What Is a Surgical Drain?

Drainage tube is a medical device used for clinical surgical drainage to guide the pus, blood, and fluid accumulated between human tissues or in the body cavity to the outside of the body to prevent postoperative infection and promote wound healing. There are many types of clinically used surgical drainage tubes, some for catheterization, some for wounds, chest cavity, brain cavity, gastrointestinal tract, and biliary tract. Surgical drainage is to guide the pus, blood, and fluid accumulated in human tissues or in the body cavity to the outside of the body to prevent postoperative infection and affect wound healing.

Chinese name: Drainage tube
Foreign name: Drainage Tube

Category Name: Drainage catheter
Management category: Class II medical devices

Basic structure of drainage tube

Generally made of materials such as silicone rubber or polyurethane. During use, one end of the catheter is inserted into the drainage site of the body or wound, and the other end can be connected to other external instruments such as drainage nozzles outside the body, and is drained to the outside through the pressure of the body, gravity, or negative pressure. Available aseptically and for single use. Used to drain patient fluid, exudate or gas out of the body. Common are thoracic drainage catheter, ventricle drainage catheter, extracerebrospinal fluid drainage catheter, extralumbar spinal drainage catheter, extracranial drainage catheter, abdominal drainage tube, thoracic drainage tube, ventricular drainage tube, bile drainage tube, bile drainage tube, etc. ^[1] .

Drainage tube works

Using the principle of siphon or negative pressure suction, it is placed in the surgical area or body cavity of the human body and passed through the skin incision to guide the pus, blood, interstitial fluid and other fluids accumulated in the human tissue or body cavity to the outside of the body to prevent fluid accumulation. Postoperative infection. Promote wound healing and disease recovery ^[2] .

Drainage tube classification

According to the purpose of placing the drainage tube, it is divided into a therapeutic drainage tube and a preventive drainage tube.

Therapeutic drainage tube
The indications for therapeutic drainage are clear, including peritoneal fluid, blood, pus, gas, necrotic tissue, foreign body, or fistula. The main indications are infectious diseases, hepatobiliary diseases, and gastrointestinal disorders.
Preventive drainage tube
Preventive drainage is used for monitoring purposes to observe the occurrence of active bleeding or gastric, intestinal, biliary and pancreatic leaks. Preventive drainage tube is often used in major abdominal surgery such as liver resection, pancreaticoduolipidectomy, gastric cancer and colorectal cancer radical operation under the chin.

According to the location of the drainage tube can be divided into thoracic drainage tube, abdominal drainage tube, cerebral effusion shunt tube, urinary catheter, bile duct drainage tube, etc. ^[3] .

Drain tube considerations

Keep the drainage pipe open, pay attention to observation at any time, do not be compressed and twisted, and turn into an angle to avoid affecting the drainage. Also pay attention to the fixing of the drainage tube to avoid displacement and prolapse.
When applying a drainage tube, pay attention that the position of the drainage bottle cannot be higher than the plane of the patient's intubation port. When moving the patient, first clamp the drainage tube; when the drainage fluid exceeds half of the bottle body, it should be dumped to prevent backflow pollution caused by too high liquid level.
Pay attention to keep the drainage tube and the wound or mucous membrane contact area clean to prevent infection.
Make a record of drainage color, traits, and quantity, and report to the doctor in a timely manner.

Lacrimal drainage tube

The lacrimal drainage tube has specifications Fr2 and Fr3 (equipped with a special surgical traction hook).

Its product features include:

Silicone rubber material, soft texture, good elasticity, little damage to lacrimal duct tissue;
Good biocompatibility, no irritation and allergies, can be left for a long time;
The front end of the metal probe is in the shape of a teardrop, which makes the transition smooth and reduces damage to the lacrimal duct. It is easy to pull out the silicone rubber material from the nasal cavity. When the lacrimal drainage tube is used clinically, the success rate of intubation is high, the drainage is smooth, and there is no obstruction. Compared with traditional surgery, the operation is simple, the patient has less pain, less bleeding, less recurrence, and no scarring. Indwelling for 3 to 6 months, stable, no irritation, no allergies; no need for anesthesia when extubation, simple and easy, no pain for patients; best anastomosis for lacrimal canaliculus rupture (irreplaceable); Narrow stenosis and nasolacrimal duct stenosis are significant.

Lacrimal drainage tube Indications for using lacrimal drainage tubes are:

Chronic dacryocystitis;
Lacrimal ductal stenosis;
The nasolacrimal duct is narrow and blocked;
Tear spots are narrow and blocked;
Lacrimal duct tears and other tear duct diseases;
Nasal lacrimal sac anastomosis.

