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“ Use of drains in
Dr sumer yadav
ms general surgery , mch plastic and
A channel by which surplus liquid is drained
or gradually carried out.
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.
Drains inserted after surgery help the wound
to heal faster and assist in preventing infection.
Hippocrates –drainage of empyema, ascitic fluid
200AD- Celsius devised means of draining ascites
with conical tubes
1700AD –Johann Schltetus-1st
person to use
1897AD Charles Penrose devised Penrose drain
1932AD Chaffin developed 1st
available suction drain
1959AD silicone rubber discovered and advantages
were reported by Santos
Soft -Minimal damage to surrounding tissues
Smooth -Efficiently evacuate effluent and easy
Sterile- not potentiate infection or allow
introduction of infection from external
Stable- Inert, non allergenic, not degraded by
Simple to manage by both patient and staff
To remove unwanted fluid/ exudate
To allow monitoring of fluid volume & quality
To promote tissue apposition
To allow diversion of body fluids
To facilitate subsequent access to a body
space or cavity
To diagnose about underlying cavity or fistula
Greater tissue contact
Slides smoothly past any tissue
Promotes ease of movement and deep
Minimal pain on removal
Comes in various sizes
Laminar flow through drain
F =dP πr4
F = flow of fluid thru the drain lumen
dP =pressure difference between the two ends
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
Halving the length will double the flow
According to Poiseuille’s law the laminar flow
rate of an incompressible fluid along a tube is
proportional to the fourth power of radius of
tube and suction pressure. Flow is inversely
proportional to viscosity of the fluid and length
of the tube.
It means that wider and small length tube
have more flow rate.
a. Prophylactic :-postoperatively to prevent
accumulation of fluid or to detect early any
leakage from anastomosis site.
b. Therapeutic :-to evacuate an existing collection.
i.e. lymph, pus, urine saliva, serum
c. Diagnostic :-MCUG,T-tube cholangiogram
a. Open:-drains directly to the exterior .e.g.
Penrose and corrugated rubber drain. There
are less chances of blockage, more comfortable
to patient but more chances of infection.
b.Closed:-drains externally into a sealed container
so having less chances of infection, better skin
care, better care and accurate assessment of
Divert retain fluids form a body cavity to another
Useful in neurosurgery, ctvs ,G.I surgery and
E.g. Celestine, southar tubes, V-P shunt, Pericardio-
Channel discharge from cavity to external
3.a.With suction :-where negative pressure is
applied to facilitate drainage. It allow the
drainage of fluid from areas where movement of
fluid is against the natural pressure gradient,
also helps apposition of tissue planes prevents
fluid accumulation and blockage of tube less
Disadvantage:-it also causes more tissue erosion
and prevent healing of an established fistula by
continued fluid drainage.
3.b.Non – Suction (passive ) drains
a. Sump suction :-in this double lumen tubes
are there. Second tube act as a vent to allow air
flow down to the tip of a drain. This prevent
negative pressure at the tip and causes less
tissue erosion and less blockage.
b. closed suction
composed of materials irritant to tissues
excite fibrous tissue response leading to fibrosis and
E.g. latex, plastic and rubber drains
Non irritant drains
Provoke minimal tissue fibrosis
E.g. polyvinyl chloride(PVC),polyurethane(PU)
silicon elastomer (silastic)
Prior used red rubber or latex.(more chances
fibrosis and allergic reactions)
Nowadays used polyurethane,
silicone(silastic), silicone elastomer, siliconised
latex or polytetrafluoroethylene(PTFE)
Material Example Properties
Latex rubber Penrose drain Soft, induces tract
Red rubber Red rubber tube
Firm, induces tract
PVC Chest tube Firm ,induce some
Silastic Jackson-Pratt drain Soft, induces minimal
Heparin coated silastic Jackson Pratt drain Aims to inhibit clot
formation and achieve
Hydrogel coating Some foley
Produce slippery surface
resistant to encrustation
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
Should not exit cavity through same surgical
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
Must be removed when no longer useful-at once or
by progressive shortening
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
Trauma to tissues during insertion and
Fistula formation/perforation –erosion of
Visceral herniation through tract
Bacterial colonization and sepsis
Fluid and electrolyte loss
Prolonged healing-delayed foreign body
A substitute for poor surgical technique or
Wrong selection of appropriate drain
Inadequate care of drain
Insertion in main surgical wound
Must not adhere to
Must contain an anti
must be replaced
Same principles of
Sheet drain wrapped
around a wick or pack
Keep tract opened and
drain the inflammatory
Require less replacement
care and removal .
Parallel tubes .
Side and end holes.
Thick fluid can block
When air tight seal
could not be
can be connected
To allow decompression of gastric contents
To reduce postoperative nausea and vomiting
To reduce abdominal distension
To lower risk of aspiration and subsequent
Study by Cheatam et al1995 shows slight postoperative
reduction of nausea & vomiting and more patient
Study by Nelson et al2005 shows with non insertion of
tube showed less respiratory complications and
early return of gastrointestinal functions by early
passage of flatus.
Once anastomotic leak occurred drainage is
accepted as the treatment of choice
In Cochrane review Karliczek et al2006 showed
drainage after routine colorectal surgery rate
of mortality, wound dehiscence, wound
infection, reintervention and extra abdominal
complications is quite similar in both drain or
without drain (573/1140).
Petrowsky et al2004 showed both wound infection
rate subsequent fistula formation is lower if no
drain left irrespective of severity of
Lewis et al1990 showed no postoperative
reduction in complication.
Cochrane review showed that postoperative
drainage increase wound infection rates
following open cholecystectomy also increases
incidence of respiratory complications.
Same review showed increased rates of wound
infection and delayed postoperative discharge
in patients in which drain was used.
Prophylactic drainage is generally
recommended for subphrenic collections and
biliomas after liver resection.
But Cochrane review showed more chances of
infection of collection if drain is present and
recommends percutaneous drain placement
Used for decompression of oedematous CBD.
To prevent biliary leakage.
To provide access for postoperative
visualization and retrieval of retained stones.
Trial by De-Roover et al, Sheen-Chen et al and
williams et al showed longer postoperative stay
in T- tube placement.
Study done in perforated duodenal ulcer cases
(75/119) showed more chances of complication
as intestinal obstruction with drain placement.
Study done in subtotal and total gastrectomy
cases (108) showed no difference in
In pancreaticoduodenectomy for a lesion of
head of pancreas one drain is put near to the
pancreaticojejunostomy site and another near
the hepaticojejunostomy site.
Study by Conlon et al in patient after
pancreatic resection rate of complication and
number of intervention for collection were
greater with drain.
Used for reducing blood and fluid
Study fails to clarify situation.
Currently the placement of drain following
incisional hernia repair has to be at the
discretion of the operating surgeon.