What is wound drainage?

Wound drainage provides a way for unnecessary body fluids or air to flow out of the body from a wound.

What is a wound drain?

After surgery, some patients require wound drains such as the one pictured above. The wound drain is
inserted while the patient is in the operating room receiving generalanesthesia. The purpose of the drain is to
remove fluid and/or blood from the surgical site. This helps the healing process. Not all patients need wound
drains following surgery. Wound drains are usually made of plastic. One end is placed within the wound to be
drained and the other end is connected to a suction collection device. The fluid may be collected in a drainage
bag, plastic bulb, and plastic carton or onto a dressing.

How long is a wound drain used?

That depends on the type of surgery and the amount of fluid or blood draining from the wound. The surgeon
closely evaluates the wound drain daily and decides when it should be removed. The nurses check on the drain
frequently and empty it when necessary.

Does the wound drain hurt?

No. Usually the patient does not know that the wound drain is present unless they are told. The wound drain
may sting when it is removed.

What happens if the patient rolls on it?

Normally nothing happens. Occasionally it may become blocked. However, the nurses assess the drain
frequently to make sure that this does not happen.

Are there any potential complications associated with use of a wound drain?
wound drains are usually not associated with significant complications.
Wound drainage is a result of an increase in blood flow that is necessary for wounds to heal. The drainage contains the
components of blood and the four types are known as serous, sanguineous, serosanguineous or purulent.
Serous
1. Serous fluid is the clear, watery fluid that separates from the blood to bring necessary nutrients like
proteins to aid the tissue in healing.
Sanguineous
2. Sanguineous drainage contains large numbers of red blood cells and has a thicker, red appearance.
Serosanguineous
3. Serosanguineous fluid, a semi-thick reddish fluid, is the most common type of drainage found in a
healing wound. It is the result of the various components of the blood separating from each other as
they attempt to perform their various functions necessary for healing to occur.
Purulent
4. Thick drainage that contains white blood cells and bacteria is called purulent. This type of drainage
has an odor, varies in color that may include gray, yellow or green, and is indicative of infection. It is
sometimes referred to as "pus."
Warning Signs
5. Notify your physician if you develop a fever, a sudden increase in swelling or drainage or purulent
drainage. Failure to treat an infection early can lead to tissue damage that may require surgery.

Wound Drainage Systems Review

To aid in a speedy recovery of surgical patients, many different types of wound drainage systems have been
created. Without the use of an effective drainage system, a post-surgical wound can easily become infected.
These infections can become extremely severe and spread to other areas and organs of the body. The most
common three wound drainage types are Penrose drains, negative pressure drains, and Jackson-Pratt drains.
Named for the famed American doctor Charles Bingham Penrose, the Penrose drain is basically a length of soft
rubber tubing that is placed inside of a wound area to facilitate the drainage of wound areas. The tubing can
also be fabricated from silicon. Usually, it is attached to the wound directly after surgery to avoid the
proliferation of bacteria in pools of blood or other bodily fluids. In addition, hydrocephalus patients have
found this drainage format beneficial in draining cerebrospinal fluid.
Negative pressure wound therapy is used primarily to improve the speed of recovery in burn victims and to
enhance healing in chronic or severe wounds. In this type of treatment the wound is sealed using gauze or a
dressing of foam, covered with a drape layer, and then a vacuum source which adds negative pressure to the
wound area. The vacuum helps the drainage of wound areas by removing fluid and dessicated tissue,
enhancing blood flow through the affected region, lowering bacterial levels, stimulating cell growth, closing
the wound edges, and promoting granulation tissue. The dressing will be replaced frequently to remove
wound fluids. This technique is most commonly associated with chronic wounds but is also used in cases of
diabetic foot ulcers, traumatic wounds, and venous insufficiency ulcers.
In the Jackson-Pratt drains, or Bulb drain, a continuous suction pressure is applied to the wound by use of a
flexible bulb. The bulb is used both as a mechanism of providing suction and as a reservoir for the escaping
fluid. After the device has been attached to the wound, a patient needs only to squeeze the plastic bulb to
create suction. Once the bulb has filled with discharge from the wound, it can easily be removed, washed, and
reattached to drain more liquid. Physicians generally recommend that the bulb should be removed when it has
become over half full with liquid. When cleaning the system, a damp towel or cloth should be used to strip the
tube of any clots or other obstructions that may limit the flow of the removal liquid.
With the many wound drainage types available, a surgical patient can be confident in the ability to keep a
wound free of foreign bacterias and reduce the chances of incurring in a potentially dangerous infection.
Before surgery, a local doctor should explain all wound drainage options to a patient. In addition to keeping
the wound sterile, the wound drainage systems can also be beneficial by greatly reducing the amount of time
needed for recovery.
While in nursing school you may not get the chance to see all types of drains or drainage systems while doing
your clinical rotations sometimes you're lucky if you even get to see one drainage system at all. Many