Thoracic drainage tube

The specifications of thoracic drainage tubes are: Fr16, Fr20, Fr24, Fr28, Fr32, Fr36.

Features of its products include:

Pleural drainage tube

Silicone rubber with X-ray marking lines;
The front section of the catheter has smooth side holes to ensure smooth drainage;
The front end has two different shapes, one is a circular arc type, and the other is a crocodile mouth type.

General drainage tube

purpose

Drain gas, liquid (digestive fluid, abdominal fluid, pus, incision exudation) to the outside body, reduce local pressure, reduce adhesions, and promote healing.
For testing and treatment.

Use
Treatment cart, treatment tray, 1 vascular forceps, 1 pin, 1 disposable drainage bag (bottle), 1 dirt bucket, 2 sterilized curved plate (1 sterilized gauze inside, 1 tweezer) 5% PVP iodine, cotton swabs.
Steps

Wear a mask and wash your hands.
Put the spare on the treatment cart, push it to the patient's bed, and explain to the patient. Close the doors and windows in winter to place the patient (lower half or supine position)
Inspect the wound, expose the drainage tube, loosen the pin, and keep warm.
Check that the sterile drainage bag is sealed and expired. Open the outer packaging, check whether the drainage bag is damaged or the tube is twisted, hang the drainage tube on the edge of the bed, and then pad the drainage bag under the drainage tube interface.
Squeeze the drainage tube and use the vascular forceps to inject 3 cm above the tail end of the drainage tube.
Use a PVP iodine cotton swab to sterilize the drainage tube connection, first sterilize the interface around the interface, and then sterilize 2.5 cm above and below the interface.
Use your left hand to remove the poisonous gauze and pinch the drainage tube part at the connection point to release the connection point.
Sterilize the nozzle of the drainage tube with PVP iodine swab.
Connect the sterile drainage bag, loosen the vascular forceps, and squeeze the drainage tube to see if it is unobstructed. Fix the drainage tube on the sheet with a pin.
Organize things and properly place the patient.
Strictly record the volume and nature of the drainage fluid.

Precautions

Strict aseptic operation, keep the drainage bag position lower than the drainage site, the drainage bag can be replaced 1-2 times a week (the drainage fluid has properties, and the color needs to be replaced daily).
Keep the drainage tube unobstructed and squeeze it regularly to prevent the drainage tube from folding and twisting.
Observe the amount of drainage fluid, characteristics, color changes, whether it is consistent with the disease, record daily, find abnormalities, and contact the doctor in time.
The drainage tube is properly fixed to prevent slipping off. Do not pull the drainage tube when the patient is moving.
The replacement method of the negative pressure drainage bottle is the same.

Drainage tube tracheostomy

purpose
Sputum suction in the trachea is a necessary means to keep the airway open. It can stimulate patients to cough and suck out airway secretions to prevent pulmonary complications.
Use
Disinfection gloves, sputum suction tube, disposable sterilization cup, normal saline, 5 ml syringe with humidified solution, syringe with 10 ml furacicillin or normal saline, negative pressure suction device, if necessary, the breathing balloon is connected with oxygen.
Steps

Wear a mask and wash your hands.
Assess whether the patient needs endotracheal suctioning. Indications include: (1) rough breathing sounds, (2) cough, and (3) faster breathing.
Explain to the patient (conscious person) or family member (coma patient) for cooperation.
Start the suction device and adjust the pressure to 13.3-16.0kpa (100-120mmHg), and the maximum should not exceed 26.7kpa (200mmHg).
Pour sterilized physiological saline into a disposable sterilization cup, open the suction tube, expose the end, and wear gloves on the right hand to maintain sterility.
The right-hand holding suction tube is connected to the left-hand holding suction tube, and the left-hand thumb is used to control the suction valve, and the sputum suction tube is soaked with sterile normal saline to test suction.
Insert the sputum tube through the tracheal tube into the trachea, quickly open the suction valve for intermittent suction, and withdraw by suction while rotating, and extract the sputum at one time. Do not twitch up and down to avoid hypoxia. Generally, the single suction time is 5-8s, and it should not exceed 15s.
After oxygen inhalation or a short rest (3min), you can re-attract but not more than 4 times.
If the secretion is thick, you can inject 2-5 ml of physiological saline into the trachea, and then pressurize and breathe 3 or 4 times, so that the dripped liquid will enter the small bronchus to dilute the accumulated sputum and stimulate the cough. .
After suctioning, separate the suction tube, soak the suction tube head in the disinfectant solution, and handle the gloves and suction tube as disposable items.
Cut the bottom of the 2 medicine cups, put a gauze between the two cups to cover the tracheostomy opening, and soak the gauze with normal saline.
Place patients, organize bed units, organize supplies, and wash hands.

