“ Surgical Drains”
Why use Drains ? Haematoma Other Fluids (serous, chyle, pus, etc)
Drain…. Indications : Life saving measure : Therapeutic benefit : Tension pneumothorax . Therapeutic benefit : Chest drainage : haem\ pneumothorax , empyema . Thoracotomy , cardiothoracic procedure , oesophegeal resection and perforation . Drainage of abscess and infected cyst . Drainage gastrointestinal , biliary and pancreatic fistula . Drainage after extensive dissection and elevation of skin flaps . After operation for injury to solid organs and partial excision of these organs . After pancreatic necrosectomy .
DRAINS What kind of drain you need and which size ? The drain should be : Soft to avoid tissue injury . Non-irritating . Firm….incompressible . Resistant to decomposition . Smooth for easy removal .
The Perfect Product Greater tissue contact Inert material. Slides smoothly past any tissue Promotes ease of movement and deep breathing Minimal pain on removal Comes in various sizes
Drain material Latex rubber ( red rubber)…soft , but excites a profound inflammatory reaction within 24 H. . Polyvinyl chloride (PVC) …less reactive and incompressible , however , tend to harden and splite with prolonged use, especially when in contact with bile . Silicon ( best drain material ) least reactive and the most pliable, and show no tendency to harden with prolonged use .
Drainage systems Open ( static) drainage ; Penrose , multitubular ,corrugate Closed siphon drainage : Closed suction drainage : Low negative-pressure ( -100 to –150 mmHg ) e,g, Portovac , Reliavac . High negative-pressure ( -300 to –500 mmHg )e,g. Redivac , . Sump suction drainage : for irritant discharge . Underwater seal drainage .
Type of Drains Suction Non - Suction Via wound Separate site
Principles of Drain Placement Maximum area Minimal trauma (nerves, vessel repair ) Gravitational Patient comfort Ease of removal
Packs Abscess cavity Infected wound Must contain an anti septic must be replaced frequently.
wicks Fistulae. Discharging sinuses. Same principles of packs.
Corrugated rubber drain Sheet drainage Simple insertion, care and removal . Not expensive. Tissue irritant.
Tube drain Most effective method of drainage. Closed drainage.
Suction machines can be connected intermittently.
Problems with Drains Obstruction Suction system Diameter vs Fluid Patient mobility Removal
Wound principles
Skin Placement
Suction Channels
Drain Length
Placement
Trochar removal
Fixation
Suction “Tip”
Suction adaption
Skin Closure
Drain “Organiser”
Patient issues Post Op