Drains Used in Abdominal Surgery

Effective management of surgical drains is crucial for optimal recovery in patients undergoing abdominal surgery. Here is an overview of drain management practices, including specific types like Robinson, Pigtail, and Chest drains.

  1. Penrose Drain:
    • Description: A soft, flat, latex tube.
    • Indication: Used for simple drainage of abscesses or post-operative wound drainage.

2. Jackson-Pratt (JP) Drain:

  • Description: A bulb suction drain connected to a small, flexible tube.
  • Indication: Commonly used in abdominal surgeries for the drainage of serous or bloody fluid.

    3. Hemovac Drain:

    • Description: A spring-action drain that uses negative pressure to remove fluid.
    • Indication: Used in surgeries requiring moderate to high drainage output.

      4. T-Tube:

      • Description: A T-shaped tube placed in the common bile duct.
      • Indication: Used after biliary surgery to drain bile.

        5. Robinson Drain:

        • Description: A multipurpose drain made of silicone or rubber, often used with a closed suction system.
        • Indication: Commonly used in abdominal and thoracic surgeries for effective fluid evacuation.

          6. Pigtail Drain:

          • Description: A catheter with a coiled (pigtail) tip to prevent dislodgement, connected to a drainage bag.
          • Indication: Used for draining abscesses, pleural effusions, or other fluid collections.

            7. Chest Drain:

            • Description: A tube inserted into the pleural cavity to drain air, blood, or other fluids.
            • Indication: Used for managing pleural effusions, pneumothorax, haemothorax, or post-thoracic surgery.

              Indications for Drain Placement

              • Postoperative Monitoring: To monitor and manage fluid accumulation, including blood, bile, and ascitic fluid.
              • Prevention of Infection: Reducing the risk of abscess formation or infection by allowing drainage of infected material.
              • Facilitating Healing: Reducing the pressure in the surgical site to promote healing and reduce complications such as seromas and hematomas.

              Management of Drains

              1. Assessment and Monitoring:

              • Drain Output: Measure and document the volume and nature of drainage (e.g., serous, sanguineous, purulent).
              • Colour and Consistency: Note the colour and consistency of the drainage, as changes may indicate complications.
              • Patency: Ensure that the drain is patent and not kinked or obstructed. Check for blockages or clots.

              2. Drain Care:

              • Securing the Drain: Ensure that the drain is securely taped or sutured to prevent dislodgement.
              • Infection Control: Maintain sterile technique when accessing or changing the drainage system. Use appropriate dressings to cover the drain site.
              • Site Care: Regularly inspect the drain insertion site for signs of infection, such as redness, swelling, or discharge. Keep the area clean and dry.

              3. Fluid Management:

              • Monitoring Fluid Balance: Record the input and output of fluids accurately to monitor for fluid imbalance or electrolyte disturbances.
              • Suction Management: For drains requiring suction, adjust the suction level according to the surgeon’s protocol and clinical guidelines.

              4. Removal of Drains:

              • Timing: Drains are usually removed when the output is minimal and the site is healing well.
              • Procedure: Ensure the procedure is performed under sterile conditions. Apply gentle pressure to the site after removal to prevent bleeding.

              Complications Associated with Drain Management

              • Infection: Signs include fever, increased redness, swelling, and purulent drainage at the site.
              • Dislodgement or Kinking: Ensure the drain remains in place and is not obstructed.
              • Bleeding: Monitor for signs of bleeding or haemorrhage at the drain site.
              • Blockage: Regularly check for clots or debris in the drain tubing.

              Best Practices for Drain Management

              • Education and Training: Ensure all nursing and medical staff are trained in proper drain management techniques.
              • Documentation: Keep thorough records of drain output, patient observations, and any interventions performed.
              • Multidisciplinary Approach: Collaborate with surgeons, intensivists, and wound care specialists to optimise patient care.

              References