Definition
Drains are tubes placed near surgical incisions in a postoperative patient, to remove pus or other fluid, and thus preventing it from accumulating in the body.
Principles
- Microorganisms are present everywhere. These may be transmitted from the source to the host directly or indirectly.
- Bacteria travel along with the dust particles.
- Cleaning an area where there is less number of organisms before cleaning an area where there are more organisms minimizes the spread of organisms to the clean area.
- Respiratory tract harbors microorganisms that can enter the wound.
- Nutrition and oxygen are carried to the wound via blood and are essential for collagen formation.
- Moisture facilitates growth and movement of microorganisms.
Types of Drains
Open or Closed
- Open drains: Fluids drain onto a gauze pad or into a stoma bag.
- Closed drains: Fluids drain into a bag or bottle.
Active or Passive
- Active drain: Maintained under suction.
- Passive drain: Works according to differential pressure between the body cavities and the exterior.
Silastic or Rubber
- Silastic drains: Relatively inert and induce minimal tissue reaction.
- Rubber drains: Induce intense tissue reaction.
Description of Common Wound Drains
| SN | Name of Drain | Description |
| 1. | Jackson-Pratt drain | A drainage system that uses a compressed bulb, and applies slight suction within the wound. |
| 2. | Hemovac drain | Closed drain system, a surgical drain to prevent blood and lymphatic fluid buildup under your skin and encourage healing; drains fluid by passive suction. |
| 3. | Wound VAC drain | A foam or gauze dressing is put directly on the wound; an adhesive film covers and seals the dressing and wound; a drainage tube leads from under the adhesive film and connects to a portable vacuum pump; this pump removes air pressure over the wound. |
| 4. | Free drainage closed drain | A closed, passive drainage system, frequently attached to A4 urinary drainage bag that can be emptied. These drains are often inserted post robotic surgery. |
| 5. | T-tube drain | A narrow flexible tube in the form of a T that is used drainage especially of the common bile duct. |
| 6. | Penrose drain | A flat, thin rubber tube inserted into a wound to allow to fluid to flow from the wound; it has an open end that drains onto a dressing. |
| 7. | Pigtail drain | A closed, passive drain, often inserted to drain a collection, A transparent drainage pouch is usually applied over the exit site, or is attached to a closed drainage bag. Pigtail catheters are coiled post insertion through the use of an internal string in the lumen, which is locked into place at the external end of the drain. |
| 8. | Mushroom-shaped drain | This natural rubber latex drain catheter has a mushroom-shaped tip and is used for renal, liver, or gallbladder surgeries. |
| 9. | Corrugated drain | It is a multichannel wound drainage used especially where airtight closure of the wound is not possible. |
Indications
- To prevent accumulation of fluid.
- To prevent accumulation of air.
- To assess the characteristics of the drained fluid
Uses
Drains are used in the following surgeries:
- Plastic surgery.
- Breast surgery.
- Orthopedic surgeries.
- Chest drainage.
- Chest surgery.
- Infected cysts.
- Pancreatic surgery.
- Thyroid surgery.
- Neurosurgery.
Instructions
- Use aseptic technique strictly.
- Create a sterile field around the wound by spreading sterile sheets.
- Cleaning should be done from the cleanest area to a less clean area.
- If the dressing is adherent to the wound due to drying of the secretions, wet it with normal saline.
- Drain’s dressing should not be combined with the dressing on the wound line.
- The discharge from the drain tube must be measured carefully and the odor, color, and consistency of the drainage noted.
Assessment
Initial
- Assess and note the type of drain inserted, amount of drain, condition of the insertion site, any signs of fluid or air leakage, and redness or irritation of the skin.
- Check whether the drain is secured well with sutures/tape and in correct position.
- Check the patency of the drain and whether it is free of any kinks or knots.
- Determine the patient’s level of comfort.
- Assess the patient’s knowledge regarding the purpose of the drain.
