Drains

1. Surgical Drains

2. Definition
• A device/conduit used to divert or facilitates the escape of a matter
from one compartment to other compartment.
• Notes
• Shunt – a system to another system
• Drain – a system to external
• Stent – in the same system.

3. Ideal Drain
• Firm but not too rigid
• Not too soft ( may twist /kink)
• Smooth
• Inert (resistant to decomposition)
• Wide and patent enough to prevent easy blockage
• Non electrolytic / Non carcinogenic / Non thrombogenic

4. Classification
• Internal drain
• Biliary (CBD stent)
• CSF (VP shunt)
• Cystogastrostomy (pseudocyst).
• External drain
• Open
• corrugated, gauze (capillary action), penrose
• Closed
• Active – Redivac (vacuum drain), chest tube
(suction)
• Passive – by gravity - latex, T-tube (siphon
drain).
• Sump
• irrigation + drainage.

5. Indications
• Therapeutic
• To evacuate harmful material – pus (abscess), blood, bile, pancreatic necrosis.
• Irrigation - necrotizing pancreatitis
• Relieve obstruction – urinary retention, NG drain in I/O.
• Life saving procedure
• Chest tube.
• Prophylactic
• Eliminate dead space; prevent seroma – mastectomy, myocutaneous flap.
• To facilitate healing
• Vacuum dressing
• Clinical monitoring
• Ryles tube
• Foley catheter.
• Early warning of complication for specific procedure – anastomotic leak.

6. Types of Materials
• Latex
• T-tube, Penrose
• Cause tissue reaction
• Cheap
• Silicon
• VP shunt
• Inert, keep longer, softer
• PVC
• Polyvinylchloride – chest tube, NG tube
• Harden, can snap
• Inert, does not form tracks

7. Complications
• Immediate
• Pain
• Bleeding
• Injury /perforation to adjacent
structures
• Early
• Infection- Open system, passive drain –
communicate with external
environment.
• Occlusion
• Leaking
• Displacement
• Fluid loss
• Late
• Pressure/Suction necrosis -
bowel / vessel
• Fistula.
• Scar
• Incisional Hernia
• During removal
• Retained /Fragmentation of
tube

8. Precautions
• Should not put through incision wound.
• Should not put across joint, tendon sheath or area where fibrosis will
impair function.
• Should not be brought across anastomosis.
• The tip should be at dependent area for gravity drain.
• Keep drain only as long as necessary.
• Should not be too stiff- prevent erosion.

9. • T-tubes are made of latex because they are less irritant to the
peritoneal cavity.
• Sump drainage is suitable for pancreatic necrosis.
• Active drains are preferred for large bowel anastomosis.
• Open passive drains predispose to ascending infection.
True/False
F
F
T
T

10. Thank you