Surgical tubes, Surgical drains

1. DRAINS AND TUBES IN
ABDOMINAL SURGERY :

2. INTRO :
• A surgical drain is a tube used to remove pus, blood or
other fluids from a wound.
• 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.

4. • Substances that are normally drained are :
• Blood
• Bile
• Pus
• Urine
• Bowel anastomotic leaks
• Saliva
• Serum/lymph
• Pancreatic secretions

5. ADVANTAGES:
1. Drainage of fluid removes potential sources of
infections
2. Drains guard against further fluid collections
3. May allow the early detection of anastomotic leaks or
haemorrhage.
4. To reduce the risk of hematoma formation and break
down of wound.
5. To prevent an excessive amount of blood and fluid that
collects in cavities of the body and around organs.
6. Faster wound healing

7. DISADVANTAGES :
1. Presence of a drain increases the risk of infection
2. Damage may be caused by mechanical pressure or
suction
3. Drains may induce an anastomotic leak.

8. PRINCIPLES OF DRAINAGE
• Septic wound should be drained.
• Aseptic wounds those having oozing vessels or large
area.
• Wounds with chances of more fluid collection inside.
• Leaking wounds from anastomosis.

9. Qualities of agooddrain
(Ideal drain)
Soft to firm-Minimal damage to surrounding
tissues
Smooth -Efficiently evacuate effluent and easy
removal
Sterile- not potentiate infection or allow
introduction of
infection from external environment
Stable- Inert, non allergenic, not degraded by
body
Simple to manage by both patient and staff

10. TYPES OF DRAIN:
• Three types of drainage systems:
1) Closed drainage system
2) Open drainage system
3) Suction drainage system

11. • The closed drainage system:
• It 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.

12. • The open drainage system :
• It is a tube or apparatus that is inserted into the body and
drains out onto a dressing.
• Suction system :
• It uses a pumps or mechanical devices to help pull the
excessive fluid from the body.
• Drains are often made from inert silastic material and they
induce minimal tissue reaction.

13. Suction drain

14. • ACTIVE DRAINS :
• They are maintained under suction.
• They can be under low or high pressure.
 Closed: Jackson pratt drain, hemovac drain.
 Open: sump drain.
• PASSIVE DRAINS(WITHOUT SUCTION):
• They have NO suction.
 Closed: NGT , Foleys catheter, T-tube
 Open: penrose drain, corrugated drain.

15. P
ASSIVE VSACTIVEDRAINS
PASSIVE
DRAINS
ACTIVE
DRAINS

16. • EXAMPLES :
• A jackson-pratt drain/bulb drain
• A penrose drain
• Redivac drain/hemovac drain
• T-Tube drain
• Cigarette drain
• Corrugated rubber drain
• Pig-tail catheters
• Nasogastric tubes
• Urinary catheters

17. • A jackson-pratt drain/bulb
drain :
• It is a surgical drainage device
used to pull excess fluid from the
body by constant suction.
• Device consist of flexible bulb
shaped thing that connects to an
internal drainage tube.
• Commonly used in mastectomy.

19. • A penrose drain:
• It consists of a soft rubber
tube placed in a wound
area to prevent the build up
of fluid.
• It removes fluid from that
area.
• it is a common passive
drain.

21. • Redivac drain/hemovac drain:
• It is a closed drainage system.
• It works by suction that pulls the drainage from body into
a collection tank.

22. • Drainage of wound to prevent hematoma e.g.after thyroid
surgery, repair of incisional hernia .

23. • T-Tube drain:
• It is used mostly for patients
who have undergone
gallbladder surgery.
• This type of drainage
resembles a T and drains
into a collecting bag.

24. • Cigarette drain:
• It is a drain made by drawing a small strip of gauze or
surgical sponge into a rubber tube.

25. • Corrugated rubber drain:
• The corrugations provide
an increased surface area
for capillary action of fluid
and also serve as channels
for fluid flow.
• Size: 250×250 mm,
• 400×25 mm sheets

26. Yeatesdrain
• Passive, open drain
• Parallel tubes .
• Side and end holes.
• Capillary action

27. a) Corrugated; b) Penrose; c)
Yeates

28. • Pig-tail catheters:
• It has a spiralled tip, which is straightened during insertion
by means of a guide wire.
• Once correctly placed, the tip can be “locked” in curled
position by means of a string in the lumen, which is
placed under tension by turning a lock at external end of
drain.
• This curled tip helps to prevent any accidental dislodging
of drain.
• It can be used for drainage of collections in most locations
including renal pelvis.

29. Used in
• Nephrostomy
• Pleural fluid drainage
• Intraperitoneal fluid drainage

30. • Nasogastric tubes:
• Following abdominal surgery GI motility is reduced for a
variable period of time. GI secretions accumulate in stoma
and proximal small bowel and it may result in :
• Post-op distention and vomitting
• Aspiration pneumonia
• May increased risk of pulmonary complications
• Tubes are usually left on free drainage.

33. • Urinary catheters:
• It is a form of drain, which commonly used to
prevent urinary retention and monitor urine
output.
• It can be inserted transurethral or suprapubically.
• Catheter may vary by following features:
• Material
• Length of catheter
• Number of channels
• Size of the balloon
• Shape of the tip

35. Foley’s catheter :

36. Problems of drains :
MECHANICAL PROBLEMS Trauma to tissues
Perforation or fistula formation
Herniation of viscera
Anatomical leak
Flap necrosis
PHYSIOLOGICAL
PROBLEMS
Bacterial colonization and sepsis
Loss of fluid and electrolytes
Pain
Restricted mobility
Pneumothorax
DRAIN MALFUNCTION Migration
Blockage
Vacuum failure