SHORTENING OF DRAINS
Shortening and removal of drains refers to the process of adjusting or cutting to an appropriate length and then removing medical devices that are used to drain fluids or provide access to specific areas within the body
A drain: A surgical implant that allows removal of fluid and/or gas from a wound or body cavity.
Examples of Drains
Nasogastric Tube (NG Tube): This is used to drain stomach contents or provide nutrition. Shortening and removal may be necessary when the tube is no longer needed or needs adjustment.
Catheters: Catheters can refer to various types, such as urinary catheters and central venous catheters. Shortening and removal may be needed when the catheter is ready to be taken out.
Ventriculoperitoneal Shunts (VP Shunts): These are used to manage excess cerebrospinal fluid in the brain. While they are typically removed in a surgical procedure, adjustments or revisions may be needed during a patient’s treatment.
Vascular Access Ports: These are used for long-term intravenous treatments. Ports are typically removed when they are no longer required, such as when a patient completes chemotherapy.
Jackson-Pratt Drain (JP Drain): Used to remove fluids that build up in surgical sites, such as after a mastectomy or abdominal surgery. They are typically removed when the drainage decreases to an acceptable level.
Hemovac Drain: Similar to the JP drain, the Hemovac drain is used to remove blood and fluids from surgical sites. It is also removed when drainage decreases.
Penrose Drain: A soft, flat rubber tube used to allow drainage from a wound. It may be removed when the wound has healed sufficiently.
Chest Tube: Inserted into the chest to remove air or fluids, often in cases of pneumothorax or pleural effusion. They can be removed when they are no longer needed.
Biliary Drainage Tube: Used to drain bile from the liver or gallbladder when there is a blockage. Removal depends on the patient’s condition and the resolution of the blockage.
Ureteral Stent: Placed in the ureter to promote urine flow, often after urological surgeries. They may need to be shortened or removed when they are no longer needed.
Gastrostomy Tube (G-tube): Used for long-term enteral feeding, often in patients who cannot eat normally. Removal may be considered when the patient can resume oral feeding.
Indications of Drains
Nasogastric Tube (NG Tube):
- Gastric decompression: To remove stomach contents and gas to relieve abdominal distention.
- Enteral feeding: To provide nutrition and medications when oral intake is not possible.
Foley Catheter (Indwelling Urinary Catheter):
- Urinary retention: To relieve the inability to urinate.
- Monitoring urinary output: In critically ill or surgical patients.
- Post-operative use: For surgeries involving the urinary tract.
Ventriculoperitoneal Shunt (VP Shunt):
- Hydrocephalus: To divert excess cerebrospinal fluid (CSF) from the brain to the abdominal cavity.
- Normal pressure hydrocephalus (NPH): To manage the accumulation of CSF in older adults.
Central Venous Catheter (CVC):
- Intravenous medications and fluids: To administer chemotherapy, total parenteral nutrition (TPN), or other treatments.
- Hemodialysis access: For patients with renal failure.
- Frequent blood draws: In critically ill patients or those with challenging peripheral access.
Thoracostomy Tube (Chest Tube):
- Pneumothorax: To remove air from the pleural space.
- Pleural effusion: To drain fluid or blood from the pleural cavity.
- Post-surgical use: After thoracic surgery to prevent pneumothorax or pleural effusion.
Classifications of Drains
Drains are categorized based on various factors, including their functionality and design. Here, we discuss the classifications of drains:
Open vs. Closed Drains
- These drains include corrugated rubber or plastic sheets.
- Drain fluid collects in a gauze pad or stoma bag.
- They increase the risk of infection.
- Example: Penrose drain.
- Consist of tubes draining into a bag or bottle.
- These drains include chest and abdominal drains.
- The risk of infection is reduced.
- Example: Jackson-Pratt drain.
Active vs. Passive Drains
- Active drains are maintained under suction, which can be low or high pressure.
- Both open (e.g., Sump drain) and closed (e.g., Jackson-Pratt, Hemovac drain) drains can be active.
Advantages of Drains:
- Keep the wound dry.
- Efficient fluid removal.
- Can be placed in various locations.
- Prevent bacterial ascension.
- Allow evaluation of the volume and nature of fluid.
