pressure in active drains
increases efficiency of active over passive drains
enables placement of drain exit in any position
can remove fluid against gravity
can be used to collapse dead space
can be continuous or intermittent
- continuous optimises drain function & reduces amount of time drain is in place
- continuous also decreases opportunity for bacteria to proliferate in static fluid
How are active drains secured?
Finger trap stitch
Describe drain removal
timing is based on quantity of fluid & its cytologic appearance
removal involves cutting any sutures that were used to secure them & applying gentle traction
exit wound is often left open to heal via second intention
to prevent ascending infection, apply soft padded bandage for 3-5 days
What are the advantages of active drains over passive drains
decreased risk for ascending infection
ability to be used in areas that are difficult to bandage
decreased risk for skin excoriation
accurate assessment of volume of fluid being produced
easy collection of fluid for cytology or chemical analysis with less possibility of environmental contamination of fluid
ability to collapse dead space
