1. Surgical Drains: Indications, Types, & Principals of Use

2. Indications The four indications for applying a surgical drain are:
1-To collapse surgical dead space in areas of redundant tissue (e.g., neck and axilla)
2- To provide focused drainage of an abscess or grossly infected surgical site
3- To provide early warning notice of a surgical leak (either bowel contents, secretions, urine, air, or blood)—the so called sentinel drain
4- To control an established fistula leak

3. Drain Types Open, Flat, Penrose
Dependent on gravity and capillary action
Drainage related to surface area
Penrose - latex
Advantages
Allow drainage
Help obliterate dead space
Soft / malleable – less painful
Disadvantages
Very irritating
Allow bacterial ingress
Cannot be connected to suction
Gravity dependent

4. Drain Types Tube Single lumen +/- side holes
Silicone, polyvinyl chloride, red rubber
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

5. Drain Types Double lumen Sump drains – open/open suction
Drainage of fluid via large lumen
Sump lumen – smaller and allows ingress of air
AIR
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
FLUID
AIR

6. Drain Types
Passive
Active
Continuous suction
Intermittent suction

7. 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

8. Passive Drains Passive closed Advantages Disadvantages
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

9. Active Drains Vacuum pulls fluid / gas from the wound
Closed to atmosphere = Closed suction
Vacuum applied to a single lumen tube
Not gravity dependent

10. Active Drains

11. Active Drains Advantages Disadvantages
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

12. 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)

13. Complications and Failure of Drains
Poor Drain Selection
Poor Drain Placement
Poor Post-operative Management

14. 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

15. 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

16. 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