Drain (surgery)

A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains
inserted after surgery do not result in faster wound healing or prevent infection but are
sometimes necessary to drain body fluid which may accumulate and in itself become a focus
of infection. The routine use of drains for surgical procedures is diminishing as better
radiological investigation and confidence in surgical technique have reduced their necessity.
It is felt now that drains may hinder recovery by acting as an 'anchor' limiting mobility post
surgery and the drain itself may allow infection into the wound. In certain situations their
use is unavoidable. Drains have a tendency to become occluded or clogged, resulting in
retained fluid that can contribute to infection or other complications. Thus efforts must be
made to maintain and assess potency when they are in use. Once a drain becomes clogged
or occluded, it is usually removed as it is no longer providing any benefit.

Drains may be hooked to wall suction, a portable suction device, or they may be left to drain
naturally. Accurate recording of the volume of drainage as well as the contents is vital to
ensure proper healing and monitor for excessive bleeding. Depending on the amount of
drainage, a patient may have the drain in place one day to weeks. Signs of new infection or
copious amounts of drainage should be reported to the health care provider immediately.
Drains will have protective dressings that will need to be changed daily/as needed.

Types of drains

Surgical drains can be broadly classified into:

 Tube drains
 Corrugated drains

Some types of surgical drains are:

 Jackson-Pratt drain - consists of a tube connected to a see-through collection

bulb. The bulb has a drainage port which can be opened to remove fluid or
air so that the bulb can be squeezed to create suction. The drain is placed
below the area of the wound.
 Penrose drain
 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.
 Redivac drain
 Pigtail drain - has an exterior screw to release the internal "pigtail" before it
can be removed
 Davol
 Chest tube
 Wound manager

Jackson-Pratt drain
A Jackson-Pratt drain, JP drain, or Bulb drain, is a surgical drainage device used to pull
excess fluid from the body by constant suction.

The device consists of a flexible rubber bulb—shaped something like a hand grenade -- that
connects to an internal drainage tube. Removing the bulb's plug, squeezing air out of the
bulb and replacing the plug creates suction in the drainage tubing.

Another method involves folding the drain in half while it is uncapped, then while folded,
recapping the drain. This action causes fluid to be gradually sucked out of the body and into
the bulb itself. The bulb may be repeatedly opened to remove the collected fluid and
squeezed again to restore suction. It is best to empty drains before they are more than half
full to avoid the discomfort of the weight of the drain pulling on the internal tubing

Patients or caretakers can "strip" the drains by taking a damp towe l or piece of cloth and
bracing the portion of the tubing closest to the body with their fingers, run the cloth down
the length of the tube to the drain bulb. One can also put a little bit of lotion or mineral oil
on their fingertips to lubricate the tube to make stripping easier. The portion of the tube
closest to the exit point of the drain from the body should be gripped first, and once the
length of the drain is stripped, the end closest to the bulb should then be released. This
increases the level of suction and helps to move clots through the drainage tube into the
bulb.

Chest tube
A chest tube (chest drain or tube thoracostomy in British medicine or intercostal drain) is a
flexible plastic tube that is inserted through the side of the chest into the pleural space. It is
used to remove air (pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema)
from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.
Penrose 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 build up of fluid.

It is named for the American gynecologist Charles Bingham Penrose (1862–1925)

Common uses

A Penrose drain removes fluid from a wound area. Frequently it is put in place by a surgeon
after a procedure is complete to prevent the area from accumulating fluid, such as blood,
which could serve as a medium for bacteria to grow in.

In Podiatry, a Penrose drain is often used as a tourniquet during a hallux nail avulsion
procedure or ingrown toenail extraction.

It can also be used to drain cerebrospinal fluid to treat a hydrocephalus patient.

Vacuum assisted closure system in the management of cervical anastomotic leakage

after gastric pull-up

The VAC system offers several advantages as compared with the traditional treatment
modalities [4]. The uniform negative pressure applied to the wound causes arteriolar
dilation and thus increase of the microcirculation. By continuous suction fluid excess and
edema are decreased, thereby reducing bacterial colonization. These positive effects
promote granulation, tissue proliferation, and wound healing [5,6–8].

The rationale for the use of the mini-VAC-system was that patients are able to remain on a
semisolid diet without the need of inconvenient nasogastric decompression and nasoenteric
feeding, as well as the direct drainage of secretions from the wound which obviates the
need for repeated daily changes of wound dressings.
Despite a short experience, the major advantages of the VAC-device in the treatment of
collar esophago-gastric anastomosis justifies the attempt of treatment of different sizes of
leakages.