Surgical Tube Drains

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Drains

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are typically used after GI surgeries and are placed near the incision where drainage is expected. Drains are also a method of collecting drainage for measurement, keeping the incision and area surrounding skin dry while helping to prevent infections.

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3 types of drainage systems

-closed drainage system
-open drainage system
-suction drainage system

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> closed drainage system is a system of tubing or other apparatus that is attached to the body to remove fluids in an airtight circuit that prevents any type of environmental contaminants from entering the wound or area being drained.

>The open drainage system is a tube or apparatus that is inserted into the body and drains out onto a dressing.

>Lastly the suction drainage system uses a pump or mechanical device to help pull the excessive fluid from the body.

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Types of drains

(vary depending on the type of surgery done, type of drainage needed, type of wounds, and how much drainage may be expected.)

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Penrose drain

T-Tube drain

Jackson Pratt (JP) drain

Hemovac drain

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Penrose Drain

-It is a length of tubing made of flexible, soft rubber and causes little tissue reaction.

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Penrose drain is an open drainage system that is placed on the incision line. The drainage will then collect onto the dressing, letting gravity work to pull the drainage out.

*most commonly used.

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Special Skin & Wound Care

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1. Maintain placement of the drain by securing a large safety pin on the tube outside the wound to prevent displacement of the drain.

2. Check the dressing to see if it is damp. Remove the damp dressing and clean the area around the drain and incision. Apply a new dressing change or gauze after this. Weigh the soaked dressing for documentation.

3. Pull the tube out and cut it shorter as the wound heals. Anchor the tube with a safety pin after cutting.

4. Assess the wound area by checking for signs of infection and drainage. Record the amount, color, consistency, and odor of any drainage. Make sure the drain is patent or free of any blockage.

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T-Tube
(biliary draining tube.)

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T-Tube drain is used for mostly for patients who have undergone gallbladder surgery or surgery of the surrounding tubes draining the gallbladder. This type of drainage most resembles a T and drains into a collection bag.

>The tube facilitates biliary drainage during healing.

>The surgeon inserts the short end (crossbar) into the common bile duct and draws the long end through an incision in the skin. The tube is then connected to a closed gravity drainage system.

>Post-operatively it remains in place between 7 to 14 days.

>Before taking out the T-tube, an X-ray is done to make sure that the duct has healed and if stones were present none remain.

>If there are any stones, they will be removed through the tube tract.

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Emptying drainage (T-Tube)

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>Put on clean gloves

>Place the graduated collection container under the outlet valve of the drainage bag. Without contaminating the clamp, valve, or outlet valve, empty the bag’s contents completely into the container and reseal the outlet valve.

>Carefully measure and record the character, color, and amount of drainage.

>Discard gloves

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Clamping the T-tube

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>As ordered, occlude the tube lightly with a clamp or wrap a rubber band around the end. Clamping the tube 1 hour before and after meals diverts the bile back to the duodenum to aid digestion.

>Monitor the patient’s response to clamping.

>To ensure the comfort and safety, check the bile drainage amounts regularly.

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Nursing Interventions (T-Tube)

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>The T-tube usually drains 300 to 500 ml of thin, blood tinged bile in the first 24 hours after surgery.

>To prevent excessive bile loss over 500ml in the first 24 hours or backflow contamination. Bile will flow into the bag only when biliary pressure increases.

>Provide meticulous skin care and frequent dressing changes since bile is irritating to the skin.

>Monitor for bile leakage, which may indicate obstruction.

>Monitor tube patency and the condition of the site hourly for the first 8 hours.

>Protect the skin edges and avoid excessive taping.

>Monitor all urine and stools for color changes.

>Reinforce with the patient that loose bowel occur commonly the first few weeks after surgery.

>Remind the patient about signs and symptoms of T-tube and biliary obstruction and to report them to physicians.

>Teach the patient how to care for the tube at home.

>Reinforce with the patient that the bile stains clothing and is irritating to the skin.

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Jackson Pratt Wound Drain
(JP Drain)

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Jackson Pratt (JP) drain is another closed drainage system that also uses suction to pull the drainage from the incision into a collection bulb.

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Emptying drainage (JP Drain)

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Empty the bulb when it is half full or every 8 to 12 hours.

Wash your hands with soap and water.

Remove the plug from the bulb.

Pour the fluid into a measuring cup.

Clean the plug with an alcohol swab or a cotton ball dipped in rubbing alcohol.

Squeeze the bulb flat and put the plug back in. The bulb should stay flat until it starts to fill with fluid again.

Measure the amount of fluid you pour out. Write down how much fluid you empty from the JP drain and the date and time you collected it.

Flush the fluid down the toilet. Wash your hands.

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When will my Jackson-Pratt drain be removed?

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The amount of fluid that you drain will decrease as your wound heals.

The JP drain usually is removed when less than 30 milliliters (2 tablespoons) is collected in 24 hours.

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What are the risks of having a Jackson-Pratt drain?

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maybe PAINFUL.

may have trouble lying on the side with your JP drain.