times when you're not use to dealing with something on a day to day basis you tend to forget some of the
information you may need, as the old saying goes "use it or lose it" it holds much truth.

Drains 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.

The drainage systems are chosen based on the needs of the patients or the preference of the surgeon. There
are 3 types of drainage systems; the 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.

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.

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.

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

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

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.
12
While in nursing school you may not get the chance to see all types of drains or drainage systems while doing
your clinical rotations sometimes you're lucky if you even get to see one drainage system at all. Many

times when you're not use to dealing with something on a day to day basis you tend to forget some of the
information you may need, as the old saying goes "use it or lose it" it holds much truth.

Drains 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.

The drainage systems are chosen based on the needs of the patients or the preference of the surgeon. There
are 3 types of drainage systems; the 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.

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.

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.

Hemovac drain is a closed drainage system. The drainage works by suction that pulls the drainage from the
body into a collection tank.
Jackson Pratt (JP) drain is another closed drainage system that also uses suction to pull the drainage from the
incision into a collection tank.

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.
12

Wound drainage is a result of an increase in blood flow that is necessary for wounds to heal. The drainage
contains the components of blood and the four types are known as serous, sanguineous, serosanguineous or
purulent.
Serous
1. Serous fluid is the clear, watery fluid that separates from the blood to bring necessary nutrients like
proteins to aid the tissue in healing.
Sanguineous
2. Sanguineous drainage contains large numbers of red blood cells and has a thicker, red appearance.
Serosanguineous
3. Serosanguineous fluid, a semi-thick reddish fluid, is the most common type of drainage found in a
healing wound. It is the result of the various components of the blood separating from each other as
they attempt to perform their various functions necessary for healing to occur.
Purulent
4. Thick drainage that contains white blood cells and bacteria is called purulent. This type of drainage
has an odor, varies in color that may include gray, yellow or green, and is indicative of infection. It is
sometimes referred to as "pus."
Warning Signs
5. Notify your physician if you develop a fever, a sudden increase in swelling or drainage or purulent
drainage. Failure to treat an infection early can lead to tissue damage that may require surgery.

Surgical Drains - Indications, Management and Removal

Surgical drains of various types have been used in different operations with the best intentions for many years.1 It is often
open to question whether they achieve their intended purpose despite many years of surgery. There is a paucity of evidence
for the benefit of many types of surgical drainage and many surgeons still 'follow their usual practice'. With better evidence
management of surgical patients should improve and surgeons should be able to practice based upon sound scientific
principles rather than simply 'doing what I always do.'2 Lack of definitive evidence has not helped the resolution of some
controversial issues surrounding the use of surgical drainage.
Indications

Surgical drains are used in a wide variety of different types of surgery. Generally speaking the intention is to decompress or
drain either fluid or air from the area of surgery. Examples include:
• To prevent the accumulation of fluid (blood, pus and infected fluids)
• To prevent accumulation of air (dead space)
• To characterise fluid (for example early identification of anastomotic leakage3)
Specific examples of drains and operations where they are commonly used include:
• Plastic surgery including myocutaneous flap surgery
• Breast surgery (to prevent collection of blood and lymph)
• Orthopedic procedures (associated with greater blood loss)
• Chest drainage4,5
• Chest surgery (with for example the associated risks of raised intrathoracic pressure and tamponade)
• Infected cysts (to drain pus)
• Pancreatic surgery (to drain secretions)
• Biliary surgery
• Thyroid surgery (concern over haematoma and haemorrhage around the airway)
• Neurosurgery (where there is a risk of raised intracranial pressure)
• Urinary catheters
• Nasogastric tubes
Management
Management is governed by the type, purpose and location of the drain. It is usual for the surgeons preferences and
instructions to be followed. A written protocol can help staff on the ward with the aftercare of surgical drains.6

