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Surgical drains

  • Drains are inserted to:
    • Evacuate establish collections of pus, blood or other fluids (e.g. lymph)
    • Drain potential collections
  • Their use is contentious
  • Arguments for their use include:
    • Drainage of fluid removes potential sources of infection
    • Drains guard against further fluid collections
    • May allow the early detection of anastomotic leaks or haemorrhage
    • Leave a tract for potential collections to drain following removal
  • Arguments against their use include:
    • Presence of a drain increases the risk of infection
    • Damage may be caused by mechanical pressure or suction
    • Drains may induce an anastomotic leak
    • Most drains abdominal drains infective within 24 hours

Types of drains

  • Drains can be:
    • Open or closed
    • Active or passive
  • Drains are often made from inert silastic material
  • They induce minimal tissue reaction
  • Red rubber drains induce an intense tissue reaction allowing a tract to form
  • In some situations this may be useful (e.g. biliary t-tube)

Open drains

  • Include corrugated rubber or plastic sheets
  • Drain fluid collects in gauze pad or stoma bag
  • They increase the risk of infection

Closed drains

  • Consist of tubes draining into a bag or bottle
  • They include chest and abdominal drains
  • The risk of infection is reduced

Active drains

  • Active drains are maintained under suction
  • They can be under low or high pressure

Passive drains

  • Passive drains have no suction
  • Function by the differential pressure between body cavities and the exterior

Nasogastric tubes

  • Following abdominal surgery gastointestinal motility is reduced for a variable period of time
  • Gastrointestinal secretions accumulate in stoma and proximal small bowel
  • May result in:
    • Postoperative distension and vomiting
    • Aspiration pneumonia
  • Little clinical evidence is available to support the routine use of nasogastric tubes
  • May increase the risk of pulmonary complications
  • Of proven value for gastrointestinal decompression in intestinal obstruction
  • Tubes are usually left on free drainage
  • Can be  also aspirated maybe every 4 hours
  • Can be removed when volume of nasogastric aspirate is reduced

Urinary catheters

  • A urinary catheter is a form of drain
  • Commonly used to:
    • Alleviate or prevent urinary retention
    • Monitor urine output
  • Can be inserted transurethrally or suprapubically
  • Catheters vary by:
    • The material from which they are made (latex, plastic, silastic, teflon-coated)
    • The length of the catheter (38 cm 'male' or '22 cm 'female')
    • The diameter of the catheter (10 Fr to 24 Fr)
    • The number of channels (two or  three)
    • The size of the balloon ( 5ml to 30 ml)
    • The shape of the tip
  • Special catheters exist such as:
    • Gibbon catheters
    • Nelaton catheters
    • Tiemann catheters
    • Malecot catheters

Complications

  • Paraphimosis
  • Blockage
  • By-passing
  • Infection
  • Failure of balloon to deflate
  • Urethral strictures

Do's and don'ts of urinary catheters

  • Choose an appropriate sized catheter
  • Insert using an aseptic technique
  • Never insert using force
  • Do not inflate the balloon until urine has been seen coming from the catheter
  • Record the residual volume
  • Do not use a catheter introducer unless you have been trained in its use
  • If difficulty is encountered inserting a urinary catheter consider a suprapubic
  • Remove at the earliest possibility

Bibliography

Liedl B.  Catheter-associated urinary tract infections.  Curr Opin Urol 2001; 11:  75-79.

Memon M A,  Memon M I, Donohue J H.  Abdominal drains:  a brief historical review.  Ir Med J 2001;  94:  164-166.

Memon M A,  Memon B,  Memon M I,  Donohue J H.  The uses and abuses of drains in abdominal surgery.  Hosp Med 2002;  63:  282-288.

Merad F, Yahchouchi E, Hay J-M et al.  Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis. Arch Surg 1998; 133: 309-314.

Parker M J,  Roberts C.  Closed suction surgical wound drainage after orthopaedic surgery.  Cochrane Database Syst Rev 2001;  4:  CD001825.

Patel H R,  Arya M.  The urinary catheter:  'a-voiding catastrophe'.  Hosp Med 2001;  62:  148-149.

Wedderburn A,  Gupta R,  Bell N,  Royle G.  Comparison between low and high pressure suction drainage following axillary clearance.  Eur J Surg Oncol 2000:  26:  142-144.

 

 
 

Last updated: 03 January 2010

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