SURGICAL DRAINS.

OLUBODUN GOODNESS
OUTLINE.
• Introduction.
• Types of drains
• Classification of surgical drains.
• Properties of an ideal drain.
• Properties of using a surgical drain.
• Indications for using a surgical drain.
• Care of a drain.
• Removal of of surgical drain.
• Complications of a surgical drain.
• Some specific drains e.g NG tube.
 Introduction.
A surgical drain is any material or device that is used to remove fluid or
air from a body cavity or wound.

TYPES OF DRAINS
Some types of drains are;
-tube drains which include chest tube, catheters, nasogastric tubes
-corrugated rubber drain.
-gauze pack.
-nylon ribbon.
-penrose tube.
-vacuum drainse.g redivav,surgivac
-sheet drain.
TYPES OF DRAINS
Classification of surgical drains
1. Open or Close Drain
2. Active or Passive Drain
3. Internal or External Drain
4. Irritant or Non-irritant Drain

1. OPEN OR CLOSE DRAIN

OPEN DRAIN: the effluent is allowed to flow outside directly and collected with he use
of guaze e.g corrugated rubber drain, penrose, e.t.c

CLOSE DRAIN: this has a recptacle into which the efflunt is collected e.g catheters,
nasogastric tube,chest tube, e.t.c

NOTE: Chest tubes are connected to an under water seal bottlr. NG-tubes and cathters
are connected to a drainage bag
 2. ACTIVE OR PASSIVE DRAIN.
▪︎Passive drain: depends on the gravity and natural forces to drain e.g NG tube.
▪︎Active drain: it uses negative pressure or suction pressure for drainage e.g
suction drain.

3. INTERNAL OR EXTERNAL DRAIN.

▪︎Internal drain: removes effluent from one body cavity into another e.g
ventriculoperitonealshunt.
▪︎External drain: removes fluid or gas from a body cavity to the exterior e.g chest
tubes connected to an under water seal

4. IRRITANT AND NON-IRRITANT DRAIN.

▪ Irritant drains: they are those that provoke tissue reaction along the path they
go through thus leading to fistula formation after they are formed e.g T-tube
used for biliary surgeries can create a fistula through which stones can be
removed
▪︎Non- irritant drains: they do not cause such reactions, once removed the track
PROPERTIES OF AN IDEAL DRAIN.
- Must be sterile.
- Should not be too hard to prevent tissue injury.
- Should be coated with a radio opaque substance so
that it can be easily tracked, especially for internal
drains.
- Must be inert except if it is used as an irritant drain.
- It should not be too soft to prevent it from kinking or
collapsing.
- The tube shouldbe wide enough so that it doesn't
easily get blocked.
PRINCIPLES OF USING A SURGICAL
DRAIN.
- There must be a clear indication for use.
- The drain must be sterile.
- It must be inserted using aseptic procedures.
- It should not stay longer than required.
- To serve its purpose the drain should be wide,
patent and left in situ for an adequate period until
drainage is minimal.
- Must not be too rigid else it damages tissue too soft
else it twists.
- A drain is better passed through a separate opening
than using the surgical wound.
 INDICATIONS FOR USING A DRAIN.

The indications could be:

1. Diagnostic
2. Prophylactic
3. Therpeutic

▪︎Diagnostic indications e.g using a NG tube to make diagnosis of esophageal atresia, upper GI
bleeding, Zollinger Ellison syndrome

▪︎Prophylactic indications e.g

i. use of NG tube to prevent aspiration in a surgical patient with full stomach,
ii use of abdomina drain to monitor:
a. an anastomosis for leakage
b. ongoing haemorrhage followng trauma laparotomy
iii use of Foley's catheter to monitor hourly urine

▪︎Therapeutic indications e.g ventriculoperitoneal (VP shunt) for treatment of hydrocephalus; use
of corrugated drain for an abscess cavity.
 CARE OF A DRAIN.
1. Storage
2.Tube
3. Opening
4. Patient

-Storage: sum of effluent- note the daily volume.

- Tube: The device

• make sure the tube was fixed properly.
• check if tube is still patent.
• note the nature of the current effluent from the tube.

-Open: this is the area of the skin where the tube enters the body
• check if there is any leakage around the tube.
• any skin infection

-Patient: examine the patient completely and check if

• look for signs of improvement
• look for any complications such as fever
REMOVAL OF SURGICAL DRAIN.

- A drain should be removed when it has finished serving its function.

- There are different ways of determining this for different drains and effluents being
drained.
- For purulent drainage, it should have completely stopped before the drain is removed.

COMPLICATIONS OF SURGICAL DRAINS.

- They inconvenient the patient.
- Wound infection.
- Trauma during insertion; may erode a vesssel and cause haemorhage
- They can irritate and induce fluid formation and collection.
- Wound breakdown, especially when brought out from the Wound.
- Breakdown of anastomosis.
-Dislodging,migration
 SOME SPECIFIC DRAINS.

1. Nasogastric tube.
2. Chest tube.
3. Urethral catheter.

NASOGASTRIC TUBE.

This is a tube passed through the nose into the stomach to drain fluid and swallowed air from the stomach e.g Ryle tube.
Types of NG tube
- Simple NG tube.
-Ryle's NG tube.

Indications for NG tube

- Diagnostic
-Prophylactic
-Therapeutic

HOW TO PASS AN NG TUBE

• Get the required material which includes: appropriate sized tube, 20ml syringes, gallipoli with water, lubricant gel, litmus paper and
stethoscope.

• Estimate the length of the tube that will go into the patient; use strategy to trace from the nose to left ear lobe and then to left
hypochondrion.

• Pass the tube after lubicating it's tip, when it gets to the oropharynx some resistance is met, then ask patient to swallow if conscious.
• If not conscious manoeuvre the tube into the esophagus yourself.
• To be sure the tube is in the stomach;
a. use the 20ml syringe to aspirate, test aspirate with litmus paper if it is acidic
b. put the outer end of tube over water in gallipoli if it is in the airway it will bubble
c. inject air into the stomach while listening with the stethoscope over the left hypochondrion- you will hear the entry of air
 CONTRA-INDICATIONS OF NG TUBE.

1.Basal skull fractures;

2.Corrosive esophagitis; there is possibility
of perforation.
3.Perforated esophagus.

REMOVAL OF NG TUBE.
Record the daily volume of effluent also
noting the nature(bilious or not).
Before removal, the effluent should have
cleared and the volume should be below
100-200ml per day in adults, for children
<1-2ml/kg/day.
REFERENCE.
• Clinical surgery tutorial manual by Omoigiade
Ernest Udefiagbon.