20325501 use and abuse of drains in surgery1

7/29/2019 20325501 Use and Abuse of Drains in Surgery1

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Use and abuse of drains in surgery

Akinsulire A.T


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Outline

Introduction/definition

History behind drains

Qualities of an ideal drain

Basic mechanism of drain action Classification of drains

Principles of drain use

Uses of drains

Abuse of drain

Complications of drains


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Introduction/definition

An appliance or piece of material that acts as

a channel for the escape (exit) of gases fluids

and other material from a cavity, wound,

infected area or focus of suppuration.

An important adjunct in a wide variety of

surgical procedures


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History of drains

Hippocratesdrainage of empyema, ascitic fluid

200AD- Celsius devised means of draining asciteswith conical tubes

1700ADJohann Schltetus-1st person to usecapillary drainage

1897AD Charles Penrose devised Penrose drain

1932AD Chaffin developed 1st

commerciallyavailable suction drain

1959AD silicone rubber discovered andadvantages were reported by Santos


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Qualities of a good drain

Soft -Minimal damage to surrounding tissues

Smooth -Efficiently evacuate effluent and easyremoval

Sterile- not potentiate infection or allowintroduction of infection from externalenvironment

Stable- Inert, non allergenic, not degraded bybody

Simple to manage by both patient and staff


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Mechanism of drain action

Laminar flow through drain

Poiseuilles law

F =dP r4 /8nL

F = flow of fluid thru the drain lumen dP =pressure difference between the two ends

n =viscosity

L= length of drain

Flow directly prop to suction pressure, radius Indirectly prop to viscosity and length of drain

Double in drain diameter 16 fold increase in flow

Halving the length will double the flow


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Factors governing effluent movt

Gravity

Capillary action

Tissue pressure

Negative pressure


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Classification of drains

Open vs. closed drain

Passive (non suction) vs. active (suction)

Internal vs. external Irritant vs. non irritant


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Open drain

Empty to the exterior

Effluent is directed into overlying dressings

High rate of bacterial dissemination with

consequent wound infection

E.g. corrugated drain, Penrose,


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Yeates drain

Rubber corrugated drain

Penrose drain


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Closed drain

Drainage tubing is exteriorized and connected to a

closed drainage system

Associated with reduced infectionrate/contamination

Reduce nursing time esp. if high output

Accurate measurement of output Protection of surrounding skin from irritating

discharges

Risk of reflux of contaminated reservoir

E.g urinary catheter, hemovac ,pigtail catheter


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Hemovac drainJacksonPratt drain

Foleys catheter Pigtail catheter


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Passive drains

Work by pressure gradient, gravity effect, capillaryaction or combination

All open drains are passive drains

Closed drains not connected to sunction

Active (suction)

Employ suction to facilitate drainage

Intermittent /continuous suction

Sump-suction vs. closed suction

Esp useful in highly viscous, negative pressure

regions


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Internal drains

Divert retain fluids form a body cavity to another

Useful in neurosurgery,ctsu ,G.I surgery and

urology

E.g celestine, southar tubes,V-P shunt, Pericardio-

pleural tube

External drains Channel discharge from cavity to external

environment


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Celestine tube

Ventriculo-

peritoneal shunt


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Irritant drains

composed of materials irritant to tissues

excite fibrous tissue response leading to fibrosis

and tract formation E.g. latex, plastic and rubber drains

Inert drains

Non irritant drains Provoke minimal tissue fibrosis

E.g. polyvinyl chloride(PVC),polyurethane(PU)

silicon elastomer(silastic)


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Material Example Properties

Latex rubber Penrose drain Soft, induces tractformation

Red rubber Red rubber tubecatheter

Firm, induces tractformation

PVC Chest tube,yeates Firm ,induce someinflammation

Silastic Jackson-Pratt drain Soft, induces minimal

inflammationHeparin coated silastic Jackson pratt drain Aims to inhibit clot

formation and achieve

greater patency

Hydrogel coating Some foley

catheter,image guided

percutaneous drain

Produce slippery surface

resistant to encrustation

Polytetrafluoro-

ethylene(PTFE)

Some foleys catheter Latex + teflon.

Smoother than latex

Silicone elastomer Some foleys catheter latex +silicone moreresistant to encrustation

Polymer hydromer Some foleys catheter Latex bounded with.smoother than latex


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Principles of drain use

Should not exit cavity through same surgicalincision.

Reach skin by safest shortest route

Appropriate size and length

A gravity drain must be placed in the safest andmost dependent recess in cavity

Must be inserted away from delicate structures Firmly secured at exit wound

Appropriate care-dressing,emptying,recharging

Must be removed when no longer useful-at


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Choice of drain

What is being drained

Consistency,-larger lumen, suction drain

Why is the drain needed

Latex, red rubber for tract formation

Where is the drain located

Related to delicate structures,

Sterile sites-closed drain

Negative pressure zones-underwater seal

Waste bin size


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Uses of drains

Prophylactic- prevent potential accumulation

of fluid in a cavity

Therapeutic- evacuate an existing collection of

fluid i.e. lymph, pus, urine saliva, serum

Diagnostic-MCUG,T-tube cholangiogram


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Use of drains in cardiothoracic surgery

Intercostal catheter

Mediastinal catheter


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Drains in Gastrointestinal surgery

Ryle tubeFine bore NG tube


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T-tube(Khers)Salem sump tube


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Drains in Neurosurgery


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Drains in urology

3-way Coude catheter

Tiemans catheter

Foleys

catheter


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Drains in plastic surgery

Vacuum assisted closure (VAC) drain


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Abuse of drains

A substitute for poor surgical technique or

inadequate hemostasis

Wrong indication

Delayed removal

Untimely removal

Wrong selection of appropriate drain Inadequate care of drain

Insertion in main surgical wound


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Complications of drains

Trauma to tissues during insertion and

removal

Fistula formation/perforationerosion of

adjacent tissues

Visceral herniation through tract

Anastomotic leak

Flap necrosis

Bacterial colonization and sepsis


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Fluid and electrolyte loss

Pain

Restricted mobility Drain malfunction-migration,blockage,vacuum

failure

Prolonged healing-delayed foreign body


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SUMMARY


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THANK YOU FOR LISTENING

20325501 use and abuse of drains in surgery1

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