Precautions

Hypoxic patients should increase the oxygen flow before breathing or pressurize the breath with a breathing sac and 100% oxygen. If the disease requires, repeat the suction according to the steps, but no more than 4 times. After sputum suction, you can breathe with a breathing sac and 100% oxygen.
Aseptic technique must be strictly performed during operation. The suction tube, gloves, suction solution and container must be replaced every time to avoid cross infection due to improper operation.
During operation, pay attention to light and fast movements to avoid damaging the tracheal mucosa.
The pipes of the suction device must be connected accurately without leaking air. The suction bottle should be poured in time. The water level should not exceed 2/3. Soak and disinfect it daily.
After using a respirator, the patient is connected to the ventilator after suctioning and adjusting parameters.
Dressing at tracheotomy is usually changed once a day.

Thoracic drainage tube

purpose
Exhaust the gas and fluid in the pleural cavity, rebuild the negative pressure, and make the lungs expand.
Use
Treatment cart, treatment tray, treatment towel, sterilized water sealed bottle, 2 curved plates (one bottom and one cover), 2 toothless tweezers inside, 3 PVP iodine cotton balls (or 2% iodine wine, 75% alcohol cotton balls 3 each, one piece of gauze), 2 vascular forceps, topical saline, bottle opener, adhesive tape, pins, dirt bucket.
Steps

Wear a mask and wash your hands.
Check the disinfection date in the treatment room, open the disinfection water seal bottle, check whether the water seal bottle is damaged, and whether the connection is accurate.
Pour external physiological saline into the bottle, close the stopper tightly, place the long glass tube under the liquid surface, keep it upright, and mark the horizontal surface outside the bottle with adhesive tape.
Put the spare on the treatment cart, push it to the patient's bed, explain to the patient to get cooperation.
Place the drainage bottle correctly. The position of the bottle and the chest cavity should be 60-100 cm.
Check the wound, loosen the pin, pay attention to warmth, squeeze the drainage tube, expose the interface of the thoracic drainage tube, and connect the curved plate to clamp the proximal end of the thoracic drainage tube with 2 vascular forceps.
Disinfect the interface and properly connect the drainage tube.
Check whether the drainage device is correct, release the vascular forceps, squeeze the chest drainage tube again, and observe the fluctuation of the water column in the water seal bottle.
Properly fix, place the patient, organize things, and record the volume, color, and properties of the drainage fluid.

Precautions

Strictly aseptic operation, water sealed bottles are changed daily.
Under no circumstances should the drainage bottle be higher than the patient's chest.
To avoid pressure, bending, slipping and blocking of the drainage tube, keep the drainage flow smooth.
To keep the drainage system sealed, the chest wall wound should be tightly covered with vaseline gauze around the drainage tube. If the water-sealed bottle is damaged, immediately clamp the drainage tube and change the water-sealed bottle. If the chest tube bursts when a large amount of gas is continuously discharged, do not pinch the chest tube, and immediately change a water-sealed bottle to avoid causing pneumothorax.
If the patient's breathing improves without drainage of the drainage tube, the drainage fluid is less than 50 ml within 8 hours, and the lungs are fully expanded, and extubation can be considered.
After extubation, observe the patient for shortness of breath, subcutaneous emphysema, or pneumothorax.
The method of disposable thoracic drainage device is the same as above, and refer to the instruction manual.

Drainage tube

purpose

Aspiration of the fluid (blood) in the gastric tube to aspirate gas and reduce gastric distension.
Compression hemostasis of esophagus and gastric vein rupture bleeding in patients with liver cirrhosis.
Understand the amount and nature of gastric juice, and provide a basis for clinical judgment of disease and treatment.

Use
Treatment disc, treatment towel, three-cavity tube, paraffin oil, gauze, cotton swab, 50ml syringe, 2 vascular forceps, sandbag (0.5kg), adhesive tape, blooming water in the treatment bowl, gastrointestinal pressure reducer, pulley traction Holder, rope, scissors.
Steps