JP drain site may leak.

may be pulled out by accident.

The tubing may get blocked, crack, or break.

The tubing may damage your tissue.

may have scar

drain site may get infected and spread inside ur body.

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Watch out for? (JP Drain)

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You drain less than 30 milliliters (2 tablespoons) in 24 hours. This may mean your drain can be removed.

You suddenly stop draining fluid or think your JP drain is blocked.

You have a fever higher than 101.5°F (38.6°C).

You have increased pain, redness, or swelling around the drain site.

You have questions about your JP drain care.

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Call Doctor if:

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• pain, swelling, or fluid around tube
• redness or warmth around the incision
• nausea and vomiting
• chills and fever
• fluid from the incision
• stitches holding the tube becoming infected/loose
• a tube that falls out
• fluid that has a bad smell
• drainage that changes color from light pink to bright
red

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Hemovac

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Hemovac drain is a closed drainage system. The drainage works by suction that pulls the drainage from the body into a collection tank.

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Emptying drainage (Hemovac)

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• lift cork (drain will expand) turn upside down and
drain fluid

(When empty…)
• place on hard surface and press down until it is flat
• reclose corking device
• never put anything in the drain to clean it

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Changing Your Dressing (Hemovac)

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Clean your hands with soap and water or an alcohol-based hand cleaner.
Put on clean (not sterile) medical gloves. Loosen the tape carefully, and take off the old bandage.
Throw the old bandage into a plastic trash bag. Look for any new redness, swelling, bad odor, or pus.

Use a cotton swab dipped in the soapy water to clean the skin around the drain. Do this 3 or 4 times, using a new swab each time.

Take off the first pair of medical gloves and put them in the plastic trash bag. Put on the second pair.

Put a new bandage around the site where the drain goes in.
Use surgical tape to hold it down against your skin. Tape the tubing to the bandages.
Throw all used supplies in the trash bag.
Wash your hands well.

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Call the Doctor if:

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The stitches that hold the drain to your skin are coming loose or are missing.
The tube falls out.
Your temperature is higher than 100 °F, or 38.0 °C.
Your skin is very red where the tube comes out (a small amount of redness is normal).
There is drainage from the skin around the tube site.
There is more tenderness and swelling at the drain site.
Your drainage is cloudy or has a bad odor.
Drainage increases for more than 2 days in a row.
The drainage suddenly stops after there has been constant drainage.

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Charting about Wound Drains.

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Nurses should make sure to note the consistency, odor, color and amount of drainage.

Noting the amount of drainage from a drain system is fairly easy if it enters into collection unit, by pouring the drainage into a measuring device.

*When a Penrose drain system is used the nurse should weigh the dressings that the drainage is draining onto it and note the weight of the dressing in her notes.

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Types of Exudate/Drainage:

Exudate is when cells, fluids or other substances have slowly exuded from cells or blood vessels through breaks in the cell membrane or small pores.

Drainage is the removal of fluids from a wound, body cavity or other source of discharge through one or more methods.

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Serous - (white) Clear, watery fluid that has separated from its solid element.

Serosanguineous - (pink) Fluid that contains blood

Sanguineous - (red) Thin, red, composed of both of serum and blood.
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Pus, purulent drainage is not a normal finding in an incision.

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Wound Assessment

-location
-size
-condition, color & temp
-type of tissue found
-wound drainage
-odor

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1. Document anatomic location of the wound.

-Size of wound (greatest length x greatest width) in cm.

Greatest depth is measured by placing a cotton-tipped applicator into the wound at the deepest point, marking the applicator at the skin level, then comparing the applicator to a ruler.

To assess for tunneled areas, use a moistened cotton-tipped applicator to probe the wound periphery, and document the location and depth of these tunneled areas. The position of the tunneled area is described according to a clock face location, in which the patient's head represents noon.

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Wound Assessment


-location
-size
-condition, color & temp
-type of tissue found
-wound drainage
-odor

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2. Describing the condition, color and temperature.

-Use correct terminology to describe your findings, such as ecchymosed (bruised), erythematous (red), indurated (firm), edematous (swollen).

Wound edges must also be carefully defined.

Wound edges can be described:
-diffuse,
-well defined or
-rolled.

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Wound Assessment


-location
-size
-condition, color & temp
-type of tissue found
-wound drainage
-odor

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3. Describe the types of tissue found in the wound.

-Normal granulation tissue has a beefy, red, shiny and textured appearance that bleeds easily.

-Necrotic tissue is usually gray and soft and is called slough. Black-gray, hard leathery tissue is referred to as eschar.

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Wound Assessment


-location
-size
-condition, color & temp
-type of tissue found
-wound drainage
-odor

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Note the amount, color and consistency of wound drainage (exudate).

Drainage can be serous (clear), serosanguinous (blood-tinged) or sanguinous (bloody).

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Wound Assessment


-location
-size
-condition, color & temp
-type of tissue found
-wound drainage
-odor

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Odor in wounds is a significant diagnostic tool. Blue-green drainage combined with a musty odor usually indicates presence of Pseudomonas in the wound.