SURGICAL DRAINS
AND TUBES
SURGICAL DRAINS
Definition
A surgical drain is a tube used to remove pus,
blood or other fluids from a wound.
Drains are sometimes necessary to drain body
fluid which may accumulate
Indications
To help eliminate dead space
To prevent the potential accumulation of fluid or gas
To remove pus, blood, serous exudates, chyle or bile
To form a controlled fistula e.g. after common bile
duct exploration
Drainage System
Drainage
Open
Closed
Passive
drain naturally
Active
connected to suction
(wall or portable suction device)
Open drainage
corrugated rubber or plastic sheets
Drained fluid collects in gauze pad
 They increase the risk of infection
corrugated rubber drain
silicone drain (Penrose drain)
Closed drainage
Draining into a bag or bottle
They include chest and abdominal drains
The risk of infection is reduced
Allow accurate volume estimation of the drained fluids
May be active or passive closed drains
Active drains maintained under suction
Passive tubes connected to a collecting bag without suction
tube drain as Nelaton catheter
Complications of Drains
Failure of drainage :
 Poor Drain Selection (e.g small size with thick exudate )
 Poor Drain Placement with fluid accumulation (e.g. improper selection of site of
insertion)
 Inefficient Drainage (eg. drain kinked or obstructed)
Infection: Ascending bacterial invasion
Erosion of hollow viscous by pressure or suction necrosis
Retained part of the drain after removal (cut inner part during removal
.. Stitched tube during closure)
Complications of Drains (Cont.)
Primary haemorrhage at the site of insertion of the drain and secondary haemorrhage
if internal vascular structures are damaged via suction or on removal.
Discomfort /Pain (as in Thoracic Tubes with diameter too large or Stiff)
Incision dehiscence
Drain site Hernia
Disruption of anastomosis
Foreign body reaction
Migration within or without the body cavity.
Timing of drain removal
• Low daily output—when draining for bile and serous collections.
• Draining for blood (the change from a bloody fluid to serosanguinous
then clear serous with cardiovascular stability encourage removal).
• Intestinal anastomosis (toleration of oral intake, absence of distension,
return of bowel sounds, passage of flatus, and bowel motion).
• Thoracostomy tubes can be removed from the chest when daily output is
low, when there is no further air leak on coughing and a non swinging
fluid level in the closed underwater drainage system.
 Drains should be removed once the drainage has
stopped or become less than 25 ml day−1, as they are
a potential track for contamination and infection into
a wound.
 Drainage of bile or faecal matter indicates
disruption of a biliary or intestinal anastomosis
Removal of the drain
• A drain is removed as soon as it is no longer required according to the
purpose for which it was inserted.
• Drains put in to indicate for postoperative bleeding and hematoma
formation, or bile leak after Lap. Chole. can come out after 24— 48
hours.
• Drains put in to cover serous collections can come out after 3—5
days.
• Where a drain has been put in because the wound MAY later become
infected, should be left for 4-5 days.
SURGICAL TUBES
Nasogastric tube (NGT)
It passes through the nostrils (sometimes through
oral cavity!) to the stomach, to the duodenum or
even jejunum
used for:
gastric decompression fluid, blood and gas
gastric lavage
enteral feeding
Sangestaken tubes
• Used to compress porto-systemic shunt at lower oesophagus
(oesophageal varices)
Types
a-Linton 2 channels b-Blakemore 3 channels
c-Minnesota 4 channels
De Pezzar and Malecot’s tube
De Pezzar tube
Malecot’s tube
Gastrostomy tube
I- Open
II- Endoscopic
Jejunostomy tube
T-tube
• Kehr's T tube : a tube consisting of a stem and a cross head
(thus shaped like a T).
• The cross head is placed into the common bile duct while
the stem is connected to a small pouch (i.e. bile bag). It is
used as a temporary post-operative drainage of common
bile duct.
T-tube Cholangiogram
When to remove T-Tube?
Extended Modular Program
29
Caecostomy tube
Rectal tube
What is the drain or tube?
Tubes used in Special Surgery
(Discussed in details in Special Surgery Departments)
IV cannula
Vascular tubes
Central lines
Fogarty’s catheter
Intercostal tube
Endo tracheal tube
Urinary Catheters
Nelaton Catheter
Foley’s Catheter
SUTURE MATERIALS
Absorbable Sutures
1- Natural
• Traditionally, catgut was popular—derived from sheep or cow
intestine.
• Abandoned due to the theoretical risk of transmission of
infections such as mad cow disease (new variant CreutzfeldJacob disease).
2- Synthetic
• Polyglactin (Vicryl), polydioxanone (PDS) and polyglycolic
acid (Dexon).
• Vicryl and Dexon are braided. They handle, tie and are
stronger than catgut.
Non Absorbable Sutures
1- Natural (silk, cotton)
• These braided sutures tie and handle well but perpetuate infection by the
capillary action caused by the braiding.
• Silk remains in popular use in skin closure.
2- Synthetic
• These may be monofilament or braided.
• Polypropylene (Prolene), polyamide (Nylon), polytetrafluoroethylene (PTFE)
and polyester (Dacron).
• They cause little tissue reaction but are a little more difficult to handle than
silk.
• Prolene use is common for abdominal wall closure, hernia repair and skin
closure.
• Suture sinus formation, such as at the site of the knot in abdominal wall closure,
are recognised complications of non-absorbable sutures.
Shapes of Needles
Students’ questions