Types of surgical drain

Drains can be:

• Open or closed:
o Open drains (Including corrugated rubber or plastic sheets) drain fluid onto a gauze pad or into a
stoma bag. They are likely to increase the risk of infection.
o Closed drains are formed by tubes draining into a bag or bottle. Examples include chest,
abdominal and orthopaedic drains. Generally the risk of infection is reduced.
• Active or passive:
o Active drains are maintained under suction (which may be low or high pressure).
o Passive drains have no suction and work according to the differential pressure between body
cavities and the exterior.
• Silastic or rubber:
o Silastic drains are relatively inert and induce minimal tissue reaction.
o Red rubber drains can induce an intense tissue reaction sometimes allowing a tract to form (this
may be considered useful for example with biliary t-tubes).

General guidance
• If active the drain can be attached to a suction source (and set at prescribed pressure).
• Ensure the drain is secured (dislodgement is likely to occur when transferring patients after anaesthesia).
Dislodgement can increase the risk of infection and irritation to the surrounding skin.
• Accurately measure and record drainage output.
• Monitor changes in character or volume of fluid. Identify any complications resulting in leaking fluid
(particularly for example bile or pancreatic secretions) or blood.
• Use measurements of fluid loss to assist intravenous replacement of fluids.

Removal

Generally, drains should be removed once the drainage has stopped or becomes less than about 25 ml/day. Drains can be
'shortened' by withdrawing them gradually (typically by 2 cm per day) and so in theory allowing the site to heal gradually.
Usually drains that protect post-operative sites from leakage form a tract and are kept in place longer (usually for about a
week).
• Warn the patient that there may be some discomfort when the drain is pulled out.
• Consider the need for pain relief prior to removal.
• Place dry dressing over the site where the drain was removed.
• Some drainage from the site commonly occurs until the wound heals.
• When to remove:
o Drains left in place for prolonged periods may be difficult to remove.
o Early removal may decrease the risk of some complications especially infection.7
Evidence and controversy
• There is insufficient evidence from randomised trials to support the routine use of closed suction drainage
in orthopaedic surgery. Further randomised trials with larger patient numbers are required for different operations
before definite conclusions can be made for all types of orthopaedic operations.8,9,10,11
• Despite the paucity of clinical evidence demonstrating any benefit supporting their use, drains continue to
be placed after elective orthopedic procedures.12
• The routine use of drains may be abandoned in uncomplicated thyroid surgery.13,14
• The routine use of a suction drain is unnecessary after an uncomplicated total joint arthroplasty.15
• There are insufficient studies which compare differing methods of chest drain clearance to support or
refute the relative efficacy of the various techniques in preventing cardiac tamponade. Nor can the need to
manipulate chest drains be supported or refuted by results from RCT's.16,17
• The optimal time to remove drains after total joint arthroplasty is 24 hours.18
• Pelvic drainage may act as an early detector of anastomotic leaks and reduce the need for reoperation in
selected patients undergoing rectal cancer surgery.3 However others consider that leaks usually occur after drains
have been removed and that they are not useful in this way.19
 • Drain use after elective laparoscopic cholecystectomy increases wound infection rates and delays
hospital discharge. We could not find evidence to support the use of drain after laparoscopic cholecystectomy20 or
open cholecystectomy.21
• Evidence for drains reducing infection and haematoma formation after breast surgery is inconsistent.22
• Many gastrointestinal operations can be performed safely without prophylactic drainage. Drains should be
omitted after hepatic, colonic, or rectal resection with primary anastomosis andappendectomy for any stage
of appendicitis.23
• Prophylactic drainage is indicated after oesophageal resection and total gastrectomy.23 For many other
gastrointestinal procedures (especially involving the upper GI tract) there is a need for more research to clarify the
value of prophylactic drainage.23
• There is insufficient evidence showing that routine drainage after colorectal anastomoses prevents
anastomotic and other complications.24 Damage may be caused by mechanical pressure or suction and drains may
even induce an anastomotic leak.
• Drains are not a substitute for good surgical technique.25

