A Surgical drainage Is a medical method to remove blood, pus or other fluids from an operating site. It can be placed in an abscess, for example, to accelerate the recovery of a localized infection, or in a cyst or seroma, to remove fluids and cells.
The drains can also be inserted into the clogged organs to relieve the pressure resulting from the accumulation of fluid inside the organs.
Drains remove blood, serum, lymph, and other fluids that accumulate in the wound bed after a procedure. If allowed to develop, these fluids exert pressure on the surgical site, as well as on adjacent organs, vessels and nerves.
Decreased perfusion delays healing; Increased pressure causes pain. In addition, an accumulation of liquid serves as a breeding ground for bacteria. The fluid can be removed from a wound using passive or active surgical drainage.
Passive drains are gravity-dependent to evacuate fluid, while active drains are attached to a vacuum or suction device on the wall. A surgeon chooses a drain that fits both at the operating site and can handle the type and amount of drainage expected.
For example, a T-tube is a fairly large passive drain that is typically placed during a cholecystectomy to accommodate the 200-500 ml of bile that is expected to accumulate in the early postoperative period.
Penrose is another passive drain that is usually placed to handle smaller amounts of drainage. That is good, because it is normally left open, that is, its free end, which protrudes an inch above the skin, is not usually connected to a bag to collect the drainage.
Instead, the wound fluid is filtered out onto a gauze pad. Active drains such as Jackson-Pratt (JP) and Hemovac always have a drainage reservoir. Drains that have some type of bag are often called closed systems.
Unlike the Penrose, the ducts in a JP or Hemovac are a little stiffer so they do not flatten under the pressure exerted by the suction. The tips of these drains are fenestrated, which means they have multiple holes to facilitate drainage. In any case, a drainage can leave a wound through the suture line or a small opening near the incision.
Types of Surgical Drainage
Drains can be:
- Open or closed: Open drains (including corrugated or plastic sheets) drain the liquid to a gauze pad or stoma bag. They are likely to increase the risk of infection. Closed drains are tubes that drain into a bag or bottle. Examples include thoracic, abdominal and orthopedic drainage. In general, the risk of infection is reduced.
- Assets or liabilities: Active drains are kept under suction (which may be low or high pressure). The passive drains do not have suction and they operate according to the differential pressure between the body cavities and the exterior.
- We also have Silasic drainage Are relatively inert which induce a minimal tissue reaction and rubber drains which can induce an intense tissue reaction, sometimes allowing a tract to form (this may be considered useful, for example, with bile T tubes).
Complications: Anticipate and limit
The disadvantage of a drainage is that it can be painful to get in and out. Depending on the case, it can be painful simply to sit on the wound. That's because drainage destroys tissue.
A drainage also provides a way for bacteria to enter the wound. In fact, the risk of infection by drainage increases significantly on the third or fourth postoperative day, as does the degree of mechanical damage to the local tissue.
To minimize these problems, the surgeon will place a drain so that it reaches the skin by the shortest and safest route. In this way, the drainage exerts the least amount of pressure on the adjacent tissue.
However, to be effective, a drain also has to reach the deeper and more wound-dependent area to adequately evacuate excess fluid. Unfortunately, the deeper the drainage, the greater the risk of complications. And because the drainage is strange, the body quickly begins to close it in a granulation tissue.
Indications
Surgical drains are used in a wide variety of surgeries. Generally speaking, the intent is to decompress or drain fluid or air from the surgery area.
Examples:
- To prevent the accumulation of fluid (blood, pus and infected fluids).
- Avoid accumulation of air (dead space).
- To characterize the fluid (eg, early identification of anastomotic leakage).
Specific examples of drains and operations where they are commonly used
- Plastic surgery
- Breast surgery (to prevent collection of blood and lymph).
- Orthopedic procedures (associated with increased blood loss).
- Thoracic drainage.
- Chest surgery (with, for example, associated risks of elevated intrathoracic pressure and tamponade).
- Infected cysts (to drain pus).
- Pancreatic surgery (to drain secretions).
- Biliary surgery.
- Thyroid surgery (concern about hematoma and hemorrhage around the airways).
- Neurosurgery (where there is a risk of increased intracranial pressure).
- Urinary catheters.
- Nasogastric tubes.
The management is governed by the type, purpose and location of the drainage. It is usual to follow the preferences and instructions of the surgeon. A written protocol can help room staff with the aftercare of surgical drains.
General orientation
If active, the drain can be connected to a suction source (and set to a preset pressure). Ensure drainage is secured (detachment is likely to occur when transferring patients after anesthesia).
Shedding can increase the risk of infection and irritation of the surrounding skin. Measure accurately and record drainage production. Changes in the character or volume of the fluid should be monitored and any complications resulting in leakage of fluid (particularly secretions of bile or pancreas) or blood should be identified. Fluid loss measurements should be used to aid intravenous fluid replacement.
Elimination
In general, drains must be removed once the drainage has stopped or becomes less than about 25 ml / day. Drains can be"shortened"by gradually removing them (typically 2 cm per day) and thus, in theory, allowing the site to gradually heal.
Generally, drains that protect the postoperative sites from leakage form a tract and are held in place longer (usually for a week). The patient should be warned that there may be some discomfort when the drainage is removed. Early withdrawal of drainage may decrease the risk of some complications, especially infection.
References
- Draper, R. (2015). Surgical Drains - Indications, Management and Removal. 2-2-2017, from Patient.info Website: patient.info.
- Beattie, S. (2006). Surgical drains. 2-2-2017, from Modern Medicine Website: modernmedicine.com.
- Imm, N. (2015). Surgical drains indications. 2-2-2017, from Patient Media Website: modernmedicine.com.