Surgical Drains

Question 1

What are 3 indications for a surgical drain?

Answer 1

Dead space cannot be obliterated
Fluid accumulation likely
Infection

Question 2

What is a disadvantage to putting in a surgical drain?

Answer 2

Increased risk of secondary infection

Question 3

What are 3 ways to get rid of dead space?

Answer 3

Tacking suture
Drain
Compression bandage

Question 4

T/F: Drains can exit through the incision line.

Answer 4

False. Drains should NEVER exit through the incision line

Question 5

What can happen to the suture line if a drain lies directly under it?

Answer 5

Increased risk of dehissance

Question 6

Why should you not use buried suture to tack a drain in place?

Answer 6

Makes drain more difficult to remove.

Question 7

What are the 2 types of drains?

Answer 7

Passive

Active

Question 8

How does a passive drain work?

Answer 8

Relies on gravity and capillary action to move fluid (surface area is important)

Question 9

How does an active drain work?

Answer 9

Suction pulls fluid from the wound

Question 10

What are 4 critical points of placing a passive drain?

Answer 10

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

Question 11

What is a common type of passive drain?

Answer 11

Penrose drain

Question 12

What is a Penrose drain?

Answer 12

Soft latex tubing that conforms well to the wound

Question 13

Why can adding fenestrations to a drain decrease its effectiveness?

Answer 13

Reduces surface area

Question 14

What is a cigarette drain?

Answer 14

A fenestrated penrose drain with gauze strip inside to give a wicking action.

Question 15

What is the best way to maintain the position of a Penrose drain?

Answer 15

Percutaneous tacking suture

Question 16

What must you remember when removing a double exit Penrose drain?

Answer 16

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.

Question 17

What are 5 benefits of an active drain?

Answer 17

Greater efficiency
Decreased risk of tissue maceration with drainage
Decreased risk of infection
Avoids obstruction (clots form in passive drains)
Enhances healing

Question 18

If making your own active drain, what should you remember about the holes?

Answer 18

Should be no more than 25% the circumference of the tube or else it can collapse

Question 19

Where can you place the exit site for an active drain?

Answer 19

Wherever it is convenient

Question 20

How large should the exit hole for an active drain be?

Answer 20

Small to minimize air leakage

Question 21

What else is necessary for the active drain to be effective?

Answer 21

Airtight skin closure

Question 22

What is an ingress/egress system?

Answer 22

Allows wound lavage after closure

Question 23

What are 3 rules that should be followed about the ingress drain?

Answer 23

Separate access
ONLY used for flushing
Cap when not in use

Question 24

What types of drains can an ingress/egress system be used with?

Answer 24

Active or passive drains

Question 25

What must you remember above all else with an ingress/egress system?

Answer 25

DO NOT INJECT INTO EGRESS DRAIN!!!!

Question 26

How long do you typically leave the drain in for?

Answer 26

3-7 days or when drainage decreases or discharge becomes serosanguineous

Question 27

How can you gain a culture from a removed drain?

Answer 27

Cut off and swap end of drain that was deepest in the wound after removal.

Question 28

Why is cytology from a drain not very helpful?

Answer 28

Because you’re swabbing the worst part of the wound (the inside of the drain)