Drain

Drain are tubes that exit the peri incisional area,either into a portable wound
suction device(closed) or into the dressings(open).the principle involved is to
allow the escape of fluids that could otherwise serve as a culture medium for
bacteria.In portable wound suction ,the use of gentle ,constant suction enhances
drainage of these fluids and collapses the skin flaps against the underlying tissue
thus removing deadspace.

Types
penrose
hemovac
jackson pratt drains

Hemovac drain

The Hemovac drain is a circular device connected to a tube.A Hemovac drain is

placed into a vascular cavity where blood drainage is expected after surgery, such
as with abdominal and orthopedic surgery.The drain consists of perforated
tubing/small holes connected to a portable vacuum unit/spring loaded canister.
Suction(negative pressure) is maintained by compressing a spring-like device in the
collection unit which draws the blood. After a surgical procedure, the surgeon
places one end of the drain in or near the area to be drained. The other end passes
through the skin via a separate incision. These drains are usually sutured in
place. /to skin to prevent accidental removal.The drainage site is covered with a
sterile dressing and should be checked periodically to ensure the drain is
functioning effectively and that no leaking is occurring.

As the drainage accumulates in the collection unit, it expands and suction is lost,
requiring recompression.A Hemovac drain can hold up to 500 ml of
drainage.Here,Romovac drain has capacity of 800ml.

Steps of emptying the drain

Typically, the drain is emptied every 4 or 8 hours and when it is half full of
drainage or air. However, based on the medical orders and nursing assessment and
judgment, it could be emptied and recompressed more frequently.

Gather necessary equipments.

Perform hand hygiene.Use standard precautions.
Explain the procedure to the patient.
Clamp the tube.
Remove the plug from the top of the drain.
Pour the fluid into a measuring cup.
Clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol.
Squeeze the drain flat and put the plug back in. The drain should stay flat until
it starts to fill with fluid again.
Make sure the tubing is not kinked or twisted.
Measure the amount of fluid you pour out. Write down how much fluid you empty from
the drain and the date and time you collected it.
Flush the fluid down the toilet. Wash your hands.

Risks of a Hemovac drain?

Discomfort at your drain site.

Trouble lying on the side with your drain.
Leakage from drain site.
The Hemovac drain may be pulled out by accident.
The tubing may crack, break, or become blocked.
The tubing may damage your tissue.
You may have a scar.
The drain site may get infected.
The infection could spread inside your body.

When should I seek immediate care?

Your drain breaks or comes out.

You are bleeding from your drain site.
You have cloudy yellow or brown drainage from your drain site.
The drainage from your drain site smells bad or looks different.

When should I contact my healthcare provider?

You suddenly stop draining fluid or think your drain is blocked.

You have a fever higher than 101.5°F (38.6°C) and chills.
You have increased pain, redness, or swelling around the drain site.
You drain less than 30 milliliters (2 tablespoons) in 24 hours.
You have questions or concerns about your Hemovac drain care.

Drain removal

The timing of drain removal after surgery depends on the type of procedure, the
average daily amount of drainage, and the surgeon's preference.
The risk of infection increases the longer the drain remains in place, so most
drains are removed within 24 to 48 hours after surgery.Generally, drains should be
removed once the drainage has stopped or becomes less than about 25 ml/day(<40ml)
or less than 30cc(1 oz.)

Nursing management

Assessment
• Assess the situation to determine the need for wound cleaning, a dressing change,
or emptying of the drain.
• Assess the patient’s level of comfort and the need for analgesics before wound
care. Assess if the patient experienced any pain related
to prior dressing changes and the effectiveness of interventions used to minimize
the patient’s pain.
• Assess the current dressing. Assess for the presence of excess drainage or
bleeding or saturation of the dressing.
• Assess the patency of the drain and the drain site. Note the characteristics of
the drainage in the collection bag.
• Inspect the wound and the surrounding tissue. Assess the appearance of the
incision for the approximation of wound edges, the color of the
wound and surrounding area, and signs of dehiscence.
• Assess the surrounding skin for color, temperature, and edema,ecchymosis, or
maceration.

NURSING DIAGNOSES
• Anxiety
• Acute Pain
• Disturbed Body Image
• Impaired Skin Integrity
• Deficient Knowledge
• Delayed Surgical Recovery
• Impaired Tissue Integrity
Perform hand hygiene and put on PPE, if indicated.Put on clean gloves; put on mask
or face shield, if indicated.
Identify the patient.
Assist the patient to a comfortable position that provides easy access to the drain
and/or wound area.
Assess the patient for possible need for nonpharmacologic pain-reducing
interventions or analgesic medication before wound care dressing change.
Administer appropriate prescribed analgesic. Allow sufficient time for the
analgesic to achieve its effectiveness before beginning the procedure.
Check the patency of the equipment. Make sure the tubing is free from twists and
kinks.
Secure the Hemovac drain to the patient’s gown below the wound with a safety pin,
making sure that there is no tension on the tubing.
Carefully measure and record the character, color, and amount of the drainage.
Discard the drainage according to facility policy
Look for signs of pulling,tearing, swelling, or infection of the surrounding skin.
Check drain status at least every 4 hours.
Check all wound dressings every shift.More frequent checks may be needed if the
wound is more complex or dressings become saturated quickly.

DOCUMENTATION
• Document the location of the wound and drain, the assessment of the wound and
drain site, and patency of the drain. Note if sutures are
intact. Document the presence of drainage and characteristics on the old dressing
upon removal. Include the appearance of the surrounding
skin. Document cleansing of the drain site. Record any skin care and the dressing
applied. Note that the drain was emptied and recompressed. Note pertinent patient
and family education and any patient reaction to this procedure, including
patient’s pain level and the effectiveness of nonpharmacologic interventions or
analgesia, if administered. Document the amount and characteristics of drainage
obtained on the appropriate intake and output record.