CARE OF DRAINS

-ANUSH
M.SC. NURSING 1ST YEAR
 DRAINS
A surgical drain is a tube used to remove pus, blood or other
fluids from a wound, body cavity, or organ. They are
commonly placed by surgeons or interventional radiologists
after procedures or some types of injuries, but they can also
be used as an intervention for decompression. There are
several types of drains, and selection of which to use often
depends on the placement site and how long the drain is
needed.
 Jackson-Pratt drain - consists of a perforated round
or flat tube connected to a negative pressure
collection device. The collection device is typically a
bulb with a drainage port which can be opened to
remove fluid or air. After compressing the bulb to
remove fluid or air, negative pressure is created as
the bulb returns to its normal shape.
 Blake drain - a round silicone tube with channels that
carry fluid to a negative pressure collection device.
Drainage is thought to be achieved by capillary action,
allowing fluid to travel through the open grooves into a
closed cross section, which contains the fluid and allows
it to be suctioned through the tube.
Negative pressure wound therapy -
 Negative pressure wound therapy - Involves the use
of enclosed foam and a suction device attached; this
is one of the newer types of wound healing/drain
devices which promotes faster tissue granulation,
often used for large surgical/trauma/non-healing
wounds.
Redivac drain
 Redivac drain - a high negative pressure drain.
Suction is applied through the drain to generate a
vacuum and draw fluids into a bottle.
 Shirley drain
 Pigtail drain - has an exterior screw to release the internal "pigtail" before it
can be removed
 Davol
 Chest tube - is a flexible plastic tube that is inserted through the chest wall
and into the pleural space or mediastinum
ASSESSMENT OF DRAINS
Initial
 Surgical drains should be assessed 1-4 hourly throughout the shift
 Assess drain insertion site for signs of fluid or air leakage, redness or
irritation to the skin.
 Document site condition and notify treating team and AUM if any
concerns.
 Assess if the drain is maintaining suction
 Assess securement type and document on LDAs.
 Assess patency of drain. Ensure drain is located below the insertion site
and free from kinks or knots.
 Document amount, output appearance, type of fluid in drain
bottle/receptacle and drain status on LDAs
Ongoing
• Monitor for infection. Signs of infection include: redness, tenderness at the drain site, warmth at
site, increased ooze, or a change in collection fluid to purulent, or if the patient is febrile
• Drain patency and insertion site should be observed at the beginning of your shift and before and
after moving a patient. A kinked, disconnected, dislodged or blocked drain tube can lead to
formation of haematoma, increased pain and risk of infection.
• Drainage needs to be documented at a minimum 4 hourly and more frequently if output is high.
This needs to be documented in flowsheets in the sections “Output in previous hours” and
“Chamber reading” so an accurate fluid balance is maintained.
• Suction needs to be assessed throughout the shift. Suction will no longer be maintained once the
drain becomes full. This drain will need to be emptied, changed or suction reapplied.
• Discuss removal plan with treating team. Drains should be removed as soon as practicable, the
longer a drain remains in situ, the higher risk of infection or development of granulation tissue.
This can cause pain and trauma upon removal.
• Pain should be assessed whilst the drain is in situ. Appropriate analgesia should be provided when
necessary. Please refer to the pain assessment and management guideline for more information.
Reinstating Suction
This is dependent on the type of drain. As fluid collects in the drain, the unit either expands or
becomes full and negative pressure is lost. The drain is then ineffective and needs to be emptied or
changed to reinstate suction.
Suction is required unless specifically stated otherwise by treating team.
Redivac: To signal that suction is being maintained the green vacuum indicator on top of the
drain should appear pressed down. If the green vacuum indicator is fully expanded, then the
redivac needs to be changed. Ensure “standard aseptic technique” is utilised when the drain is
changed. If suction is unable to be maintained, the treating team should be notified.
Jackson Pratt: The bulb of the drain will appear like it has been squeezed to demonstrate that
suction is being maintained. If the bulb appears expanded, kink the tube above the bulb, pull
the output. Then squeeze the bulb and insert the plug back into the drain.
Mini-vacuum drain: The bellows can be twisted off from the cap and squeezed together to
increase vacuum.
Bellovac: If there has been no drainage: ensure bellovac is below wound and gently shake
sideways and give bellows 2 quick squeezes to start flow without vacuuming.
Mini-vacuum drain: The bellows can be twisted off from the cap and squeezed together to
increase vacuum
Emptying
Redivac: drain cannot be emptied. Once the drain is full document output into
flowsheets and change drain container.
Jackson-Pratt: kink the tube above the bulb and pull the plug out. Empty the
contents, measure and document output. Then compress or squeeze the bulb and
insert the plug back in to close bulb.
