Drain (surgery)

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Surgical drain on the left hand after surgery of Bennett's fracture basis MTC primi manus 1. sin (S62.20) which was treated by alignment of a fracture and inside fixation by two titanium screws MS. Hand with drain after surgery (2).jpg
Surgical drain on the left hand after surgery of Bennett's fracture basis MTC primi manus 1. sin (S62.20) which was treated by alignment of a fracture and inside fixation by two titanium screws MS.
Drainage with bottle after implant removal Drainage.JPG
Drainage with bottle after implant removal
Photograph showing a subcutaneous neck drain in the left neck wound Photograph showing a subcutaneous neck drain in the left neck wound.png
Photograph showing a subcutaneous neck drain in the left neck wound

A surgical drain is a tube used to remove pus, blood or other fluids from a wound, [1] body cavity, or organ. They are commonly placed by surgeons or interventional radiologists after procedures or some types of injuries, but they can also be used as an intervention for decompression. There are several types of drains, and selection of which to use often depends on the placement site and how long the drain is needed.

Contents

Use and Management

Drains help to remove contents, usually fluids, from inside the body. This is beneficial since fluid accumulation may cause distension and pressure, which can lead to pain. For example, nasogastric (NG) tubes inserted through the nose and into the stomach can help remove stomach contents for patients who have a blockage further along in their gastrointestinal tract. After surgery, drains can be placed to remove blood, lymph, or other fluids that accumulate in the wound bed. This helps to promote wound healing and allows healthcare providers to monitor the wound for any signs of internal infection or damage to surgically repaired structures.

Drains may be classified as passive or active, open or closed, and external or internal. Passive drains rely on gravity or capillary action to remove fluid, whereas active drains rely on a suction/vacuum force, whether that be through connection to wall suction, a portable suction device, or a bulb that has been squeezed to create a vacuum. Open drains are commonly used for superficial wounds and drain into dressings or a stoma bag. Closed drains are tubes or other channel-like structures that are connected to a container, thereby creating a closed system. External drains go from inside the body to outside the body and can be seen, while internal drains are completely inside the body. An example of an internal drain is a ventriculo-peritoneal shunt, which is a tube that connects ventricles of the brain to the peritoneal cavity. This helps remove extra cerebrospinal fluid from the brain.

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. Drains will have protective dressings that will need to be changed daily/as needed.

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.

Complications

Drains risk becoming occluded or clogged, resulting in retained fluid that can contribute to infection or other complications. Thus efforts must be made to maintain and assess patency (condition of being open) when they are in use. Once a drain becomes clogged or occluded, it should be removed, as it is no longer providing any benefit.

Types of drains

Surgical drains can be broadly classified into:

See also

Related Research Articles

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<span class="mw-page-title-main">Negative-pressure wound therapy</span> Therapeutic technique

Negative-pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), is a therapeutic technique using a suction pump, tubing, and a dressing to remove excess exudate and promote healing in acute or chronic wounds and second- and third-degree burns. The therapy involves the controlled application of sub-atmospheric pressure to the local wound environment using a sealed wound dressing connected to a vacuum pump. The use of this technique in wound management started in the 1990s and this technique is often recommended for treatment of a range of wounds including dehisced surgical wounds, closed surgical wounds, open abdominal wounds, open fractures, pressure injuries or pressure ulcers, diabetic foot ulcers, venous insufficiency ulcers, some types of skin grafts, burns, sternal wounds. It may also be considered after a clean surgery in a person who is obese.

<span class="mw-page-title-main">Jackson-Pratt drain</span> Surgical drain device

A Jackson-Pratt drain is a closed-suction medical device that is commonly used as a post-operative drain for collecting bodily fluids from surgical sites. The device consists of an internal drain connected to a grenade-shaped bulb or circular cylinder via plastic tubing.

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<span class="mw-page-title-main">Cerebral shunt</span> Surgical implant to treat hydrocephalus

A cerebral shunt is a device permanently implanted inside the head and body to drain excess fluid away from the brain. They are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid (CSF). If left unchecked, the excess CSF can lead to an increase in intracranial pressure (ICP), which can cause intracranial hematoma, cerebral edema, crushed brain tissue or herniation. The drainage provided by a shunt can alleviate or prevent these problems in patients with hydrocephalus or related diseases.

Autotransfusion is a process wherein a person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood. There are two main kinds of autotransfusion: Blood can be autologously "pre-donated" before a surgery, or alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device. The latter form of autotransfusion is utilized in surgeries where there is expected a large volume blood loss – e.g. aneurysm, total joint replacement, and spinal surgeries. The effectiveness, safety, and cost-savings of intraoperative cell salvage in people who are undergoing thoracic or abdominal surgery following trauma is not known.

A lumbar–peritoneal shunt is a technique to channelise the cerebrospinal fluid (CSF) from the lumbar thecal sac into the peritoneal cavity.

Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling. Postoperative wounds are different from other wounds in that they are anticipated and treatment is usually standardized depending on the type of surgery performed. Since the wounds are 'predicted' actions can be taken beforehand and after surgery that can reduce complications and promote healing.

<span class="mw-page-title-main">Chest drainage</span>

Chest drains are surgical drains placed within the pleural space to facilitate removal of unwanted substances in order to preserve respiratory functions and hemodynamic stability. Some chest drains may utilize a flutter valve to prevent retrograde flow, but those that do not have physical valves employ a water trap seal design, often aided by continuous suction from a wall suction or a portable vacuum pump.

References

  1. Jain, Sudhir Kumar; Stoker, David L.; Tanwar, Raman (2013-04-30). Basic Surgical Skills and Techniques. JP Medical Ltd. pp. 70–73. ISBN   9789350903759 . Retrieved 2014-09-07.
  2. Obney, James; Mary Barnes; et al. (2000). "A method for mediastinal drainage after cardiac procedures using small silastic drains". The Annals of Thoracic Surgery. 70 (3): 1109–110. doi: 10.1016/s0003-4975(00)01800-2 . PMID   11016389.