1. “ Surgical Drains”

2. Why use Drains ?
Haematoma
Other Fluids (serous, chyle, pus, etc)

3. 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 .

4. 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 .

5. 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

6. 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 .

7. 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 .

8. Type of Drains
Suction
Non - Suction
Via wound
Separate site

9. Principles of Drain Placement
Maximum area
Minimal trauma (nerves, vessel repair )
Gravitational
Patient comfort
Ease of removal

10. Packs Abscess cavity Infected wound Must contain an anti septic
must be replaced frequently.

11. wicks
Fistulae.
Discharging sinuses.
Same principles of packs.

12. Corrugated rubber drain
Sheet drainage
Simple insertion, care and removal .
Not expensive.
Tissue irritant.

13. Tube drain
Most effective method of drainage.
Closed drainage.

14. Suction machines can be connected intermittently.

15. Problems with Drains Obstruction Suction system Diameter vs Fluid
Patient mobility
Removal

16. Wound principles

17. Skin Placement

18. Suction Channels

19. Drain Length

20. Placement

21. Trochar removal

22. Fixation

23. Suction “Tip”

24. Suction adaption

25. Skin Closure

27. Drain “Organiser”

28. Patient issues Post Op