Factors To Consider In Surgical Drain Management

By Thomas Lewis


Many surgical operations are usually characterized with fluid formation after the operation. If this fluid is not removed, there is a risk that it could get infected resulting in unwanted effects. The type of tube to be used in a specific case is determined by the type of operation that is conducted. There is need to have proper surgical drain management if the tubes are to serve their purpose.

Generally, tubes help with decompression of body cavities by preventing accumulation of fluid. Such fluid may be serous fluid, blood or pus. Apart from getting rid of fluids, the drains may also help in the removal of unwanted air (or dead space). This may be necessary such as in the case of tension pneumothorax in which excessive air in the chest cavity causes excesses pressure on the lungs.

The surgeon will decide to place a tube in the body depending on their presence and the nature of operation. Among the commonest operations requiring the use of these tubes is breast surgery. Such surgeries are characterized with accumulation of fluid after the operation which significantly increases the risk of infections. Orthopedic surgeries (more so those in which a joint has to be opened) also frequently require the use of drains.

One of the classifications of drain tubes considers the tubes as being either open or closed. Open tubes include corrugated rubber and plastic sheets and typically direct the fluid onto a pad made of gauze or a stoma bag. This type is more prone to infections. The closed type is that which drains into a bottle or bag. This is the type preferred for orthopedic and chest operations.

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.

After leaving the operating room, the patient is admitted to the surgical wards. Most of the care of the drain occurs in these wards. The tube should be examined at regular intervals. Some of the things that you need to look out for include signs of infections, the color of fluid being drained, knots and kinks in the tube and so on. The passage of pus in an indicator of infections.

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 drain tubes will be removed when they have stopped functioning. In most centers, they will be removed if the 24 hour output is 25ml or less. The tube can be pulled out gently in one instance or can be removed slowly over time. The second option is said to aid in gradual healing of the insertion site. There may be associated pain or discomfort.




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