Classification of Drains:

• Open vs. Closed Systems:

 Open - Include corrugated rubber or plastic sheets

- Drain fluid collects in gauze pad or stoma bag.
- They increase the risk of infection
 Closed - Consist of tubes draining into a bag or bottle.
- They include chest and abdominal drains.
- The risk of infection is reduced.
• Active vs. Passive

 Active - Active drains are maintained under suction

- They can be under low or high pressure
 Passive - Passive drains have no suction
- Drain by means of pressure differentials, overflow, and gravity between body cavities
and the exterior.

2) Types of Drains

Jackson-Pratt drain
• Jackson-Pratt drain, JP drain, or Bulb
drain, is a drainage device used to pull
excess fluid from the body by constant
suction.
• The device consists of a flexible plastic
bulb -- that connects to an internal plastic
drainage tube.
• The Jackson-Pratt drain used as negative
pressure vacuum, which also collects fluid.
As a low negative pressure suction system,
it is designed so that intra-abdominal
contents such as the omentum or intestines
are not sucked into the tube, minimizing
the risk of bowel perforation or
Ischemia

Penrose drain (open drain)

• A Penrose drain is a surgical device placed
in a wound to drain fluid. It consists of a
soft rubber tube placed in a wound area, to
prevent the buildup of fluid
Corrugated Rubber Drain (open drain)
• Rubber causes a tissue reaction and the
drain track caused by this material persists
longer than when inert materials arc used.
The drain is fixed by a suture at the end of
the wound and a safety pin must he placed
through the end to prevent the drain
slipping inwards. Corrugated rubber drains
can be used either for the wound or for
deep drainage.

Negative pressure wound therapy:

• Negative pressure wound therapy - Involves
the use of enclosed foam and a suction device
attached; this is one of the newer types of
wound healing/drain devices which promotes
faster tissue granulation, often used for large
surgical/trauma/non-healing wounds.

T-Tube
• Kehr's T tube: a tube consisting of a stem and a
cross head (thus shaped like a T). The cross head
is placed into the common bile duct while the
stem is connected to a small pouch (i.e. bile bag).
It is used as a temporary post-operative drainage
of common bile duct. Sometimes it’s used in
ureteric problems too.
Chest Tube (close drain)
• Open (incisional) vs. close ( traocar use), open
is preferred (less risk in term of intranl organ
penetration by strong trocar inserion).
• Used as closed system under water seal.
• Used to drain; haemothorax, pneumothorax,
chylothorax, pleural effusion and epyema.
• Put in the pleural space in the 4th intercostal
space (mid axillary or ant. Axillary or between
them for better mobility of the patient ) above
the upper border of the rib bellow ( VAN
structure)

Pigtail drain
• Pigtails are inserted percutaneously (through
the skin) by a radiologist. It maybe inserted to
allow, for example, urine to drain directly from a
kidney, if the ureter is diseased or blocked. This
is called a nephrostomy.
Other conditions requiring the insertion of
a pigtail drain include a blocked bile duct that
needs to be drained of bile, or a pus-filled
abscess. The type of fluid that drains depends
upon the reason for its insertion.

Davol Drain
• In soft, supple silicone with x-ray opaque strip.
Designed to minimize tissue trauma and
discourage clogging.
• Drains have a triple lumen configuration to
increase drain versatility and effectiveness. Large
center lumen for maximum removal; filtered air
vent helps reduce risk of infection. Third lumen
permits irrigation and instillation of medication.
0.3 micron antibacterial filter removes virtually
all bacteria from incoming air. Suture cuff helps
fasten drain. Packaged 5 per box.
Redivac Drain (a close drain)
• This is a fine tube. with many holes at the end,
which is attached to an evacuated glass bottle
providing suction. It is used to drain blood beneath
the skin, e.g. after mastectomy or thyroidectomy, or
from deep spaces, e.g. around a vascular
anastomosis.

