This presentation is about surgical drains and the techniques of draining the surgical wounds. Advancements in the surgical drains are also discussed and mentioned.

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2. Surgical Drains & its
Recent Advancements
By Dr. Hakeem Ullah
(TMO SDW LRH)
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3. Contents
 Introduction
 Why to Drain ?
 Classification
 Advantages/Disadvantages
 Ideal Drain
 General Guidance
 Removal
 Evidence and Controversy
 Mechanical Problems of Drains
 Recent Advancements
 Conclusion
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4. Introduction
 A drain is a tube to allow fluid or air that might collect at an
operation site or in a wound to drain freely to the surface.
 The fluid to be drained may include – Blood, serum, pus,
urine, faeces, bile or lymph.
 It can be used for longer or short periods.
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5. Why to Drain ?
 To allow wound irrigation in certain specific circumstances.
( reduce - haematoma formation )
 To prevent an excessive amount of blood and fluid that
collects in the cavities of the body, and around organs that
may delay wound healing.
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6. Classification of Drains
Surgical Drains can be classified as:
 Open and Closed
 Active and Passive
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7. Classification (Continued)
Open Drains
 Include corrugated rubber or
plastic sheets.
 Drain fluid collects in gauze
pad or stoma bag.
 They increase the risk of
infection.
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9. Classification (Continued)
Closed Drains
 Consist of tubes draining into
a bag or bottle.
 They include chest and
abdominal drains.
 The risk of infection is
reduced.
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12. Classification (Continued)
Active Drains
 Active drains are maintained under suction
 They can be under low or high pressure
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13. Classification (Continued)
Passive Drains
 Passive drains have no suction
 Function by the differential pressure between body
cavities and the exterior
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14. Comparison of Active & Passive Drains
Active Drain Passive Drain
Function Works by negative pressure
created by compressible
drums or mechanical
evacuation system
Depends upon pressure
differentials & gravity
Pressure Gradient Negative Pressure Normal
Drain Exit Site Dependent Position is not
necessary
Dependent position for best
function
Retrograde Infection Lower incidence Higher incidence
Fluid Collection Decreased incidence
because negative pressure
improves tissue apposition
& obliterates dead space
Increased incidence
because of limited effect on
dead space
Obstruction of Drain More common Less common
Pressure necrosis Greater incidence Less common
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15. Advantages of Drain
 Removal of any intraperitoneal or wound collection of ascites,
serum, bile, chyle, pancreatic or intestinal secretions.
 Act as a signal for any post-op. hge or anastomotic leakage.
 Provides a track for later drainage.
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16. Disadvantages of Drain
 Presence of a drain increases the risk of infection.
( intra-abdominal & wound )
 Drains may induce an anastomotic leak.
 Increase abdominal pain.
 Increase hospital stay.
 Decrease pulmonary function.
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17. Ideal Drain
An ideal drain should be….
 Drain should be firm, not too rigid.
 It should not be too soft as it may twist or kink or become
blocked.
 It should be smooth.
 It should be resistant to decomposition or disintegration.
 Wide and patent enough to prevent easy blockage.
 It should be non electrolyte non carcinogenic and
thrombogenic when used in vascular surgery. 17

18. General Guidance
 If active, the drain can be attached to a suction source (and set
at a prescribed pressure).
 Ensure the drain is secured (dislodgement is likely to occur
when transferring patients after anaesthesia). Dislodgement can
increase the risk of infection and irritation to the surrounding
skin.
 Accurately measure and record drainage output.
 Monitor changes in character or volume of fluid. Identify any
complications resulting in leaking fluid (particularly, for
example, bile or pancreatic secretions) or blood.
 Use measurements of fluid loss to assist intravenous
replacement of fluids.
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19. Removal
 Generally, drains should be removed once the drainage has
stopped or becomes less than about 25 ml/day. Drains can
be 'shortened' by withdrawing them gradually (typically by
2 cm per day) and so, in theory, allowing the site to heal
gradually. Usually drains that protect postoperative sites
from leakage form a tract and are kept in place longer
(usually for about a week).
 Warn the patient that there may be some discomfort when
the drain is pulled out.
 Consider the need for pain relief prior to removal. 19

