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1. Drains and draining
By Solomon (MD)

2. • The purpose of a drain is to let blood, pus, or other fluids escape from a wound while it
heals, without letting bacteria get in
• Blood or pus will flow through a tubular drain or round a solid one
• You will have to use a tube to drain a patient's gut, his bladder, or his pleural cavity
• You can let the exudates flow down a tube, or you can let them seep away round the
edge of a corrugated rubber drain
• If you have the equipment for suction drainage, you may be able to suck them away
• Suction drains are much more effective than corrugated ones, especially if bleeding is
expected
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3. • Not all wounds need drains, and drains have their risks:
• (1) Bacteria may enter from outside, especially if nursing care is poor.
– The risk of this is small if you use a closed drainage system and your nurses are good.
• (2) Bacteria may come from inside a patient and infect the tissues through
which the drain passes, particularly the abdominal wall
• (3) A drain may erode a vessel or a suture line, especially if you leave it in
for a week or longer.
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4. • If possible, insert a tube drain with a tight seal to the tissues through
which it passes, usually the abdominal wall, and lead it into a
bag or bottle
• There will be less soiling of the dressings and less contamination than
with a corrugated rubber drain
• Unfortunately, if a tubular drain blocks, it can seal infection in, so that
some surgeons prefer corrugated rubber ones
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5. • The modern trend is not to insert a drain unless there is a good reason to do so
• So don't drain all wounds routinely , insert a drain when the advantages outweigh
the risks
• (1) Where possible (see above), try to use a tube which will lead the exudate safely
into a bottle, rather than a piece of corrugated rubber which will lead it into
dressings
• (2) Try to place the drain at the bottom of the cavity to be drained, so that
exudate can easily flow out downwards.
• (3) Make it follow a straight path
• (4) If a drain is in any danger of falling out, stitch it in as it passes through the skin.
• (5) Don't try to drain the whole peritoneum in peritonitis it is impossible anyway
– Instead, wash out the peritoneal cavity and instill tetracycline
• (6) Finally, be sure to explain to the ward staff why you have inserted a drain, how
they are to manage it, and when they are to remove it
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6. • INDICATIONS FOR DRAINAGE.
• (1) To allow the escape of blood when the control of bleeding after an
operation has been incomplete
• (2) To complete the drainage of an abscess cavity
• (3) To drain an abscess or a local area of peritonitis (draining generalized
peritonitis is impossible,)
• (4) To permit the escape of secretions from a possibly leaky suture line, for
example when you have removed a stone from the ureter or anastomosed
unprepared large gut which cannot be protected by an ostomy, as when ileum
is anastomosed to transverse colon
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7. • HOW TO PLACE DRAINS.
• Where possible, insert a drain through a separate stab wound; if you drain
pus through the main wound, it is more likely to become infected
• Make sure the drain lies loosely in the cavity to be drained and follows the
shortest path from the site to be drained to the exterior
• To avoid cutting blood vessels, cut only the skin with a scalpel, use a
haemostat to poke a hole through the abdominal wall and then use the
haemostat to push the drain through the hole
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8. • CAUTION ! If you are draining a possibly leaky suture line, place the drain close to
it but not actually touching it, or the drain may help to disrupt the sutures
• Ideally, there should be no such thing as a ''leaky suture line ,it should not have
been made so that it does leak, or if it looks like leaking, it should be made again
• If there is severe sepsis, as in a septic Caesarean section or a typhoid perforation,
make an adequate muscle cutting incision, large enough to take three fingers side
by side
• Using a scalpel, cut all layers of the abdominal wall in the line of the incision
• Control bleeding with a gauze pack
• If any bleeding vessels remain after 5 minutes, tie them
• Even when the corrugated drain is in place you should still be able to get two
fingers into the wound.
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9. • Don't put any drain through the main incision
• If it is a tube drain you will not be able to make a good seal round it,
and it will make an incisional hernia more likely
• A tube drain which blocks is useless
• SUCTION DRAINS are ideal, especially the disposable plastic kind
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10. • THE TIME TO REMOVE A DRAIN… varies with the fluid to be drained
• Draining blood ….48 to 72 hours.
• Draining down to a suture line……..5 to 7 days.
• Draining a septic cavity….until pus ceases to flow, usually in 5 to 7 days
• Don't leave a drain in longer than is necessary, because you run the risk that it may
erode a vessel
• There is seldom any need to leave a drain more than a week at the most, except in a
very large deep abscess, as in the subphrenic space, where you may need to leave one
in for 10 days
• If you remove a drain too early, pus may build up and seek to discharge itself elsewhere
• If a drain is long, shorten it progressively over several days before you remove it
• Shorten it by pulling it out, not by cutting it off.
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