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Drains - Vasanjee 4

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78 views40 pages

Drains - Vasanjee 4

Uploaded by

baronvdw
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Surgical Drains:

Indications, Types, & Principals of


Use

Sunil C. Vasanjee, BVSc


Companion Animal Surgery Resident
LSU SVM / VTH&C
vasanjee@vetmed.lsu.edu
Learning Objectives
 Goals / Indications for Use
 Why use a drain ?
 Types
 What are the major types of drains and how
do they work ?
 Principals of Use
 Which drain to use ?
 What are the complications ?
Goals
• Decrease Infection Rate
• Decrease Healing Time
Indications
1. To help eliminate dead space

2. To evacuate existing accumulation of fluid or


gas

3. To prevent the potential accumulation of


fluid or gas
Drain Types
 Flat
• Dependent on gravity and
capillary action
• Drainage related to surface
area
• Penrose - latex
Drain Types
 Flat drains - Penrose
 Advantages
 Allow drainage
 Help obliterate dead space
 Soft / malleable – less painful
 Disadvantages
 Very irritating
 Allow bacterial ingress
 Cannot be connected to suction
 Gravity dependent
Drain Types
 Tube
• Single lumen
• +/- side holes
• Silicone, polyvinyl
chloride, red rubber
Drain Types
 Tube drains
 Advantages
 Drain from both within and outside of lumen
 Can be connected to suction
 Can be used with closed collection system

 Disadvantage
 Discomfort due to stiffness
Drain Types
 Double lumen
 Sump drains –
open/open suction
 Drainage of fluid via
large lumen
AIR
 Sump lumen –
FLUID
smaller and allows
AIR
ingress of air
Drain Types
 Double lumen
 Advantages
 More efficient than single lumen
 Maintain patency longer than single lumen

 Disadvantages
 Risk of contamination of wound as
environmental air drawn in – reduced with
filter
Drain Types
 Passive
 Active
 Continuous suction
 Intermittent suction
Passive Drains
 Passive
 Drain by means of pressure
differentials, overflow, and gravity
 Provides a stent that keeps a draining
tract / cloaca open
 Allow egress via a path of least
resistance
 Flat or with a lumen
 Open or Closed – Closed preferred
Passive Drains
 Passive closed
 Advantages
 Allow evaluation of volume and
nature of fluid
 Prevent bacterial ascension
 Eliminate dead space
 Help appose skin to wound bed –
quicker wound healing
 Disadvantages
 Gravity dependent – affects location
of drain
 Drain easily clogged
Active Drains
• Vacuum pulls fluid / gas from the
wound
• Closed to atmosphere = Closed
suction
• Vacuum applied to a single lumen
tube
• Not gravity dependent
Active Drains
Active Drains
 Advantages
 Keep wound dry – efficient fluid removal
 Can be placed anywhere
 Prevent bacterial ascension
 Help appose skin to wound bed – quicker wound
healing
 Allows evaluation of volume and nature of fluid
 Disadvantages
 High negative pressure may injure tissue
 Drain clogged by tissue
Principals of Ideal Use
 Aseptic site preparation (clip, scrub, debride, lavage)
 Place to avoid anastomosis sites and major vessels
 Exit through separate stab incision, away from surgical
incision
 Aseptic postoperative management (cover with sterile
bandage, change before strike through, clean & dry
cage)
Principals of Ideal Use
 Protect from premature removal
or loss – E-collar
 Remove as soon as possible -
drainage decreases or fluid
changes character (2 – 5 days)
 Bacterial culture on removal
Complications and Failure of Drains

 Poor Drain Selection

 Poor Drain Placement

 Poor Post-operative Management


Complications and Failure of Drains
 Infection
 Ascending bacterial invasion
 Foreign body reaction
 Decreased local tissue resistance
 Bacterial hiding places
 Poor placement – fluid accumulation, drain kinked
 Poor postoperative management
Complications and Failure of Drains
 Discomfort / Pain
 Thoracic Tubes – diameter too large
 Stiff tubing
 Inefficient Drainage
 Exiting in non-dependent locale (passive drains)
 Kinked tube
 Obstructed
 Poor drain selection – diameter too small to remove
viscous fluid
Complications and Failure of Drains
 Breakdown of anastomotic sites
 Erosion into hollow organs (firm drains)
 Incisional dehiscence / hernia
 Poor placement
 Premature Removal
 Accumulation of fluid
Abdominal Drains
 Controversial!  Passive closed
systems
Wound Drainage
 The “I will never use a
Penrose drain”
promise
Wound Drainage
 Closed Suction –
Butterfly Catheter +
Vacutainer® Tubes
Wound Drainage
Thoracic Cavity
 Drain Selection  Diameter – Intercostal
Space (ICS)
 Tubular type
Thoracic Cavity
 Drain Selection  8 – 10th ICS
 Placement  Mid-dorsal 1/3rd
Thoracic Cavity
 Drain Selection  Skin incision
 Placement
Thoracic Cavity
 Drain Selection  Curved hemostat
 Placement
Thoracic Cavity
 Drain Selection  Tunnel under skin
 Placement  Cranial 2 ICS
Thoracic Cavity
 Drain Selection
 Placement
Thoracic Cavity
 Drain Selection
 Placement
Thoracic Cavity
 Drain Selection
 Placement

Chinese Finger Trap


Thoracic Cavity
 Drain Selection  Dependent on why
drain placed
 Placement
 Negative pressure
 When do I remove it ?  Often within a few
hours post-operatively
for non-trauma cases
 Significant drop in fluid
production
What NOT to do...
What NOT to do...
What to do...
What to do...
What to do...

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