AUTHOR: SONIA ALBERT RUBI
Wound Drains – Types, characteristics and removal of drains. A simple nursing procedure.
A drain is inserted into or close to a surgical wound, where large amount of drainage is expected and when keeping wound layers closed is especially important. Accumulation of fluid under tissue prevents closing of the wound edges.
The drains are inserted and sutured through the incision line or inserted through stab wounds, a few inches away from the incision line. The latter site allows incision to be kept dry. Drains vary in length and width. Sometimes a rubber tubing of required length and width with 2 or 3 holes on one end is used as a drain. In order to facilitate healing and drainage of tissues from inside to outside or from the bottom to the top, the drains are to be pulled out or shortened from day to day until it falls out on its own.
Common Types of Drains
1. Corrugated drains: used after incision and drainage of an abscess.
2. Rubber tubes: used after chest surgery. A water seal drainage system is attached to this type of drains.
3. ‘T’ Tubes: used in case of cholecystectomy.
4. Intercath or paediatric Feeding Tubes: used after mastectomy or thyroidectomy where a continuous transudate is expected. These drains are installed with a continuous suction.
5. Gauze Wick: used to keep the sinus open, so that healing can take place from the base of the wound.
Character of Wound Drainage
The amount, color and consistency of the drainage must be observed daily and documented. The amount of drainage depends on the location and extends of the wound. The types of drainage include the following:
1. Serous – clear watery plasma
2. Sanguineous – bright red in color and indicates flesh bleeding
3. Sero sanguineous – pale, watery drainage
4. Purulent – thick yellow, green or brown drainage
If the drainage has a pungent or strong odor, an infection must be suspected.
In order to get an accurate measurement of drainage within a dressing, the dressing can be weighed and compared with the weight of the dressing when clean and dry. A rule of thumb is 1 GM of drainage equal 1 ml.
Care of the Drain
The drain site is considered as the most contaminated. Therefore, it is cleansed after the wound has been cleansed from the cleanest area to the most contaminated area. The skin around the drain is cleaned from the drain site outward.
Shortening or Removal of the Drain
The physician often places a pin or clip through the drain to prevent it from slipping further into the wound. The nurse must assess and record the following:
1. Placement of drain, character of drainage and condition of collecting apparatus.
2. Observe the security of the drain and its location with respect to the wound.
3. If there is a collecting device, measure the volume of drainage.
4. Observe the drainage flow through the tubing to ascertain its patency. A sudden decrease may indicate blockage, which must be reported immediately.
5. If the drain is connected to suction system, make sure that the pressure ordered is being exerted. If the evacuation device is not able to maintain a vacuum on its own, a secondary vacuum system may be connected by the surgeon. If the fluid is allowed to accumulate under the tissues, infection may occur and also delayed healing may result.
The drain should be removed as soon as its purpose is achieved. When the amount of drainage is reduced, the drains may be shortened daily until it falls. It is essential to confirm the doctor’s order prior to this procedure. In some hospitals, this shortening procedure is performed only by the doctors and in others it may be performed by the nurse.
The shortening of the drain is done in conjunction with the change of dressing. The preparation of the patient and the equipment is the same as for a dressing change. A pair of straight scissors is needed to cut the sutures that fix the drain to the site. A sterile safety pin will hold the drain in place above the skin. After cleaning the incision and the drain site, cut off the suture to release the drain. Hold the drain with artery forceps and pull out the drain gently but firmly until one to two inches of the drain have come out. Using a artery forceps, insert the sterile safety pin through the drain as close to the skin as possible and fasten the safety pin. Cut off the excess drain. Complete the procedure as for a sterile dressing.
Drainage seeks a low level. Therefore the bulk of the dressing should be at the lower edge of the wound. Dressing over the drains needs to be changed frequently.