Hemovac, Jackson-Pratt & Vascular graft.

1. Hemovac, Jackson-Pratt &
Vascular Graft.
Dr. O’Shea’s Tutorial.
Valmiki Seecheran.
Surgery Senior Clerkship.
UWI Cave Hill | Class of 2015.

2. Closed-Active Drains.
• Hemovac.
• Jackson Pratt.
• J-Vac.
• Chest tube on suction. (*Passive)

3. Closed-Active Drains.
• Indications.
• Large potential dead space.
• Necrotic or infected tissue.
• Uncertain hemostasis.
• Fistula.
• Significant amount of fluid accumulation.
• Examples:
• Abdominal surgery.
• Breast surgery.
• Mastectomy.
• Thoracic surgery.

5. Anatomy.
• A drainage tube that is inserted at the site of incision with multiple
fenestrations that allow for fluid to flow in.
• A tube connected to a flexible bulb that acts a s a reservoir for collected fluid.
• An ejection hole and plug to remove drained fluid.
• May have a ring to allow hanging from patient’s clothes.

6. Jackson Pratt Drain.
• Is an active close drain.
• Drains about 100cc.
• Care
• Drain should be emptied when half full to avoid discomfort by weight.
• Plug is removed and care must be taken not to touch ends to minimize
contamination.
• Bulb should be squeezed in and the plug and ejection hold wiped with an alcohol pad
then recapped to restore vacuum.
• Removed on a 24 hour basis.
• Complications.
• Clot.
• Infection.

8. Anatomy.
• A drainage tube, which can be single or dual, that is inserted at the site of
incision with multiple fenestrations that allow for fluid to flow in.
• A large cylindrical reservoir that collects the fluid
• Springs inside the reservoir that can be compressed to create negative
pressure and allow suctioning.
• An ejection hole and plug to empty drained fluid.

9. Hemovac.
• Is an active closed drain.
• Drains about 200, 400 & 800ccs.
• Because it is closed there is less likely to be secondary infection.
• Care -
• Drain should be emptied when half full, contents measured and recorded.
• Ends should be wiped clean before recapping to minimize contamination.
• Complications.
• Clots
• Infection – site of incision becomes red, swollen or tender and the fluid is
yellow tinged or foul smelling. Patient may have a fever.

11. Vascular graft.
• Redirect blood flow in a region of body.
• Autograft/ Allograft.
• Synthetic.
• ePTFE, dacron.
• Dacron grafts are frequently used in aortic and aorto-iliac surgery.
• E.g.. Aneurysm.
• Venous grafts have a superior result to synthetic grafts when used
below the inguinal ligament.*

12. Medical uses.
• Cardiac bypass.
• Lower extremity bypass – manage PVD, aneurysms, trauma.
• ‘Fem-fem’ – No inflow to one fem artery but there is aortic flow.
• ‘Aorto-Bi-Fem’- Aortic to bilateral femoral arteries. Disease @ aortic bifurcation/ iliac
arteries.
• ‘Fem-Tib’ –Fem to 1 of 3 tibial arteries. Used for disease of femoral/ tibial arteries.
• ‘DP’- Distal target is dorsalis pedis artery.
• Hemodialysis access.
• Arteriovenous fistula – connects a vein to an artery without synthetic material.
• Cerebral artery bypass.

13. Contraindications.
• Lack of an adequate venous conduit.
• Medical co-morbidities increase risk of surgery.
• ‘High risk’ – candidate for angioplasty.

14. Technique.
• Obtain proximal and distal control.
• Exposure of furthest and nearest extents of vessel where bypass is to
be created – minimize and visualize blood loss.
• Intervening occlusion – no blood flow through target vessel, no
hemostasis.

15. Complications.
• Acute Graft Occlussion.
• Blockage of vascular bypass graft shortly after procedure.
• Perforation, dissection.
• Requires reoperation.
• Hemorrhage.
• Infection.
• Embolism.

16. PTFE (polytetrafluroethylene).
• Gortex is a synthetic vascular graft.
• Indications:
• As a vascular prosthesis for replacement or bypass of diseased vessels in
patients suffering occlusive or aneurysmal disease.
• In trauma patients requiring vascular replacement.
• For dialysis access or for other vascular procedures.

17. PTFE (polytetrafluroethylene)
• Contraindications:
• Should not be used as a patch  leaking.
• Should not be used for CABG or cerebral reconstruction procedures.
• Complications:
• Graft occlusion.
• Graft infection.
• True and false aneurysms at the site of anastomosis.
• Distal embolization.
• Erosion into adjacent structures e.g. aorto-enteric fistulae.

18. Thank you.