Endotrachial Tubes
• Endotracheal tubes (ET Tubes) are used to
assist in airway management.
• ET tubes may be placed when an airway
obstruction has occurred, or when a patient is
unable to breath independently and needs
mechanical ventilation.
• In the latter case, the ET tube provides a route
for the ventilator to deliver oxygenated air.

Nasogastric Tubes
Naso-gastric tube; as the name implies a tube (available in different sizes and types) passes through
the nostrils (sometimes through oral cavity) to the stomach, to the duodenum or even jejunum [i.e.
nasoenteric; here by the action or peristalsis].
- The ordinary NG tube measurement:

• Extend the tube from the nasal orifices to the ear (lateral face) to the xiphi sternum.
- Insertion; enquire about any previous nasal surgery, or trauma or difficulty in breathing through a
particular nostril check for nostrils patency, ask the patient to blow his/her nose,
- During the insertion the tube has to point downward toward the xiphoid process, once reach the
nasopharynx, twist it to 180 degrees this minimizes the risk of tube coiling at the back or the pharynx,
lubricate the proximal end of the tube with lidocain jelly, insert the tube through the nostril
(sometimes one is wider than the other), insert till u reach the nasopharynx, here u will face some
resistance twist the tube (as we said 180) and push, ask the patient to swallow, the tube is now in the
stomach.
Types of Nasogastric Tubes

LEVIN TUBE:
• Single lumen, holes near tip
• Prevents accumulation of intestinal liquids and
gas during and following surgery. Prevents
nausea, vomiting and distention due to reduced
peristaltic action

SUMP: (SALEM)
• Double lumen, radiopaque

1st lumen: suction of gastric contents

2nd lumen: blue extension (pig tail) open to

room air to maintain a continuous flow of
atmospheric air into the stomach.
• Controls the amount of suction pressure placed
on stomach walls. Prevents injury, ulcers.

MOSS TUBE
• Tri-lumen

1st. lumen: Balloon anchors it in the stomach

2nd lumen: Feeding tube

3rd lumen: Aspiration and lavage.

SENGSTAKEN-BLAKEMORE
• Triple lumen
1st lumen: Inflates the balloon in the stomach to
press against the esophagogastric junction.

2nd lumen: Inflates the balloon in the

esophagus to press directly against varices.

3rd lumen: Used for aspiration and lavage.

MINNESOTA TUBE:
• 4 LUMEN

NUTRIFLEX TUBE
• Feeding tube: usually radiopaque.
• Mercury weighted
• Coated with lubricant
• activated with gastric secretions to keep
• tube supple and not injure stomach lining

3) Kinds of Sponges

ATRAUMATIC LINT-FREE SPONGES

Sinus Sponges
• Helps prevent lateralization of the middle turbinate
• Significantly reduces renewed ostiomeatal obstruction following FESS
(Functional Endoscopic Sinus Surgery)
• Compressed configuration for easy insertion
• Expands anatomically so antibiotics stay in contact with surgical site
• Micro-pore size minimizes tissue growth
• Clears clots and debris upon removal, leaving a clean, open cavity
• Not made with natural rubber latex
• Sterile

Nasal Sponges

• Provides gentle, even support to aid in patient comfort

• Absorbs post-operative drainage following nasal surgery, ethmoidectomy procedures, or other
endoscopic sinus surgeries
• Fiber free to reduce risk of adhesions or active rebleeding upon removal
• Quickly expands to control and absorb post-nasal discharge
• Optional airway tube aids in patient comfort for better breathing and pressure reduction
• Sterile
• Not made with natural rubber latex

Epistaxis Sponges

• Provides quick and effective control of epistaxis

• Provides unsurpassed patient comfort
• Atraumatic removal prevents active rebleeding
• Compressed configuration slides easily into nasal cavity
• Quickly expands to absorb fluids while maintaining patient comfort
• Sterile
• Not made with natural rubber latex

