Surgical DrainsBY DR LAIQ MUHAMMAD TMO SBW STH

INTRODUCTION

THESE ARE APPLIANCES THAT ACT AS DELIBERATE CHANNELS WHICH IS USED TO DRAIN ESTABLISHED OR POTENTIAL COLLECTION OF BLOOD,PUS OR AIR.

IDEAL DRAIN

AN IDEAL DRAIN SHOULD BE…. FIRM,NOT TOO RIGID. IT SHOULD NOT BE TOO SOFT AS IT MAY TWIST OR KINK OR BECOME BLOCKED. SMOOTH IT SHOULD BE RESISTANT TO DECOMPOSITION OR DISINTEGRATION WIDE AND PATENT ENOUGHTO PREVENT EASY BLOCKAGE. IT SHOULD BE NON ELECTROLYTIC NON CARCINOGENIC AND NON THROMBOGENIC WHEN

USED IN VASCULAR SURGERY.

CLASSIFICATION OF DRAINS

SURGICAL DRAINS CAN BE A. OPEN OR CLOSED B. ACTIVE OR PASSIVE

PASSIVE VS ACTIVE DRAINS

PASSIVE DRAINS THAT TYPE OF DRAINS THAT SIMPLY ACT BY MEANS OF THE CAPILLARY ACTION OR GRAVITY. EXAMPLES

CORRUGATED RUBBER DRAIN PENROSE DRAIN(A VERY SOFT RUBBER TUBE

WITH GUAZE WICK INSIDE). SUMP DRAIN(A multiple lumen tube for

continuous drainage,irrigation,and aspiration) THESE DRAINS ARE USED WHEN DRAINAGE

FLUID IS TOO VISCOUS.

ACTIVE DRAINS THESE ARE TUBE DRAINS THAT ARE AIDED

BY ACTIVE SUCTION. EXAMPLES.

REDIVAC DRAINS HAEMOVAC SURGIVAC JACKSON-PRATT DRAIN

PASSIVE VS ACTIVE DRAINS

PASSIVE DRAINS ACTIVE DRAINS

INDICATION OF DRAINS

THERE ARE DIFFERENT INDICATIONS.IT INCLUDE1. THERAPEUTIC2. DIAGNOSTIC3. PROPHYLACTIC4. MONITORING5. PALLIATIVE

THERAPEUTIC

TENSION PNEUMOTHORAX PLEURAL FLUID ABSCESS CAVITY SEROMA ACUTE URINARY RETENTION ACUTE SUPPORATIVE ARTHRITIS INFECTED CYST

DIAGNOSTIC

T-TUBE CHOLANGIOGRAM FOR RETAINED GALL STONES IN COMMON BILE DUCT

BILIARY FISTULA.

PROPHYLACTIC

POST THYROIDECTOMY THORACOTOMY SPLENECTOMY PANCREATECTOMY ESOPHAGEAL RESECTION CARDIOTHORACIC PROCEDURES

MONITORING AND PALLIATIVE

FOR MONITORING IT IS USE FOR. GASTROINTESTINAL BLEEDING. URETHRAL CATHERIZATION.FOR PALLIATIVE. ADVANCED CA ESOPHAGUS. HYDROCEPHALUS.

ESOPHAGUS.

CARE OF SURGICAL DRAIN

IT INCLUDES INTRA OPERATIVE CARE SECURING A SURGICAL DRAIN POST OPERATIVE CARE

A. INTRA OPERATIVE CARE

PLACED SUCH THAT THEY TAKE THE SAFEST ,SHORTEST ROUTE POSSIBLE.

SHOULD REACH THE DEEPEST,MOST DEPENDENT PART OF THE CAVITY OR WOUND.

TUBES SHOULD REMAIN FREE OF KINKS,DEBRIS AND CLOTS.

SHOULD BE SECURED WELL TO AVOID FALLING OFF OR ITS MIGRATION INTO THE CAVITY OR EROSION OF SURROUNDING TISSUE.

DRAIN SHOULD BE LOWER THEN THE INCISION AT ALL TIMES.

B. SECURING A SURGICAL DRAIN

DRAINS HAVE BEEN SECURED USING VARIOUS TECHNIQUES AND MATERIALS. ROMAN GARTER TECHNIQUE WHICH USES SILK TO SECURE THE

DRAIN. USES OF NYLON SUTURES. SAFETY PIN. DRAIN CLIP. ADHESIVE.

C. POST OPERATIVE CARE

THE POST OPERATIVE CARE DEPENDS ON THE TYPE,PURPOSE AND LOCATION OF THE DRAIN. SKIN AROUND THE WOUND MUST BE KEPT CLEAN,AND DRY TO PREVENT INFECTION

AND SKIN IRRITATION. METICULOUS SKIN CARE AND ASEPTIC TECHNIQUES MUST BE OBSERED DURING

APPLICATION AND CHANGE OF DRESSING OVER DRAIN. GAUZE DRESSING ARE USED AROUND AND OVER DRAINAGE TUBES.

TO PROTECT THE TUBE ABSORB SOME AMOUNT OF DRAINAGE. ASSIST WITH THE STABILIZATION OF THE TUBES. PROTECT FROM EXTERNAL CONTAMINATION.

AN ACCURATE MEASUREMENT AND RECORD KEEPING OF DRAINAGE OUTPUT. DRAIN CONTAINER SHOULD BE EMPTIED AT LEAST ONCE A DAY.

WHEN TO DISCONTINUOUS A SURGICAL DRAIN.

ONCE THE DRAINAGE HAS STOPED. ITS OUT PUT HAS BECOME <25-50 ML/DAY. THE DRAIN HAS STOPPED SERVING THE

DESIRED FUNCTION.

COMPLICATIONS.

IMMEDIATE. PAIN IRRITATION BLEEDING PERFORATTION OR INJURY TO ADJACENT STRUCTURES.

EARLY. OCCLUSION LEAKING AROUND DRAIN DISPLACEMENT INFECTION LOSS OF FLUID,ELECTROLYTES AND PROTEIN

COMPLICATIONS….

LATE. PRESSURE/SUCTION NECROSIS OF BOWL OR VESSEL. FISTULA. SCAR. HERNIA.

COMPLICATIONS DURING REMOVAL. PAIN INFECTION(CELLULITIS/ABSCESS) INJURY TO ADJACENT STRUCTURES. RETAINED OR FRAGMENTATION OF TUBE.

CONCLUSIONS.

THE USE OF DRAINS IN SURGICAL PRACTICE HAS BEEN CONTENTIOUS OVER THE YEARS.THE ESSENTIAL QUESTIONS A SURGEON NEEDS TO ANSWER WHEN DECIDING ON THE VALUE OF SURGICAL DRAINS ARE..

WHAT PURPOSE WOULD A DRAIN SERVE IF PLACED? WHAT TYPE OF DRAIN SHOULD BE USED? HOW LONG SHOULD THE DRAIN BE LEFT IN PLACE?

ONCE THESE QUESTIONS ARE CAREFULLY AND ADEQUATELY ANSWERED EACH TIME A DRAIN IS USED, THE EFFECTIVENESS AND ADVANTAGE CAN BE MAXIMIZED WITH MINIMAL PROBLEMS.

THANK YOU