If you plan on transferring to critical care or med/surg, you'll quickly learn that drains come with the territory. In fact, postop patients who undergo orthopedic, cardiac, or general surgery often come back from the OR with more than one. That's because drains serve a necessary function postop: They promote healthy wound healing, prevent infection, and reduce pain.
But don't be fooled. While drains are helpful, they're not innocuous. In this review, we'll cover some of the most common postop drains and how to properly manage patients who have them.
Different drains do different things
Drains remove blood, serum, lymph, and other fluids that accumulate in the wound bed after a procedure. If allowed to build, these fluids put pressure on the surgical site as well as adjacent organs, vessels, and nerves. The decreased perfusion delays healing; the increased pressure causes pain. In addition, a buildup of fluid serves as a breeding ground for bacteria.
Fluid can be removed from a wound using either a passive or active surgical drain. Passive drains rely on gravity to evacuate fluid, while active drains are attached to a vacuum device or wall suction. A surgeon chooses a drain that both fits the operative site and can handle the type and amount of drainage expected. For instance a T-tube is a fairly large passive drain that's typically placed during a cholecystectomy to accommodate the 200 – 500 ml of bile that's expected to accumulate in the early postop period.
The Penrose is another passive drain. But it's usually placed to manage much smaller amounts of drainage. That's good, because it's typically left open, meaning its free end, which protrudes a mere inch above the skin, isn't usually attached to a bag or pouch to collect the drainage. Instead, fluid from the wounds seeps out onto a gauze pad.
Active drains like the Jackson-Pratt (JP) and Hemovac always have a drainage collection reservoir attached. Drains that have some type of pouch are often called closed systems. Unlike the Penrose, which looks like a large limp straw, the tubing on a JP or Hemovac is a little stiffer so that it won't flatten under the pressure exerted by suction. The tips of these drains are fenestrated, meaning they have multiple holes to facilitate draining.
In any case, a drain may exit a wound through the suture line or from a small opening near the incision.
Complications: Anticipate and limit them
The downside of a drain is that it can be painful going in and coming out. For that matter, it can be painful just sitting in the wound. That's because the drain destroys nearby tissue that it rubs up against. A drain also provides a pathway for bacteria to get into the wound.
In fact, the risk of infection from a drain rises significantly by the third or fourth day postop, and so does the degree of mechanical damage to local tissue. To minimize these problems, the surgeon will place a drain so that it reaches the skin by the shortest, safest route. That way the drain exerts the least amount of pressure on adjacent tissue.
However, to be effective, a drain also has to reach the deepest, most dependent area of a wound to adequately evacuate excess fluid. Unfortunately, the deeper a drain goes, the greater the risk of complications.
And because the drain is foreign, the body quickly starts to wall it off by encasing it in granulation tissue. This can hamper the drain's ability to function, so making sure that it's patent is part of basic care.
Follow the basics for all drains
A systematic approach to drain care can limit complications and ensure the best outcome for the patient. It helps to first label each drain with a number for easy identification, and consistency in documentation. Note the location and type of fluid that ought to be draining from each.
Next, you will need to monitor drainage for color, consistency, and quantity of drainage. During the initial postop period, drainage tends to be sanguineous, which is dark red and thick from leftover blood around the operative site.