Disadvantages of Drains:
- High negative pressure may injure tissue.
- Drains can be clogged by tissue.
- Passive drains operate without suction and rely on pressure differentials, overflow, and gravity between body cavities and the exterior.
- Passive drains include closed (e.g., NGT, Foley’s catheter, T-Tube) and open (e.g., Penrose drain, corrugated drain) drains.
Advantages of Passive Drains:
- Allow evaluation of volume and nature of fluid.
- Prevent bacterial ascension.
- Eliminate dead space.
Disadvantages of Passive Drains:
- Gravity differences may affect the location of the drain.
- Drains can easily become clogged.
pigtail jackson hemovac
Types of Drains:
- Inserted under radiological guidance.
- Used to remove unwanted body fluids from organs, ducts, or abscesses.
- The tip forms a pigtail shape, facilitating drainage.
- A fine tube with multiple holes at the end.
- Attached to an evacuated glass bottle for suction.
- Drains blood under the skin.
Penrose Drain (Open Drain):
- A soft, flexible drain.
- Empties into absorptive dressing material passively.
- Prevents fluid from moving from areas of greater pressure to areas of lesser pressure.
- Placed into the common bile duct.
- Connected to a small pouch (bile bag).
- Used for temporary post-operative drainage of the common bile duct.
Chest Tube (Closed Drain):
- Used to drain hemothorax, pneumothorax, pleural effusion, chylothorax, and empyema.
- Inserted into the pleural space in the 4th intercostal space above the upper border of the rib below (4th to 6th).
- Complications to assess for include arterial thrombosis, air embolism, hematoma, bleeding, and infection.
Nasogastric Tube (NG Tube):
- Passed through the nostrils to the stomach.
- Indications include gastric juice aspiration, lavage in cases of poisoning, overdose medication, and feeding.
- Complications include epistaxis, aspiration, and erosions in the nasal cavity and nasopharynx.
- Hollow, flexible tubes used to collect urine from the bladder.
- Indications include relieving urinary obstructions, managing bladder weakness or nerve damage, draining the bladder during and after surgery, and treating urinary incontinence.
- Catheter materials can include rubber, silicone, or latex.
PROCEDURE FOR SHORTENING AND REMOVAL OF DRAINS
Emptying a drain
Perform hand hygiene.
- Rationale: Hand hygiene reduces the risk of infection.
Collect necessary equipment.
- Rationale: Having the required supplies readily available, such as a drainage measurement container, non-sterile gloves, waterproof pad, and alcohol swab, ensures a smooth and efficient procedure.
Apply non-sterile gloves and goggles or a face shield where necessary.
- Rationale: Personal protective equipment (PPE) reduces the transmission of microorganisms and protects against accidental exposure to body fluids.
Maintaining principles of asepsis, remove the plug from the pouring spout as indicated on the drain.
- Rationale: Aseptic technique is crucial to prevent contamination. Opening the plug away from your face reduces the risk of accidental splashing of body fluid.
Gently tilt the opening of the reservoir toward the measuring container and pour out the contents. Note the character of drainage: color, consistency, odor, and amount.
- Rationale: Pouring away from yourself prevents exposure to body fluids. Monitoring and documenting the characteristics of drainage are essential for patient care and record-keeping.
Swab the surface of the pouring spout and plug with an alcohol swab. Place the drainage container on the bed or a hard surface, tilt it away from your face, and compress the drain to flatten it with one hand.
- Rationale: Swabbing with alcohol maintains cleanliness. Flattening the drain before closing helps expel air, ensuring efficient functioning of the drainage system.
Place the plug back into the pour spout of the drainage system, maintaining asepsis.
- Rationale: Reinserting the plug while maintaining aseptic principles reestablishes the vacuum suction in the drainage system.
Secure the device onto the patient’s gown using a safety pin; ensure the drain is functioning; make sure that enough slack is present on the tubing.
- Rationale: Securing the drain minimizes the risk of inadvertent removal. Providing adequate slack accommodates patient movement and prevents tension at the drain insertion site.
Discard drainage according to agency policy.
- Rationale: Proper disposal procedures protect healthcare workers against exposure to blood and body fluids.
Remove gloves and perform hand hygiene.
