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Surgical Drains:Surgical Drains:
Indications, Types, & Principals ofIndications, Types, & Principals ofUseUse
Sunil C. Vasanjee, BVScSunil C. Vasanjee, BVScCompanion Animal Surgery ResidentCompanion Animal Surgery Resident
LSU SVM / VTH&CLSU SVM / VTH&[email protected]@vetmed.lsu.edu
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Learning ObjectivesLearning Objectives
Goals / Indications for UseGoals / Indications for Use
Why use a drain ?Why use a drain ?
TypesTypes What are the major types of drains and howWhat are the major types of drains and how
do they work ?do they work ?
Principals of UsePrincipals of Use
Which drain to use ?Which drain to use ?
What are the complications ?What are the complications ?
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GoalsGoals
Decrease Infection RateDecrease Infection Rate
Decrease Healing TimeDecrease Healing Time
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IndicationsIndications
1.1. To help eliminate dead spaceTo help eliminate dead space
2.2. To evacuate existing accumulation of fluid orTo evacuate existing accumulation of fluid or
gasgas
3.3. To prevent the potential accumulation ofTo prevent the potential accumulation of
fluid or gasfluid or gas
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Drain TypesDrain Types
FlatFlat
Dependent on gravity andDependent on gravity and
capillary actioncapillary action
Drainage related to surfaceDrainage related to surface
areaarea
PenrosePenrose -- latexlatex
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Drain TypesDrain Types
Flat drainsFlat drains -- PenrosePenrose
AdvantagesAdvantages Allow drainageAllow drainage
Help obliterate dead spaceHelp obliterate dead space Soft / malleableSoft / malleable less painfulless painful
DisadvantagesDisadvantages Very irritatingVery irritating
Allow bacterial ingressAllow bacterial ingress Cannot be connected to suctionCannot be connected to suction
Gravity dependentGravity dependent
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Drain TypesDrain Types
TubeTube
Single lumenSingle lumen
+/+/-- side holesside holes
Silicone, polyvinylSilicone, polyvinyl
chloride, red rubberchloride, red rubber
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Drain TypesDrain Types
Tube drainsTube drains
AdvantagesAdvantages
Drain from both within and outside of lumenDrain from both within and outside of lumen Can be connected to suctionCan be connected to suction
Can be used with closed collection systemCan be used with closed collection system
DisadvantageDisadvantage Discomfort due to stiffnessDiscomfort due to stiffness
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Drain TypesDrain Types
Double lumenDouble lumen
Sump drainsSump drains
open/open suctionopen/open suction
Drainage of fluid viaDrainage of fluid via
large lumenlarge lumen
Sump lumenSump lumen
smaller and allowssmaller and allowsingress of airingress of air
AIR
AIR
FLUID
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Drain TypesDrain Types
Double lumenDouble lumen
AdvantagesAdvantages
More efficient than single lumenMore efficient than single lumen Maintain patency longer than single lumenMaintain patency longer than single lumen
DisadvantagesDisadvantages
Risk of contamination of wound asRisk of contamination of wound asenvironmental air drawn inenvironmental air drawn in reduced withreduced with
filterfilter
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Drain TypesDrain Types
PassivePassive
ActiveActive
Continuous suctionContinuous suction
Intermittent suctionIntermittent suction
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Passive DrainsPassive Drains PassivePassive
Drain by means of pressureDrain by means of pressure
differentials, overflow, and gravitydifferentials, overflow, and gravity
Provides a stent that keeps a drainingProvides a stent that keeps a draining
tract / cloaca opentract / cloaca open Allow egress via a path of leastAllow egress via a path of least
resistanceresistance
Flat or with a lumenFlat or with a lumen
Open or ClosedOpen or Closed Closed preferredClosed preferred
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Passive DrainsPassive Drains
Passive closedPassive closed AdvantagesAdvantages
Allow evaluation of volume andAllow evaluation of volume andnature of fluidnature of fluid
Prevent bacterial ascensionPrevent bacterial ascension
Eliminate dead spaceEliminate dead space
Help appose skin to wound bedHelp appose skin to wound bed quicker wound healingquicker wound healing
DisadvantagesDisadvantages Gravity dependentGravity dependent affects locationaffects location
of drainof drain
Drain easily cloggedDrain easily clogged
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Active DrainsActive Drains
Vacuum pulls fluid / gas from theVacuum pulls fluid / gas from the
woundwound
Closed to atmosphere = ClosedClosed to atmosphere = Closed
suctionsuction
Vacuum applied to a single lumenVacuum applied to a single lumen
tubetube
Not gravity dependentNot gravity dependent
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Active DrainsActive Drains
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Active DrainsActive Drains
AdvantagesAdvantages
Keep wound dryKeep wound dry efficient fluid removalefficient fluid removal
Can be placed anywhereCan be placed anywhere
