Drains
Types
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Jackson-Pratt drain
The Jackson-Pratt drain is probably the most common type. It’s used in all kinds of surgeries to drain fluid from a surgical site.The drain itself is connected to a bulb reservoir, which you compress before attaching to create a constant low level of suction. The bulb comes in two sizes — 100 mL and 400 mL — and which one a surgeon chooses will depend on the amount of fluid they expect to need draining.
Patients often go home with Jackson-Pratt drains and can learn to empty and reattach those themselves.
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Hemovac drain
A Hemovac drain is similar to a Jackson-Pratt, but the design is a little different. It uses a round device with a spring-like mechanism to generate suction instead of a bulb.Hemovac drains are used primarily in major surgeries, such as a total pelvic exenteration or a total joint replacement when there’s extensive reconstruction. These surgeries tend to generate a significant amount of fluid, so this reservoir can hold up to 500 mL (about 2 cups).
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Penrose drain
The Penrose drain relies on gravity rather than suction for drainage. It is used mostly in sensitive areas like the head and neck, so you’re not putting any undue pressure on delicate structures that can’t withstand it.A Penrose drain also creates a larger opening for fluid to drain out of, so it’s ideal for abscesses and infected fluids, which tend to be thicker and not flow as easily.
Indication: observation window into an anastomosis / area of post-surgical risk
Abdominal Drainage: know what to expect based on what anatomy is adjacent to the drain (what surgery was performed)
- Good: serous / serosanguinous
- Bad: Test it!
- Bile: visual (or bilirubin assay but not usually needed)
- Chyme: visual
- Chyle: Triglycerides
- Central lymphatics - fat absorption - won’t appear until fat is in diet
- Blood: Clotting
- Pancreatic juice: Amylase
- Looks clear - test for amylase on day 3/4
- Urine: spot Cr
- Suspect when urine output does down and drain output goes up
- Most anastomotic leaks (minor / low volume) will get better with time
- Estimate severity of leak based on drain output volume compared to standard organ production volume
-Abdominal organ outputs- Pancreas: ~500mL / day
- Bile: ~500-750ml / day
- Urine: .5mL / kg / day
- Gastric juices: 1-1.5L (+ any PO diet going through alimentary canal)
- Peritoneum: cycles 1L every day
Lines
Peripheral
Central
Removing central line (IJ/EJ)
- Prevent air embolism
- Trendelenberg
- Forceful exhale during removal (increased intrathoracic pressure decreases venous return, hopefully wont “suck” air into vessel)
- Occlusive dressing
Chest Tubes
- Chest tubes
These are placed in the pleural cavity to drain fluid or air after any type of chest surgery. That could include surgery for esophageal cancer, lung cancer or thymic cancer.