use and abuse of drains in surgery1
DESCRIPTION
surgical info about drainsTRANSCRIPT
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
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
History of drains
Hippocrates –drainage of empyema, ascitic fluid 200AD- Celsius devised means of draining
ascites with conical tubes 1700AD –Johann Schltetus-1st person to use
capillary drainage 1897AD Charles Penrose devised Penrose drain 1932AD Chaffin developed 1st commercially
available suction drain 1959AD silicone rubber discovered and
advantages were reported by Santos
Qualities of a good drain
Soft -Minimal damage to surrounding tissues Smooth -Efficiently evacuate effluent and easy
removal Sterile- not potentiate infection or allow
introduction of infection from external environment Stable- Inert, non allergenic, not degraded by
body Simple to manage by both patient and staff
Mechanism of drain action
Laminar flow through drain Poiseuille’s law
F =dP πr4 /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
Classification of drains
Open vs. closed drain Passive (non suction) vs. active (suction) Internal vs. external Irritant vs. non irritant
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,
Closed drain Drainage tubing is exteriorized and connected to a
closed drainage system Associated with reduced infection
rate/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
Passive drains Work by pressure gradient, gravity effect, capillary
action 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
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
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)
Material Example Properties
Latex rubber Penrose drain Soft, induces tract formation
Red rubber Red rubber tube catheter
Firm, induces tract formation
PVC Chest tube,yeates Firm ,induce some inflammation
Silastic Jackson-Pratt drain Soft, induces minimal inflammation
Heparin 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 –more resistant to encrustation
Polymer hydromer Some foleys catheter Latex bounded with .smoother than latex
Principles of drain use
Should not exit cavity through same surgical incision.
Reach skin by safest shortest route Appropriate size and length A gravity drain must be placed in the safest and
most 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 once
or by progressive shortening
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
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
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
Complications of drains
Trauma to tissues during insertion and removal
Fistula formation/perforation –erosion of adjacent tissues
Visceral herniation through tract Anastomotic leak Flap necrosis Bacterial colonization and sepsis
Fluid and electrolyte loss Pain Restricted mobility Drain malfunction-migration,blockage,vacuum
failure Prolonged healing-delayed foreign body