Wear a mask and wash your hands.
Explain to the patient and get cooperation.
Mark the three lumens of the three-lumen tube separately, use a 50 ml syringe to pump the gas in the gastric and esophageal sacs, and then inject 200 ml into the gastric sac and 150 ml in the esophagus sac. .
Paraffin oil is used to lubricate the gastric tube and the double balloon, and the three-lumen tube (gastric tube) is inserted in the same way as the nasogastric tube. The gastric juice is aspirated. When gastric juice is extracted, it is proved in the stomach.
First inject 200 ml of gas into the gastric balloon, clamp the open end of the gastric balloon with a clip, mark it, and pull the three-lumen tube outward until it has a slight elastic resistance. Then fix the three-lumen tube with adhesive tape at the end of the tube. Tie a roving rope and use a 0.5kg sandbag to pull the three-lumen tube through the pulley device to compress the bottom of the stomach and raise the tip of the bed.
The direction of traction should be at a 45-degree angle along the longitudinal axis of the body and the nasolabial, and then inject 150 ml of air into the esophageal balloon with a syringe, clamp the open end of the esophageal balloon with a clip, and mark it.
The gastric lumen is connected to a gastrointestinal decompressor, the negative pressure is adjusted to 8kPa, and the suction is performed regularly.
Organize supplies and place the patient.

Precautions

Place the three-lumen tube balloon for no more than 48 hours, and deflate the balloon every 5 hours to 5-10 ml to prevent erosion and necrosis of the esophagus and gastric mucosa.
Deflate the airbag once after 12h of compression. Red blood was still sucked out of the gastric tube 48 hours after the balloon compression, which indicated that the hemostatic effect of the balloon compression was not effective, and the doctor should be reported immediately.
Record daily gastric juice aspiration volume and properties for daily reference when replenishing water and electrolytes.
Oral care 2-4 times a day, drip a few drops of paraffin oil from the nasal cavity along the three-lumen tube.
Prevent esophageal balloon from blocking the throat and causing suffocation caused by excessive pulling or slipping, especially when the balloon is inflated and traction, if the patient has difficulty breathing, immediately relax the traction and extract the air from the esophageal balloon. Cut the two sacs.
The negative pressure of the gastrointestinal decompressor is maintained at 8kPa to facilitate drainage, and it must be cleaned and disinfected after use.
After the bleeding stops for 12 hours, you can inject the medicine from the gastric tube. Before the injection, you must recognize the mark to prevent the wrong irrigation to the esophageal or gastric balloon, which will cause the balloon to rupture.
Patients with liver disease can avoid inducing liver coma by injecting medicinal solution through the gastric tube to promote the intestinal effusion and other nitrogen-containing substances to be discharged, while inhibiting intestinal bacteria to reduce ammonia production.
After 48-72 hours of bleeding stop, you can consider extubation. Before extubation, completely remove the air from the balloon and continue to observe for 12 hours. If there is no bleeding, swallow 30-50 ml of paraffin oil, lubricate the gastric wall, and then extubate to avoid blood clots The mucous membrane was broken and the mucosa bleeded again.

Abdominal drainage tube

classification

Leather tube: rubber tube and silicone tube
Special drainage tube: T-shaped tube, U-shaped tube, etc.

Indication

Cavity organ trauma or trauma rupture, often with secondary peritonitis
Abscesses in the peritoneum and internal organs, which can be punctured with a catheter or surgically opened for drainage
The surgical wound is very large, with local exudation and bleeding, which is prone to secondary infection

Nursing

According to the needs of the disease, observe that several drainage materials and several drainage tubes may be placed in the abdominal cavity. The patient must be counted when transferring into the ward. It is best to mark the disease according to the role or name of the drainage bottle.
Observe and record the properties and quantity of the discharged material separately, replace the outer dressing in a timely manner and estimate the amount of liquid. The drainage tube may be blocked if there is no drainage flow. If the drainage liquid is blood and the flow rate is fast or more, the doctor should be promptly notified deal with.
The patient should prevent the drainage tube from coming out or breaking into the abdominal cavity when turning over, getting out of bed, and defecation. The person who slides out should replace it with a new one.
Those who need negative pressure drainage should adjust the required negative pressure and pay attention to maintaining the negative pressure state.
Gauze or vaseline gauze stuffing hemostatic person should closely observe the situation of the whole body, if stable, it should be removed within 48-72 hours, or replace with new gauze and stuffing.
The drainage tube for preventive application should be removed within 48-72 hours. If the digestive juice leaks into the abdominal cavity after the anastomotic rupture is removed, it should be removed within 4-6 days.
If the drainage tube in the abdominal cavity cannot be removed for 2-3 days, the leather tube should be rotated every 2-3 days to avoid secondary injury caused by long-term fixed compression.
If you need to use a drainage tube to inject antibiotics and other drugs or for lumen flushing, you must strictly follow the aseptic principle.
Observe the complications that may be caused by drainage, such as compression of tissue necrosis and bleeding, intestinal fistula, subsequent infection, pain, etc., should be removed or replaced in time to deal with complications.
If a T-shaped drainage tube is used after gallbladder surgery, it must be removed 14 days after surgery to prevent bile from entering the abdominal cavity and causing peritoneal irritation or infection.