Important Considerations In Surgical Drain Management

By Thomas Lewis


There are many types of drains that are used after surgical operations. The type that is used depends on the nature of operation performed. The success of these tubes is largely dependent on how they are taken care of in the immediate post-operative period. There are a number of important things to learn about surgical drain management for persons working in surgical wards. We will look at a few of them in this article.

The main role of drain tubes is to help with the removal of fluid that may be accumulating in different body cavities. The fluid may be blood, serous fluid or pus. If not removed, this fluid may contribute to infection in the cavities in which it is held. Another important function is the removal of excess air (also referred to as dead space). Such air may find its way to the chest cavity and compromise on gaseous exchange.

The decision to have a drain is determined by the nature of the operation as well as surgeon preference. One of the surgical operations for which drain tubes are usually needed is breast surgery. There is a huge risk of fluid accumulation in the breast tissue after surgery and having a drain significantly reduces this risk. Orthopedic procedures particularly those in which joint cavities have to be opened also require tubes.

There are many different classifications that are used for the tubes. The tubes may be classified as being closed or open. The closed type is that in which the fluid drains into a bottle or a bag. The open type is so called because of the fact that both ends are open. The tube empties its contents into a stoma bag or onto a gauze pad. This type has a higher risk of infections.

The tubes may also be classified into active and passive types. The active types are those that rely on a suctioning force to work. The passive tubes, in contrast, work under the influence of gravity hence do not need to be connected to a suctioning tube. All that one needs to do is to have the patient placed at a higher level than the collection container. The third classification takes into consideration the material used. Thus we have silicon and rubber tubes.

Once the patient has been admitted to the ward after surgery, it is important to ensure that the tube is inspected regularly. The ideal time interval should be every four hours. During the inspections, look out for kinking or blockages, signs of infections and the type of fluid being drained. Passage of pus in a situation where there was none previously should be a warning sign that an infection has set in.

The amount of fluid that is lost every day must be quantified and the value recorded. Suctioning helps to get out as much fluid as possible. It is important to prescribe the pressure that is needed for the suctioning as this helps avoid unnecessary injury to structures. The tube should also be properly secured with a suture to prevent it from getting dislodged.

The removal of the tubes is done as soon as the output has dropped below 25ml per day. In some other centers 50ml of fluid per day is considered the cut off. The tube can be removed at once or can be removed gently in a gradual manner. This option is considered better as it allows for healing to take place gradually as the tube is pulled out.




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