Definition :
A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains inserted after surgery do not result
in faster wound healing or prevent infection but are sometimes necessary to drain body fluid which may accumulate and in
itself become a focus of infection. Definition

Slide 3:
Drains may be hooked to wall suction, a portable suction device, or they may be left to drain naturally.

Slide 4:
Accurate recording of the volume of drainage as well as the contents is vital to ensure proper healing and monitor for
excessive bleeding. Depending on the amount of drainage, a patient may have the drain in place one day to weeks.

Indication :
Prophylactic To remove excess blood and serum . To remove pus, blood, serous exudates, chyle or bile . To form a controlled
fistula e.g. after common bile duct exploration Indication

Indication :
Therapeutic 1) To drain pus, blood, serous exudates, chyle or bile . 2) To drain air from the pleural cavity. 3) To drain ascites
Classification Indication

Slide 7:
Signs of new infection or copious amounts of drainage should be reported immediately. Drains will have protective dressings
that will need to be changed daily/as needed.

classification :
Closed system Open system classification

Types of drain :
Jackson-Pratt drain - Penrose drain Negative pressure wound therapy – Chest tube Redivac drain Pigtail drain - has an
exterior screw to release the internal "pigtail" before it can be removed Chest tube Types of drain

Jackson-Pratt drain :
Jackson-Pratt drain, JP drain, or Bulb drain, is a drainage device used to pull excess fluid from the body by constant suction.
The device consists of a flexible plastic bulb -- that connects to an internal plastic drainage tube. Jackson-Pratt drain

Slide 11:
The Jackson-Pratt drain used as negative pressure vacuum, which also collects fluid. As a low negative pressure suction
system, it is designed so that intra abdominal contents such as the omentum or intestines are not sucked into the tube,
minimizing the risk of bowel perforation or ischemia
Continue Jackson drain :
Removing the plug and squeezing the bulb removes air, which reduces air pressure within the drainage tubing. This is
usually accomplished by folding the drain in half while it is uncapped, then while folded, recapping the drain. Continue
Jackson drain

A penrose drain :
A Penrose drain is a surgical device placed in a wound to drain fluid. It consists of a soft rubber tube placed in a wound area,
to prevent the build up of fluid. A penrose drain

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. Negative pressure wound therapy

Removal of drains :
A drain is removed as soon as it is no longer required. Hence it is necessary to know the purpose for which it was inserted
and you should ascertain this from the surgeon at the time of operation. The following are general guidelines: Drains put in
to cover preoperative bleeding and hematoma formation, can come out after 24— 48 hours. Removal of drains

Slide 16:
Drains put in to cover serous collections can come out after 3—5 days. Where a drain has been put in because the wound
may later become infected, it should be left for 1-5 days.

Continue… :
Drains put in to cover intestinal anastomoses should not be removed until after 5—7 days. A T-tube can be removed after 6
— 10 days. Before this is done, a T-tube cholangiogram must be performed to make sure that there is distal patency in the
common bile duct. Some surgeons clamp the T-tube for 24 hours before it is removed. Continue…

Literature review :
A Comparative Study of Closed-wound Suction Drainage vs. No Drainage in Total Hip Arthroplasty W. A. Hadden, FRCSEd,
FRCSEd(Orth), and A. G. McFarlane, FRCS Literature review

Slide 19:
High-vacuum drains rival conventional underwater-seal drains after pediatric heart surgery☆ Andrew E.2004,

Slide 20:
Conclusions of the study : Redivac drains are as safe and effective as conventional drains in the pediatric setting, and
resulted in a lower incidence of residual pleural effusions requiring drainage. Together with their ease of care, earlier
mobilisation of patients and greater cost-effectiveness, the routine use of high-vacuum drains can be recommended
following pediatric heart surgery.