CHAPTER CONTENTS

Caution 171 Types 172

Packs and wicks

Sheet drains 172 Tube drains 173

Sites 174

Subcutaneous 174 Subfascial and intramuscular 175 Extraperitoneal 175 Intraperitoneal 175 Pleural cavity 176

Abscesses and cysts 177 External fistulas 177 Negative pressure wound healing 177

Abnormal accumulation of fluids – liquid, vapour or gas – may have deleterious effects from, for example, the space they
occupy, pressure they exert, tracking within the tissues, susceptibility to infection or spread of existing infection, or
absorption of toxic substances.

1. The value of most drains is hotly debated. As a trainee, follow the practice of the consultant who is
responsible for the patients and watch the outcome so that you can draw your own conclusions about their
value.
2. The use of drains can often be avoided by delaying operations if there is swelling that can be allowed to
settle, by taking extra care over haemostasis, closure of vessels and ducts, and elevating parts to prevent the
build-up of fluid swelling. In some cases the possible source of a collection can be brought to the surface.

3. In some circumstances drains are inserted as sentinels to warn of complicating blood or fluid discharge –
but they are unreliable.
4. Drains can be used to bring together or keep together surfaces that would be separated by intervening
fluids, such as air in the pleural cavity or oozing of blood from apposed raw surfaces.
5. In some cases the source can be brought to the surface where it can discharge and if the fluid to be drained
is within a tube, a stoma can be formed.

172

Key points

 The value of drains is hotly debated.

 Proponents claim they remove harmful fluids, monitor

complications and do little harm.

 Opponents claim they cause irritation, perpetuate

discharge and offer an inward track for contamination.

CAUTION

1. In the absence of scientific knowledge or extensive personal experience, use drains where orthodox practice favours them.

2. As a trainee, follow the practice of your chief, but observe the results so you can develop your own views. 3. Use the
softest and least irritant materials; ensure the

drain does not press on damaged, delicate or vital

structures, or suture lines.
4. If there is a main wound, prefer to bring the drain

to the surface through a separate wound, to avoid prejudicing the healing of the main wound.

171

Chapter
Handling drains

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5. When possible make the track lead outwards and downwards to benefit from gravity drainage. When this is
not possible and you must lead a drain down to a sump and suck it out, ensure that the drain tip reaches the
lowest point, where fluid is likely to collect.
6. Whenever possible used a closed system to avoid the possibility of inward contamination.

TYPES
Packs and wicks

1. Gauze packs are sheets of sterile cotton gauze

(Fig. 11.1), placed on a raw surface where discharge is expected to occur over a wide area, such as an
abscess cavity, a laid-open superficial fistulous track, or as an initial treatment of an infected wound. It
soaks up fluid most effectively if it is dry but some surgeons prefer it moistened with sterile isotonic saline
solution or antiseptic solution. Unfortunately it needs to be changed frequently.
2. Gauze in contact with raw tissues soon adheres
as it is invaded with fibrin threads. You can avoid this by soaking it in sterile liquid paraffin alone or
emulsified with an antiseptic such as flavine. This destroys its ability to soak up fluid, which now tracks
between the pack and the raw surface. As

an alternative, first lay on a thin non-adherent net of tulle gras (F tulle = net + gras = fat), or a plastic
substitute.

3. The absorbent pack may be overlaid with cotton wool so that it can be compressed with crepe bandage,
a corset or by means of elastic adhesive strapping. Compression may reduce oozing and oedema. Since the
cotton wool is intended to remain dry and elastic

Fig. 11.2 Gauze wick. This is a folded gauze sheet or ribbon, passed down a track to keep the track open.

to distribute the pressure evenly, make sure that

it does not get soaked or it will form a hard cake; moreover, a completely soaked pack forms a moist channel for
microorganisms from the exterior to the raw surface.

4. When the source of discharge cannot be brought to the surface, a wick of folded gauze or a gauze ribbon can be passed
down to it (Fig. 11.2). It may block rather than hold open the channel. It is fully effective only until the gauze is soaked;
thereafter it lies moistly and inertly in the channel. To avoid the wick becoming adherent to the tissues it may be passed
through a thin-walled latex tube open at both ends (Fig. 11.3) – a so-called ‘cigarette drain.’ For very small tracks, twisted
threads are sometimes inserted.
Sheet drains

1. A track may be kept open by inserting a sheet of latex rubber or plastic material (Fig. 11.4), which is often
corrugated to create spaces. Alternatively, a Yeates drain (Fig. 11.5) comprises parallel plastic tubes.
However, these are inert and fluid reaches the surface by gravity or vis a tergo (L = push from behind),
where it must be soaked up by gauze packs. Fix them to prevent them from slipping into the wound by
stitching them to the skin and also placing a large safety pin through the projecting portion.
2. Although these are not very effective, they are popular for the drainage of abscess cavities and to provide a
track in case there is any subsequent discharge.