Prevent bacterial ascensionPrevent bacterial ascension
Help appose skin to wound bedHelp appose skin to wound bed quicker woundquicker wound
healinghealing
Allows evaluation of volume and nature of fluidAllows evaluation of volume and nature of fluid
DisadvantagesDisadvantages
High negative pressure may injure tissueHigh negative pressure may injure tissue
Drain clogged by tissueDrain clogged by tissue
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Principals of Ideal UsePrincipals of Ideal Use
Aseptic site preparation (clip, scrub, debride, lavage)Aseptic site preparation (clip, scrub, debride, lavage)
Place to avoid anastomosis sites and major vesselsPlace to avoid anastomosis sites and major vessels
Exit through separate stab incision, away from surgicalExit through separate stab incision, away from surgical
incisionincision Aseptic postoperative management (cover with sterileAseptic postoperative management (cover with sterile
bandage, change before strike through, clean & drybandage, change before strike through, clean & dry
cage)cage)
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Principals of Ideal UsePrincipals of Ideal Use
Protect from premature removalProtect from premature removal
or lossor loss EE--collarcollar
Remove as soon as possibleRemove as soon as possible --
drainage decreases or fluiddrainage decreases or fluidchanges character (2changes character (2 5 days)5 days)
Bacterial culture on removalBacterial culture on removal
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Complications and Failure ofComplications and Failure of
DrainsDrains Poor Drain SelectionPoor Drain Selection
Poor Drain PlacementPoor Drain Placement
Poor PostPoor Post--operative Managementoperative Management
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Complications and Failure ofComplications and Failure of
DrainsDrains InfectionInfection Ascending bacterial invasionAscending bacterial invasion
Foreign body reactionForeign body reaction
Decreased local tissue resistanceDecreased local tissue resistance Bacterial hiding placesBacterial hiding places
Poor placementPoor placement fluid accumulation, drain kinkedfluid accumulation, drain kinked
Poor postoperative managementPoor postoperative management
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Complications and Failure ofComplications and Failure of
DrainsDrains Discomfort / PainDiscomfort / Pain
Thoracic TubesThoracic Tubes diameter too largediameter too large
Stiff tubingStiff tubing
Inefficient DrainageInefficient Drainage Exiting in nonExiting in non--dependent locale (passive drains)dependent locale (passive drains)
Kinked tubeKinked tube
ObstructedObstructed
Poor drain selectionPoor drain selection diameter too small to removediameter too small to removeviscous fluidviscous fluid
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Complications and Failure ofComplications and Failure of
DrainsDrains Breakdown of anastomotic sitesBreakdown of anastomotic sites
Erosion into hollow organs (firm drains)Erosion into hollow organs (firm drains)
Incisional dehiscence / herniaIncisional dehiscence / hernia
Poor placementPoor placement
Premature RemovalPremature Removal
Accumulation of fluidAccumulation of fluid
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Abdominal DrainsAbdominal Drains
Controversial!Controversial! Passive closedPassive closedsystemssystems
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Wound DrainageWound Drainage
The I will never use aThe I will never use a
Penrose drainPenrose drain
promisepromise
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Wound DrainageWound Drainage
Closed SuctionClosed Suction
Butterfly Catheter +Butterfly Catheter +
VacutainerVacutainer TubesTubes
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Wound DrainageWound Drainage
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection DiameterDiameter IntercostalIntercostalSpace (ICS)Space (ICS)
Tubular typeTubular type
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
88 1010thth ICSICS
MidMid--dorsal 1/3dorsal 1/3rdrd
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
Skin incisionSkin incision
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
Curved hemostatCurved hemostat
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
Tunnel under skinTunnel under skin
Cranial 2 ICSCranial 2 ICS
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
Chinese Finger TrapChinese Finger Trap
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Thoracic CavityThoracic Cavity
Drain SelectionDrain Selection
PlacementPlacement
When do I remove it ?When do I remove it ?
Dependent on whyDependent on why
drain placeddrain placed
Negative pressureNegative pressure
Often within a fewOften within a fewhours posthours post--operativelyoperatively
for nonfor non--trauma casestrauma cases
Significant drop in fluidSignificant drop in fluid
productionproduction
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What NOT to do...What NOT to do...
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What NOT to do...What NOT to do...
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What to do...What to do...
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What to do...What to do...
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What to do...What to do...