Ongoing
- Monitor for signs of sepsis (fever, redness, tenderness, excess oozing at drain site).
- Notify the surgical team and obtain blood and wound cultures if needed.
- Monitor the drain patency and check for any block or displacement.
- Note the amount of drainage minimum 4 hourly.
- Assess the level of pain and any unusual changes reported by the patient.
- Identify the need for analgesia especially prior to wound care or drain removal.
- Check the patient’s awareness regarding care of the drain and precautions to be taken.
Articles
Preparation of Equipment
- A sterile dressing set containing:
- K-basin.
- Bowl.
- Artery clamps (2).
- Thumb forceps (nontoothed) (1).
- Cotton balls, gauze pieces.
- Cleaning solution and medication prescribed.
- Sterile saline.
- Sterile gloves and mask.
- Adhesive bandages, scissors.
- Waterproof bag for disposal.
- Dressing drum.
- Ether (according to the hospital policy).
- Scissors.
- Mackintosh or underpad.
Procedure
| Nursing Action | Rationale | |
| 1. | Explain the procedure to the patient. | Relieves anxiety and promotes understanding of healing process. |
| 2. | Assemble equipment on a trolley and take it to the bedside. | Prevents waste of time and chance of break in sterile technique by accidental omission of a needed supply. |
| 3. | Provide privacy; switch off the fan. | Reduces air currents that may transfer the microorganisms. |
| 4. | Position the patient comfortably and drape the patient. | Prevent the contamination of wound supplies. |
| 5. | Expose the wound area and instruct not to touch the wound. | Minimizes unnecessary exposure and provides access to wounds. |
| 6. | Perform hand hygiene in an aseptic technique. | Removes the microorganisms. |
| 7. | Wear a clean glove if needed and remove the old dressings, keeping the soiled surface away from the patient. If wound drain is present, remove only a layer at a time. | Prevents dislodging of drains. |
| 8. | If the wound is soiled, place a mackintosh or underpad under the wound before irrigation. | To prevent soiling of linen. |
| 9. | Pour sterile saline over the wound dressing if adhering gauze piece needs to be removed. | Prevents pain and bleeding from the tissue. |
| 10. | Open the dressing pack; arrange the articles; pour the solution; open the sterile glove; put it in; and close the pack without contamination. | To prevent contamination. |
| 11. | Perform surgical hand washing; wear sterile gloves. | Reduces transmission of microorganisms. |
| 12. | Using artery clamp, remove the adhered gauze. | For easy removal. |
| 13. | Observe the character of wound and amount of drainage. | Provides an estimate of the amount of drainage and assessment of wound condition. |
| 14. | Use separate gauze piece for each stroke. | Prevents transmission of microorganisms. |
| 15. | Move in progressive strokes away from incision line or wound edge; if it is a diabetic wound or infected wound, the center of the wound is considered as unclean; hence, strokes should be from periphery to center. | Prevents introduction of microorganisms. |
| 16. | Use dry gauze to clean the incision line. | Reduces moisture which harbors organisms. |
| 17. | Apply loose woven gauze as a contact layer. | Promotes proper absorption of drainage. |
| 18. | Clean around the drain in a circular manner; secure a sterile gauze around the drain insertion site. | Secures its placement. |
| 19. | Apply ointment if advised and apply a surgical pad. | For absorption of drainage. |
| 20. | Secure dressing with bandages/ adhesive tapes. | For proper placement of dressing and protection of the wound. |
| 21. | Wash hands and replace the articles. | Prevents transmission of microorganisms. |
| 22. | Document time, date, condition of the wound, presence of discharge, and comfort of the patient. | Helps in assessing the wound healing process. |
Removal & Healing
Drains are typically removed when output is <30 mL/day for 2 consecutive days or after 3 weeks post-op. Removal may cause slight discomfort but is usually quick. The site is then dressed and monitored for healing.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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