Bellovac: close the clamp above the bellows, ensure the clamp below the
bellows is open. Compress the bellows fully, this can be done slowly and in
stages. The bellows will not re-expand due to the one-way valve. Fluid from the
bellows should drain into the collection bag. Re-open the clamp above the
bellows.
Mini-vacuum drain: only empty if drain is full. Can be twisted off from the cap
to empty output. Output should be minimal and emptying this drain is not
usually indicated. If there is a large amount of output, notify the treating team.
Penrose and Pigtail: gauze or contents in drainage bag should be weighed and
documented in flowsheets
Moving a patient with a drain tube
Assess the patient including all drains and attachment sites prior
to mobilising. Ensuring drains are secured and will not
dislodge/pull on patient.
When appropriate, patient mobilisation with a drain should be
encouraged to reduce risk of DVT and enhance recovery.
Reassess drains post mobilising to ensure dislodgement of
drains has not occurred.
At all times, ensure drainage tube is not entangled with other
leads (IV tubing, O2 leads, etc.) as this could lead to inadvertent
removal of the tube
Leakage
If leakage occurs at a surgical drain site, please notify the treating team
and consider the following:
 Redress or retaping the surgical drain dressing (preferably with an
occlusive dressing) using standard aseptic technique.
 Placing a Coloplast™ drainage bag (2245) over the surgical drain
tubing.
 Consider taking a clinical image on EPIC if deemed necessary.
 Review the wound care nursing guideline for further information.
 Refer patient to Stomal Therapy for further input if necessary.
Inadvertent removal/Drain dislodgement
 If the drain is suspected to have moved position, the
drain should be secured and the treating team notified.
 In the event a drain has been removed or dislodged, a
sterile dressing should be applied and the treating team
notified immediately.
 If the drain is suspected to have receded into the patient,
the treating team should be notified and imaging (x-ray,
etc.) should be performed.
Removal
1. Ensure plan for removal of drain tube is discussed with and ordered by the treating team in the patient’s progress
notes on EMR.
2. Inform patient/parent about removal process and possible associated pain, administer pain relief.
3. Ensure drain is taken off suction:
 Redivac: ensure both clamps are clamped
 Jackson Pratt: pull plug out of bulb and ensure the bulb is fully expanded
 Bellovac: slide the clamp above the bellows up the tubing to the point just below the connection to the catheter
and close it off. Needs to be un-clamped 30 minutes prior to removal to allow the pressure in the catheter to
dissipate
 Mini-vacuum: ensure bellows appears expanded
4. Clean work surface with detergent and prepare waste bag.
5. Perform hand hygiene.
6. Identify and collect all equipment for procedure.
7. Perform hand hygiene.
8. Open aseptic field (small general or large critical) and peel open any additional sterile equipment and drop onto
field.
9. Perform hand hygiene.
10. Prepare patient, use gloves if removing dressings.
11. Remove gloves if worn and perform hand hygiene, if using surgical aseptic technique don
sterile gloves.
12. Perform procedure ensuring all key parts are protected.
13. Sterile items are used once and not returned to the aseptic field; waste is disposed into waste
bag.
14. Clean around the site with normal saline and remove any sutures.
15. Rotate tubing from side to side gently to loosen, then remove the drain using a smooth, but
fast, continuous traction.
16. Immediately apply occlusive dressing with gentle pressure until bleeding or oozing stops.
17. Inspect drain for intactness.
18. If required, cut the tip of the tube for cultures.
19. Remove gloves and perform hand hygiene.
20. Clean work surface, dispose of waste and perform hand hygiene.
21. Document removal of drain and that it is intact/not intact in LDA’s and progress notes as well
as amount of drainage in the flowsheets. If drain is not intact report to treating team and keep drain
for further inspection.
Drain Tube Fractures
If the tube fractures during drain removal and remnants of the tubing is left
within the patient contact the treating team immediately.
The surgical fellow should order an immediate X-ray of the drain tube site.
The patient should be prepared for theatre, inform the parents and consider the
need to keep the child nil by mouth in anticipation for surgical removal of the
remaining drain tube.
The whole drain unit should be kept in the patient’s room until surgical review
and will need to be kept for collection to enable quality review.
The piece of drain tubing that remains in the patient will also be kept once
surgically removed to allow for appropriate follow up of the incidents cause.
A VHIMS must be completed by the nurse delegated to remove the drain
Post removal
 Monitor site for signs of infection, obtain swabs or samples if
required.
 Monitor and mark dressings to ensure minimal leakage, replace
dressings as required to minimise risk of infection. Excessive
leakage should be reported to surgeon.
 Dressing should be removed when wound has healed (3-5 days)