Wound drains
The insertion of a drain provides a channel to the body surface for fluid which might otherwise collect in the wound space. This can reduce the risk of infection, and allows closer apposition of the tissues aiding the healing process.
Article by John Fowler
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Overview
Wound drains are widely used within the surgical setting for two main reasons:
- Removal of fluid (e.g. exudate, pus, blood and other body fluids)
- To remove air from a cavity or dead tissue space (Pudner, 2005)
The insertion of a drain provides a channel to the body surface for fluid which might otherwise collect in the wound space. This can reduce the risk of infection, and allows closer apposition of the tissues aiding the healing process (Torrance and Serginson, 2007)
There are a variety of wound drains available, but they all work by one of two mechanisms: passive drainage, using gravity to release the fluid into a collecting bag or dressing (e.g. corrugated drains, tube drains); or active drainage, using a vacuum or suction mechanism to remove the fluid.
Wound drains are used for three main reasons:
Therapeutic drainage
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Risks and complications
There are relatively few complications associated with wound drains. However, Torrance and Serginson (2007) have identified some risks:
- The drain is a ‘foreign body’, which may impair healing
- Inflammation
- Movement or misplacement of the drain
- Kinking or obstruction of the tubing
- Breakage or accidental removal
- Pain
- Tissue in-growth
- Fluid and electrolyte loss
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Assessment
Observation and careful handling of wound drains are of paramount importance within the practice setting. There are many factors that should be taken into account when caring for a patient with a drain in situ. An aseptic technique should be used when handling the drainage system, which should be disturbed as little as possible to reduce the risk of infection (Pudner, 2005).
Monitoring the drain/drainage fluid
The colour, amount, and nature of the drainage fluid should be recorded onto the fluid balance/wound drainage chart. Excessive drainage or changes in the type of fluid (particularly fresh blood) should be recorded and reported to the medical team.
Observation of the drain/drain site
Observe the drain site for damage to the surrounding skin caused by inflammation or fluid exudate. Gloves should be used when handling drains or the drainage system. Check that the drain system is well secured with
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Procedure
Procedure for removing a drain
- Explain the procedure fully to the patient and ask him/her to get into a comfortable position before removal
- Check the medical notes to ensure that the drain is to be removed
- If the drain is on an active drainage system (the vacuumed/suction method), de-vacuum the drain to reduce trauma to the tissues as the drain is pulled out
- Wash hands and apply sterile gloves. Maintain an aseptic technique during the procedure
- Cut the retaining suture
- Gently and smoothly remove the drain (difficulty in removing the drain may indicate adhesions, so always seek medical advice if you are unsure)
- Apply a sterile dressing to the drain site, and observe for bleeding/leakage
- Dispose of all equipment appropriately (drains are clinical waste)
- Document the procedure in the nursing notes
Procedure for changing a vacuum drainage system bottle
- Explain the procedure fully to the patient
- Wash hands, put on
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Resources
Brooks, N. What are the principles of caring for patients with wound drains? In: John Fowler, Staff Nurse: Survival Guide (2nd edition). Quay Books Division. 2010. 70-72.
Pudner R (ed). Nursing the Surgical Patient (2nd edn). Elsevier. London. 2005.
Torrance C, Sergison E. Surgical Nursing (13th edn). Bailliere Tindall, London. 2007.
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