- Rationale: Hand hygiene should be performed after removing gloves, as gloves are not puncture-proof or leak-proof. Hands may become contaminated during glove removal.
Document the procedure and findings accordingly. Report any unusual findings or concerns to the appropriate healthcare professional.
- Rationale: Documentation ensures accurate recording of drainage and any changes. If multiple drains are present, numbering and noting their locations in the chart is essential. Any significant changes or concerns must be reported to the healthcare provider per agency policy.
Removal of Drains
Confirm that the prescriber’s order correlates with the amount of drainage in the past 24 hours.
- Rationale: Ensuring the prescriber’s order aligns with recent drainage amount is crucial for safe removal. It helps avoid early removal if the drainage is not yet at an acceptable level.
Explain the procedure to the patient; offer analgesia and a bathroom visit as required.
- Rationale: Patient education and offering analgesia reduce anxiety about the procedure. Preparing the patient for the sensation they might experience during removal promotes cooperation. Analgesia ensures comfort during the procedure.
Assemble supplies at the patient’s bedside: dressing tray, sterile suture scissors or sterile blade, cleansing solution, tape, garbage bag, outer dressing.
- Rationale: Organizing supplies in advance ensures efficiency and readiness for the procedure, enhancing patient safety and comfort.
Apply a waterproof drape or mackintosh for setting the drain onto once it has been removed.
- Rationale: This provides a designated place for the removed drain, preventing contamination and maintaining cleanliness.
Perform hand hygiene.
- Rationale: Hand hygiene before the procedure reduces the risk of introducing microorganisms from other sources to the patient.
Apply non-sterile gloves and PPE accordingly.
- Rationale: Wearing non-sterile gloves and appropriate PPE as assessed at the point of care reduces the risk of transmission of microorganisms and provides added protection against contamination.
Release suction on the reservoir and empty; measure and record volumes greater than 10 ml. Remove the dressing.
- Rationale: Releasing suction ensures safe removal. Measuring and documenting the drainage volume is crucial for patient care and record-keeping.
Clean and dry the incision and drain site following principles of asepsis.
- Rationale: Preparing the wound and surrounding area through aseptic cleaning minimizes the risk of infection.
Carefully cut and remove the securing suture following principles of asepsis.
- Rationale: Removing the suture safely is essential to avoid complications and ensure smooth removal of the drain.
While holding two to three 4 × 4 sterile gauze in the non-dominant hand, stabilize the skin.
- Rationale: Sterile gauze helps absorb any additional drainage during the removal process, reducing the risk of introducing microorganisms. Stabilizing the skin minimizes discomfort to the patient during the procedure.
- Ask the patient to take a deep breath and exhale slowly; remove the drain as the patient exhales. Firmly grasp the drainage tube close to the skin with the dominant hand, and with a swift and steady motion, withdraw the drain.
- Rationale: Patient cooperation, distraction, and timed removal reduce discomfort. The gentle resistance felt during removal is expected, but if resistance is strong, taking a pause and encouraging relaxation is essential.
- Place the drain and tubing onto a waterproof pad or into a garbage bag. Remove gloves.
- Rationale: Proper disposal prevents contamination of the environment and maintains hygiene.
- At this point, some nurses may clean and dry the wound.
- Rationale: The decision to clean the wound can vary based on the specific situation and healthcare provider’s preferences.
- Dress the wound with a sterile dressing.
- Rationale: Dressing the wound post-removal is essential as drain sites may continue to drain for a few days.
- Discard the drain and garbage.
- Rationale: Proper disposal follows agency policy and decreases the risk of exposure to blood and body fluids for others.
- Perform hand hygiene.
- Rationale: Hand hygiene after the procedure minimizes the risk of contamination.
- Assess the dressing 30 minutes after drain removal. Likewise, ask the patient to call if they notice any increased drainage from the site.
- Rationale: Monitoring for changes in drainage after removal is essential for patient safety and early detection of complications.
- Document the procedure (including drain removal, drain output and characteristics, how the patient tolerated the procedure, dressings applied) accordingly. Report any unusual findings or concerns to the appropriate healthcare professional.
- Rationale: Accurate and timely documentation and reporting are crucial for patient care and safety, ensuring that any concerns are addressed promptly.