Surgical Drains: Indications, Types,

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Surgical DrainsIndications, Types, Principals
of Use
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Learning Objectives

• Goals / Indications for Use
• Why use a drain ?
• Types
• What are the major types of drains and how do
  they work ?
• Principals of Use
• Which drain to use ?
• What are the complications ?

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Goals

• Decrease Infection Rate
• Decrease Healing Time

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Indications

• To help eliminate dead space
• To evacuate existing accumulation of fluid or gas
• To prevent the potential accumulation of fluid or
  gas

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Drain Types

• Flat
• Dependent on gravity and capillary action
• Drainage related to surface area
• Penrose - latex

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Drain Types

• Flat drains - Penrose
• Advantages
• Allow drainage
• Help obliterate dead space
• Soft / malleable less painful
• Disadvantages
• Very irritating
• Allow bacterial ingress
• Cannot be connected to suction
• Gravity dependent

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Drain Types

• Tube
• Single lumen
• /- side holes
• Silicone, polyvinyl chloride, red rubber

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Drain Types

• Tube drains
• Advantages
• Drain from both within and outside of lumen
• Can be connected to suction
• Can be used with closed collection system
• Disadvantage
• Discomfort due to stiffness

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Drain Types

• Double lumen
• Sump drains open/open suction
• Drainage of fluid via large lumen
• Sump lumen smaller and allows ingress of air

AIR
FLUID
AIR
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Drain Types

• Double lumen
• Advantages
• More efficient than single lumen
• Maintain patency longer than single lumen
• Disadvantages
• Risk of contamination of wound as environmental
  air drawn in reduced with filter

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Drain Types

• Passive
• Active
• Continuous suction
• Intermittent suction

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Passive Drains

• Passive
• Drain by means of pressure differentials,
  overflow, and gravity
• Provides a stent that keeps a draining tract /
  cloaca open
• Allow egress via a path of least resistance
• Flat or with a lumen
• Open or Closed Closed preferred

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Passive Drains

• Passive closed
• Advantages
• Allow evaluation of volume and nature of fluid
• Prevent bacterial ascension
• Eliminate dead space
• Help appose skin to wound bed quicker wound
  healing
• Disadvantages
• Gravity dependent affects location of drain
• Drain easily clogged

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Active Drains

• Vacuum pulls fluid / gas from the wound
• Closed to atmosphere Closed suction
• Vacuum applied to a single lumen tube
• Not gravity dependent

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Active Drains
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Active Drains

• Advantages
• Keep wound dry efficient fluid removal
• Can be placed anywhere
• Prevent bacterial ascension
• Help appose skin to wound bed quicker wound
  healing
• Allows evaluation of volume and nature of fluid
• Disadvantages
• High negative pressure may injure tissue
• Drain clogged by tissue

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Principals of Ideal Use

• Aseptic site preparation (clip, scrub, debride,
  lavage)
• Place to avoid anastomosis sites and major
  vessels
• Exit through separate stab incision, away from
  surgical incision
• Aseptic postoperative management (cover with
  sterile bandage, change before strike through,
  clean dry cage)

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Complications and Failure of Drains

• Poor Drain Selection
• Poor Drain Placement
• Poor Post-operative Management

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Complications and Failure of Drains

• Infection
• Ascending bacterial invasion
• Foreign body reaction
• Decreased local tissue resistance
• Bacterial hiding places
• Poor placement fluid accumulation, drain kinked
• Poor postoperative management

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Complications and Failure of Drains

• Discomfort / Pain
• Thoracic Tubes diameter too large
• Stiff tubing
• Inefficient Drainage
• Exiting in non-dependent locale (passive drains)
• Kinked tube
• Obstructed
• Poor drain selection diameter too small to
  remove viscous fluid

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Complications and Failure of Drains

• Breakdown of anastomotic sites
• Erosion into hollow organs (firm drains)
• Incisional dehiscence / hernia
• Poor placement
• Premature Removal
• Accumulation of fluid
• Decreased Mobility
• DVT/PE
• Increased hospital stay