SURGICAL DRAIN SITE

CARE
R O S A LY N T A I J E R O N R N , B S N A N D E L I D E L O Y O Z A R N , B S N
UNIVERSITY MEDICAL CENTER

SURGICAL DRAIN AKA WOUND

DRAINAGE SYSTEMS
Closed drain systems:
Bulb suction
Hemovac
Percutaneous drain

Open drain system:

Penrose drain

PURPOSE OF SURGICAL DRAINS

Prevent hematomas and seromas
Facilitate removal of infected material to decrease
bacterial load.

NURSING RESPONSIBILITIES OF SURGICAL

DRAIN SYSTEMS ACCORDING TO UMC POLICY
Policy NC-PA-9, C. Drains
All drains will be checked for patency.
Jackson Pratt drains and hemovac drains will be
compressed at all times unless otherwise ordered.
Document the amount and color of fluid collected from
any drains and report any abnormal findings to the
physicians.

Refer to Smith and Duell when there is no policy

in place: Unit 3, Chapter 25, pages 915-916
Caring for a Wound With a Drain

WHAT IS THE PROBLEM

There are no clear cut guidelines for dressing
placement, how often dressings should be
changed, and patient education for drain care
when patients are discharged home with a
surgical drain system in place.
Variations in practice within the clinical setting.
Hospital wide problem
Patients at risk for drain site complications
Drains associated with SSIs and SSIs cost the
hospital money due to loss of reimbursement

COMPLICATIONS ASSOCIATED WITH

SURGICAL DRAINS
Hemorrhage
Tissue inflammation
Retrograde bacterial migration, drain serves as a
means for bacteria to migrate to surgical site
Drain entrapment (tissue growth around drain
causes more trauma to surrounding tissues when
removed)

COMPARISON TO OTHER
INTERVENTIONS
Wounds, PIVs, and PICCs
Wounds have orders for care
PIVs have a standard of 72 hours before they must be
changed
PICC lines have a standard of 7 days before dressings must
be changed, dressings should be changed as needed, and
they must be removed if they have finished serving their
purpose.
Comparison to surgical drains
Drain is a foreign body inserted into tissues similar to PIV or PICC,
neither a PICC or PIV is treated like a wound
Wounds are a break in skin integrity
A drain is a foreign body and in having a drain place, a patient has a
break in skin integrity

INITIAL EBP QUESTION

Will implementing nursing education for drain
insertion site care reduce adverse events and
improve patient outcomes?

LITERATURE REVIEW
Study finds that having a drain in place increases
patients risk for surgical site infection
Complications associated with surgical drains
Suggestions for drain site care listed at end of
presentation

EXPERIMENTAL DESIGN
Use an assessment tool to evaluate current
practice for insertion site care in clinical setting
and evaluate patients for adverse effects of drain

DATA

Drain type

Total #
of
drains

Dressing

Dated

Open to air

Drainage
present

Bulb suction

16

12

Percutaneous

Hemovac

Penrose

CHART
18
16
14
12
10
8
6
4
2
0

Drain
Dressing
Dated
No dressing
Drainage

RECOMMENDATIONS FOR NURSING INTERVENTIONS

BASED ON LITERATURE REVIEW
Label drains if there are more than one
Label dressing with date
Dressings of surgical drains should be monitored regularly to
ensure drainage is minimal.
Drainage should be outlined with pen and timed to monitor
leakage
Dressings may be removed in 3-5 days once drain site is
healed. Post op dressing can be in place for 3-5 days unless
requires replacement due to drainage.
Excessive drainage should be reported to physician
Dressings may be removed in 3-5 days once drain site is
healed
Immobilize drain to minimize irritation to local tissues

CONCLUSION
Post operative monitoring and consistency in practice
aimed at prevention of complications and early
identification of complications
Drains typically inserted for 24-48 hours and removed
once drainage has stopped, however some drains are left
in place for a much longer period and have a greater
potential for complications
Nursing education regarding drain site care implemented
to improve patient outcomes
Eventually work on material for patient education in the
event that patients are discharged home with drain and
make available in Depart as well as conduct experiment
to determine evidence based practice for drain site care

REFERENCES

Walker J (2007) Patient preparation for safe removal of surgical drains. Nursing
Standard. 21, 49, 39-41. Date of acceptance: May 25, 2007
Caring for your Jackson-Pratt Drainage System. Memorial Sloan Kettering Cancer
Center. Web. https://www.mskcc.org/cancer-care/patient-education/caring-yourjackson-pratt-drainage-system.
Closed Suction Drain with Bulb. National Institutes of Health. U.S. National Library
of Medicione, 9 Apr. 2014. Web 17 May 2015.
<http://www.nlm.nih.gov/medlineplus/ency/patientisntrucitons/000039.htm>.