Otology Sponges

• Helps prevent stenosis of the external ear canal following otic surgery
• Compressed configuration allows easy insertion into the ear canal
• Keeps antibiotics in contact with the wound site through anatomical expansion
• Fiber free to minimize tissue ingrowth
• Not made with natural rubber latex
• Sterile

OPHTHALMIC SPONGES
Lint-Free Ophthalmic Sponges

• Allows the ophthalmologist to perform completely lint-free fluid control

• A variety of premium absorbent lint-free ophthalmic sponges
• Extremely soft and fast-wicking
• Not made with natural rubber latex
• Sterile

Eye Spear/Fine Dissector

• X-Ray Detectable
• Designed for microscopic sponging in the ocular area, fine dissecting, and delicate surgery
• Fine-pore, cellulose fiber is virtually non-linting and extremely absorbent
• Fiber is compressed and die-cut into a “spear” shape and attached to a small plastic handle
• Not made with natural rubber latex
• Sterile

PVA Eye Spear

• Designed to be used in Lasik surgery in addition to cataract surgery

• Constructed of virtually lint-free polyvinyl acetal, causing less eye irritation
• Absorbs up to five times more fluid than standard cellulose spears
• Expands instantly in contact with fluids
• Allow for gentle manipulation of delicate tissues
• High tensile strength without breaking apart

DISSECTING SPONGES
Rosebud Dissector

• Excellent for blunt dissection and delicate surgery

• Smaller and firmer than a Peanut or Round Dissector
• Complete with the exclusive x-ray detectable radiopaque element
• Count holder, per pack, enables easy sponge count
• Not made with natural rubber latex
• Sterile

Peanut Sponge

• Excellent for delicate sponging and soft tissue dissection

• Soft, round construction may be used as is, or folded
• Complete with the exclusive x-ray detectable radiopaque element
• Count holder, per pack, enables easy sponge count
• Not made with natural rubber latex
• Sterile

Cherry Sponge

• Largest of the Dissectors

• Very absorbent and ideal for general dissecting
• Complete with the exclusive x-ray detectable radiopaque element
• Count holder, per pack, enables easy sponge count
• Not made with natural rubber latex
• Sterile

Round (Hard) Dissector

• Also known as the “Beehive”

• Roundness and firmness make our hard dissectors beneficial for blunt dissection and ideal for surgical
procedures
• Small hole in center of dissector makes it easier to grasp with forceps
• Complete with the exclusive x-ray detectable radiopaque element
• Count holder, per pack, enables easy sponge count
• Not made with natural rubber latex
• Sterile

Kittner (Blunt) Dissector

• Can be used as a longitudinal or folded sponge for dissection

• Constructed of high quality cotton twill
• Complete with the exclusive x-ray detectable radiopaque element
• Count holder, per pack, enables easy sponge count
• Not made with natural rubber latex
• Sterile

TONSIL & ADENOID SPONGES

Single-Strung Tonsil Sponges

• Constructed with a 15”, white, memory-free cotton string

• Covered with gauze and cotton filled for maximum absorbency
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Double-Strung Tonsil Sponges

• Constructed with a No. 3 blue thread for ease of retrieval

• Covered with gauze and cotton filled for maximum absorbency
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Round Adenoid Sponge

• Designed to control hemorrhaging following adenoid surgery

• Gauze-cotton filled with a No. 3 blue thread
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

SURGICAL GAUZE SPONGES

Flat Stick Sponges

• Pre-folded with the edges tucked in
• May be used with a Forester clamp for deep stick sponging
• Excellent for absorption
• Ideal for prepping prior to surgery
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Round Stick Sponges

• Can be used as a prep sponge for surgery

• Complete with the exclusive x-ray detectable radiopaque element
• Sterile
• Not made with natural rubber latex

Triangle Sponge

• Ideally shaped for sponging

• May be easily rolled or folded for dissection or used as a prepping sponge
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

