drains - vasanjee 4

8/6/2019 Drains - Vasanjee 4

1/40

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


2/40

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 ?


3/40

GoalsGoals

Decrease Infection RateDecrease Infection Rate

Decrease Healing TimeDecrease Healing Time


4/40

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


5/40

Drain TypesDrain Types

FlatFlat

Dependent on gravity andDependent on gravity and

capillary actioncapillary action

Drainage related to surfaceDrainage related to surface

areaarea

PenrosePenrose -- latexlatex


6/40


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


7/40


TubeTube

Single lumenSingle lumen

+/+/-- side holesside holes

Silicone, polyvinylSilicone, polyvinyl

chloride, red rubberchloride, red rubber


8/40


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


9/40


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


10/40


Double lumenDouble lumen


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


11/40


PassivePassive

ActiveActive

Continuous suctionContinuous suction

Intermittent suctionIntermittent suction


12/40

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


13/40

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


14/40

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


15/40



16/40



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


17/40

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)


18/40

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


19/40

Complications and Failure ofComplications and Failure of

DrainsDrains Poor Drain SelectionPoor Drain Selection

Poor Drain PlacementPoor Drain Placement

Poor PostPoor Post--operative Managementoperative Management


20/40


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


21/40


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


22/40


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


23/40

Abdominal DrainsAbdominal Drains

Controversial!Controversial! Passive closedPassive closedsystemssystems


24/40

Wound DrainageWound Drainage

The I will never use aThe I will never use a

Penrose drainPenrose drain

promisepromise


25/40


Closed SuctionClosed Suction

Butterfly Catheter +Butterfly Catheter +

VacutainerVacutainer TubesTubes


26/40



27/40

Thoracic CavityThoracic Cavity

Drain SelectionDrain Selection DiameterDiameter IntercostalIntercostalSpace (ICS)Space (ICS)

Tubular typeTubular type


28/40


Drain SelectionDrain Selection

PlacementPlacement

88 1010thth ICSICS

MidMid--dorsal 1/3dorsal 1/3rdrd


29/40



PlacementPlacement

Skin incisionSkin incision


30/40



PlacementPlacement

Curved hemostatCurved hemostat


31/40



PlacementPlacement

Tunnel under skinTunnel under skin

Cranial 2 ICSCranial 2 ICS


32/40



PlacementPlacement


33/40



PlacementPlacement


34/40



PlacementPlacement

Chinese Finger TrapChinese Finger Trap


35/40



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


36/40

What NOT to do...What NOT to do...


37/40

What NOT to do...What NOT to do...


38/40

What to do...What to do...


39/40



40/40


drains - vasanjee 4

Documents