20. Removal (Continued)
 Place a dry dressing over the site where the drain was removed.
 Some drainage from the site commonly occurs until the wound
heals.
 When to remove:
 Drains left in place for prolonged periods may be difficult to
remove.
 Early removal may decrease the risk of some complications,
especially infection.
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21. Evidence & Controversy
 There is insufficient evidence from randomised controlled trials
(RCTs) to support the routine use of closed suction drainage in
orthopaedic surgery. Further RCTs with larger patient numbers
are required for different operations before definite conclusions
can be made for all types of orthopaedic operations.
 Despite the paucity of clinical evidence demonstrating any
benefit supporting their use, drains continue to be placed after
elective orthopaedic procedures.
 The routine use of drains may be abandoned in uncomplicated
thyroid surgery.
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22. Evidence & Controversy (Continued)
 The routine use of a suction drain is unnecessary after an
uncomplicated total joint arthroplasty.
 There are insufficient studies which compare differing methods
of chest drain clearance to support or refute the relative efficacy
of the various techniques in preventing cardiac tamponade. The
need to manipulate chest drains can neither be supported nor
refuted by results from RCTs.
 The optimal time to remove drains after total joint arthroplasty
is 24 hours.
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23. Evidence & Controversy (Continued)
 Pelvic drainage may act as an early detector of anastomotic leaks
and reduce the need for re-operation in selected patients
undergoing rectal cancer surgery. However, others consider that
leaks usually occur after drains have been removed and that
they are not useful in this way.
 Drain use after elective laparoscopic cholecystectomy increases
wound infection rates and delays hospital discharge. Evidence
to support the use of drain after the following procedures could
not be found:
 Laparoscopic cholecystectomy.
 Open cholecystectomy.
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24. Evidence & Controversy (Continued)
 Evidence for drains reducing infection and haematoma
formation after breast surgery is inconsistent.
 There is insufficient evidence showing that routine
drainage after colorectal anastomoses prevents
anastomotic and other complications.
 Damage may be caused by mechanical pressure or suction
and drains may even induce an anastomotic leak.
 Drains are not a substitute for good surgical technique.
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25. Mechanical Problems of Drains
 Trauma to tissues.
 Erosion of adjacent tissues, may lead to perforation or fistula
formation, haemorrhage.
 Herniation of viscera through the drain tract.
 Anastomotic leak- drains are sometimes placed near
anastomoses.
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26. Recent Advancements
 Several attempts have been made to improve the functionality
and reduce significantly, complications associated with the use
of drains in surgery. Thus, over the few years, major advances
in surgical drains have been recorded in the following
areas.
1. Drains with one way entry valves to secure against reflux of
contaminated fluid from reservoir have now been developed.
2. Bottom drainage ports placed at the opposite end of the
reservoir from entrance port, to prevent contamination, and
ease the emptying process.
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27. Recent Advancements (Continued)
3. Soft, supple and low profile drains to enhance easy positioning
and conformation to anatomical curvatures.
4. Multiple sump lumens to create high internal flow rates
that accelerate fluid removal without applying excessive or
traumatic suction to delicate tissues.
5. Dual lumen to allow introduction of saline, anesthetic or
use as a sump.
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28. Recent Advancements (Continued)
6. Rotating garment clips to bring about convenience to care
giver and increase mobility to the patient have been
developed.
7. The use of variable sizes of drains with special
specifications to meet specialist demands is expanding
rapidly .
8. Non-clogging silicone formulation has solved the problem of
clot build-up. The high flow through accelerates fluid
movement without excessive suction.
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29. Recent Advancements (Continued)
9. Anti-thrombogenic coating of drains (both internally and
externally) provides surfaces with lowest coefficient of
friction. It makes insertion and removal easier and reduces
the problem of adjacent tissue trauma or erosion.
10. Further efforts are in place to provide surgeons the needed
specificity, functionality and greater flexibility in their
selection of drain systems. The drainage need of all
surgical specialties is intended to be met by offering the
widest range of sizes, options and specialty specific
features.
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30. Conclusion
 There are a variety of factors which are very important for the
use of surgical drains but surgeons should understand the
benefits and application of drains and the tissue responses
to the constituent material so as to prevent some of the
commonly seen complications. Three questions are essential
and serve as a basic frame work which must be considered
when deciding on the value of surgical drains.
 1. What purpose would a drain serve if placed?
 2. What type of drains should be used?
 3. How long should the drain be left in place?
 Once these questions are carefully and adequately answered
each time a drain is used, the effectiveness and advantages can
be maximized with minimal problems. 30

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