Surgical Drains Flashcards
What are 3 indications for a surgical drain?
Dead space cannot be obliterated
Fluid accumulation likely
Infection
What is a disadvantage to putting in a surgical drain?
Increased risk of secondary infection
What are 3 ways to get rid of dead space?
Tacking suture
Drain
Compression bandage
T/F: Drains can exit through the incision line.
False. Drains should NEVER exit through the incision line
What can happen to the suture line if a drain lies directly under it?
Increased risk of dehissance
Why should you not use buried suture to tack a drain in place?
Makes drain more difficult to remove.
What are the 2 types of drains?
Passive
Active
How does a passive drain work?
Relies on gravity and capillary action to move fluid (surface area is important)
How does an active drain work?
Suction pulls fluid from the wound
What are 4 critical points of placing a passive drain?
Must exit dependent area of wound
Single exit is preferred (decreases risk of infection)
Exit site kept clean and dry (avoid tissue maceration)
Bandage to absorb fluid
What is a common type of passive drain?
Penrose drain
What is a Penrose drain?
Soft latex tubing that conforms well to the wound
Why can adding fenestrations to a drain decrease its effectiveness?
Reduces surface area
What is a cigarette drain?
A fenestrated penrose drain with gauze strip inside to give a wicking action.
What is the best way to maintain the position of a Penrose drain?
Percutaneous tacking suture
What must you remember when removing a double exit Penrose drain?
Put tension on the drain and cut below the exposed part, then pull remaining portion like with a single exit.
NOTE: Important because avoids dragging contaminated part of drain through the healed wound.
What are 5 benefits of an active drain?
Greater efficiency
Decreased risk of tissue maceration with drainage
Decreased risk of infection
Avoids obstruction (clots form in passive drains)
Enhances healing
If making your own active drain, what should you remember about the holes?
Should be no more than 25% the circumference of the tube or else it can collapse
Where can you place the exit site for an active drain?
Wherever it is convenient
How large should the exit hole for an active drain be?
Small to minimize air leakage
What else is necessary for the active drain to be effective?
Airtight skin closure
What is an ingress/egress system?
Allows wound lavage after closure
What are 3 rules that should be followed about the ingress drain?
Separate access
ONLY used for flushing
Cap when not in use
What types of drains can an ingress/egress system be used with?
Active or passive drains
What must you remember above all else with an ingress/egress system?
DO NOT INJECT INTO EGRESS DRAIN!!!!
How long do you typically leave the drain in for?
3-7 days or when drainage decreases or discharge becomes serosanguineous
How can you gain a culture from a removed drain?
Cut off and swap end of drain that was deepest in the wound after removal.
Why is cytology from a drain not very helpful?
Because you’re swabbing the worst part of the wound (the inside of the drain)