STERILE PUFFS

Sterile Cotton Balls

• Ideal for prepping, wound cleaning, and perineal care

• Not made with natural rubber latex
• Sterile

Double-Strung Cotton Balls

• Constructed with a 15” blue silk thread for ease of retrieval

• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Sterile Rayon Balls

• 100% pure medical grade

• Virtually lint-free, uniformly shaped, and soft
• Sterile
• Not made with natural rubber latex

MISCELLANEOUS SPONGES

Double-Strung Cylindrical Sponges

• Highly absorbent
• Designed for tonsil, adenoid, and nasal surgery
• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Dental Rolls

• Highly absorbent
• Designed to keep the area dry, absorbing saliva and moisture
• Available in regular and quilted
• Not made with natural rubber latex
• Sterile

Ear Wicks (Cellulose)

• Atraumatic and virtually lint-free

• Designed to meet the surgeon’s need in otolaryngology surgery
• Compressed and die-cut of highly absorbent fine-pore cellulose fiber
• Not made with natural rubber latex
• Sterile

Tracheotomy Sponge

• Made of highly absorbent 4 x 4 12-ply gauze sponge

• Ideal around any drainage area to protect from chafing
• Not made with natural rubber latex
• Sterile

Bronchial Sponge

• Highly absorbent cotton

• Complete with the exclusive x-ray detectable radiopaque element
• Not made with natural rubber latex
• Sterile

Nasal Plugs

• Ideally shaped for easy insertion and comfortable use following surgery
• Not made with natural rubber latex
• Sterile
 NEUROLOGY SPONGES

Neuro Sponges in Patties & Strips

• High-quality rayon fibers prevent disintegration and linting, reducing the risk of granulomas
• Very pliable when wet, allowing patties and strips to conform to irregular contours
• X-Ray detectable element is secured on one side of pad
• Locator string attached to the patties increases visibility and assists in identification
• Patties come with counting card in each pack
• Also available with extended counting card
• Not made with natural rubber latex
• Sterile

LAPAROTOMY GAUZE SPONGES

Cotton Lap Sponges

• Consists of 100% cotton

• X-ray detectable
• Pre-washed consisting of 24/20 gauze
• Wrapped in CSR and placed in peel pouch for easy sterile presentation
• Manufactured in Mexico, a NAFTA partner country
• Not made with natural rubber latex
• Sterile

Lap Sponges

• Pre-washed consisting of 24/20 gauze

• Economically priced for a variety of uses
• Consists of 100% cotton
• X-ray detectable
• Not made with natural rubber latex
• Sterile

GAUZE SPONGES

Vaginal & Perineal Packing

• Pre-washed, 4-ply gauze

• Vaginal packing complete with the exclusive x-ray detectable radiopaque element
• Folded and packaged in peel pouch
• Not made with natural rubber latex
• Sterile
1) Methods of Hemostasis

MECHANICAL METHODS

 Digital pressure – direct pressure, e.g. Pringle maneuver

 Tourniquet
 Ligation
 Suturing
 Preventive hemostasis
 Clips
 Bone wax
 Other

THERMAL METHODS

 Low temperature
 Hypothermia – eg. stomach bleeding
 Cryosurgery
o Dehydratation and denaturation of fatty tissue
o Decreases the cell metabolism
o Vasoconstriction
o
 High temperature
 Electrosurgery – electrocauterization
 Monopolar diathermy
 Bipolar diathermy
 Harmonic devices
 Laser surgery coagulation and vaporization for fine tissues
 Electrocoagulation
 Electrofulguration (A)
 Electrodessication
 Electrosection

CHEMICAL WITH BIOLOGICAL METHODS

 VASOCONSTRICTION COAGULATION HYGROSCOPIC EFFECT
Absorbable collagen
Absorbable gelatin
Microfibrillar collagen
Oxidized cellulose
Oxytocin
Epinephrine
Thrombin
QuikClot

Bicol University
College of Nursing
Legazpi City

Assignment in
Skills Laboratory

Mary Mae B. Buella

(III-C)
Professor Rosario M. Ludovice
Clinical Instructor