Drain systems are a common feature of post-operative surgical management and are used to remove drainage from a wound bed to prevent infection and the delay of wound healing. A drain may be superficial to the skin or deep in the tissue, duct, or cavity. The number of drains depends on the extent and type of surgery. Active drains are closed systems that use vacuum action to withdraw fluids from the site into a collection reservoir. The drainage tube is a silastic tube with perforations to allow fluid to be sucked away from the site. Closed systems should be emptied when they are 1/3 to 1/2 full to allow the drain to function optimally. At minimum they should be emptied and measured at least once every shift, and the ports cleaned according to agency policy. These drains are very common and are referred to as Hemovac or Jackson Pratt (Perry et al., 2018).
Hemovac drains (see Figure 4.5) can hold up to 500 ml of drainage. A Jackson Pratt (JP) (see Figure 4.6) is used for wounds anticipated to have smaller amounts of drainage. Drains are often sutured to the skin to prevent accidental removal. The drain insertion site is covered with a sterile dressing. Assessment of drain functioning periodically throughout the day is important. These types of drains are referred to as active drains because of the suction action used to remove drainage. They are also referred to as closed wound drains because the drain system is closed.
Passive drains, also known as capillary drains, work by providing an opening from the area of concern to the outside of the body. Gravity and body movement allow excess fluid to simply escape through the opening. Penrose drains are pieces of surgical tubing inserted into a surgical site, secured with a suture on the skin surface, and they drain into a sterile dressing (Perry et al., 2018). Care and maintenance includes frequent dressing changes and attention to the peri-wound skin, which is at risk for breakdown in the presence of ++ moisture. Removal of capillary drains requires attention to avoid losing the drain into the patient’s body when the securing suture is released.
Pigtail drains (see Figure 4.7) are another type of passive drain. They are a type of tubing inserted into the site, held in place by the tube’s curl at the end. These can also be sutured on the skin surface. Pigtail drains are attached to a drainage bag and are often used to manage the treatment of abscesses (RSNA, 2018).
Checklist 40 outlines the steps to take when emptying a closed wound drainage system.
Maintain asepsis in relation to the plug.
The vacuum will be broken and the reservoir (drainage collection system) will expand.
If more than one drain is present, number them, note their location in the chart. Chart each one separately.
If the amount of drainage increases or changes, notify the appropriate healthcare provider according to agency policy.
Data sources: BCIT, 2010b; Perry et al., 2018
Removal of a drain must be ordered by the prescriber. A drain is usually in place for 24 to 48 hours, and removal depends on the amount of drainage over the previous 24 hours.
Checklist 41 outlines the steps for removing a wound drainage system (hemovac and JP) ** this is not the guidelines for removal of pigtail drains. Refer to your agency policy.
Gather up the drain tubing in your hand as it is being removed.
Watch the video JP Drain Removal developed by Renée Anderson & Wendy McKenzie Thompson Rivers University School of Nursing (2014).
Figure 4.7 Pigtail drain by Agency for Clinical Innovation is used under a CC BY 4.0 license.
Clinical Procedures for Safer Patient Care Copyright © 2018 by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.