Surgical Drains

What is a surgical drain?

A surgical drain is a device that moves fluid away from your wound after surgery. After surgery, the area where your surgeon operated will shed cells and ooze body fluids as it heals. Placing a surgical drain prevents fluid from collecting and may help to prevent complications. Moving fluid away can help your wound heal faster. A drain can decrease your risk of infection if you care for it properly.

Part of having a drain involves writing down how much fluid (drainage) you’re losing each day and how it looks. This information lets your surgeon know how you’re healing and can help them decide when to remove it. It can also alert them of a complication, like an infection or leak.

Wearing a surgical drain might feel weird or uncomfortable. It can take time to get used to it. But remember it’s a key part of your healing process — and it’s temporary. Even if it doesn’t feel like it right now, the surgical drain can speed up your recovery.

When would you need a surgical drain?

Surgeons place drains after all types of surgeries. Depending on the surgery, you may need a drain to:

• Prevent fluid from accumulating within a wound
• Drain pus or infected fluid
• Prevent hematomas (collection of blood)
• Prevent seromas (a collection of clear fluid)

Your provider inserts a surgical drain while you’re asleep (under anesthesia) so you won’t feel them put it in.

How do surgical drains work?

All drains move fluids in a wound, like blood or lymphatic fluid (lymph), out of your body. How this happens depends on the type of drain.

• Open drainage systems use an open-ended tube to drain fluid from your wound onto gauze taped to your skin. Gravity pulls the fluid out of your wound, through the tube and onto the gauze. The Penrose drain is an open system.
• Closed drainage (suction) systems have an open-ended part that goes inside your wound and a closed end outside your body that collects the drainage. Squeezing the closed end creates air pressure that gently pulls fluid from your wound into the collection container. Jackson-Pratt (JP) drains and Hemovac drains are closed systems.

What are the types of surgical drains?

Surgical drains come in different brands and model variations. But most surgeons rely on three main types:

• Jackson-Pratt (JP) drain. A JP drain is a long flexible tube with a lemon-shaped collection bulb at the end. The open end of the tube goes inside your wound. The bulb end remains outside your body. When the bulb is squeezed (compressed), it draws fluid from your wound. A JP drain is the most common type of surgical drain.
• Penrose drain. A Penrose drain is a soft, flexible tube with two open ends. One end goes inside your wound and allows fluid to seep in. The other end sticks out of your wound so fluid can drain out. A piece of gauze dressing on your skin collects the drainage.
• Hemovac drain. A Hemovac drain works like a JP drain. Instead of a bulb-shaped collection container, a Hemovac has a collapsible cylindrical container that draws out fluid when compressed. It holds more fluid than a JP drain.

What are possible problems with surgical drains?

The benefits of having a surgical drain outweigh the potential complications. Still, there are problems to be aware of:

• There’s a risk of infection.
• Your skin may be itchy or red where the tube enters your skin.
• The drain may accidentally fall out, leak or become blocked.

Keeping the area clean and following care instructions can prevent most of these problems from happening. Contact your healthcare provider if you have any questions about caring for your drain.

How do I care for my drain?

Your care team will give you instructions on how to care for your wound and drain. The details depend on the type of surgery you had and the type of drain. Follow the instructions closely.

Generally, drain care involves ensuring your wound is clean and infection-free. You’ll need to regularly change your dressing and empty closed-system drains. You’ll also need to log information about your drainage.

Changing the dressing on an open drain system

Follow your provider’s guidance on how often you need to change the dressing (usually a piece of gauze) and clean your wound. It’s a good idea to care for your wound near a sink so you can wash your hands. Your hands should always be clean before handling your dressing or wound.

1. Wash your hands thoroughly (or use an alcohol-based sanitizer). Turn off the faucet using a towel.
2. Remove the old dressing and throw it away.
3. Wash your hands again and put on non-sterile gloves.
4. Clean the wound gently with soap and water or wound cleanser. Pat dry using a clean towel.
5. Place new dressing on your wound. The technique you’ll use will depend on the type of drain.

Emptying closed system drains

The fuller closed system drains get, the less fluid they pull out. This is why you need to empty them regularly. Empty them when they’re about halfway full.

1. Wash your hands thoroughly.
2. Using your non-dominant hand, pinch the drain tubing about a finger’s length away from where it’s inserted into your wound (surgical site). Hold it securely in place. This prevents the tubing from pulling at your wound in the next step.
3. Use your dominant hand (the hand you use more often) to pinch the tubing underneath where your non-dominant hand is pinching the tube. Push any fluid in the tubing down into the collection container.
4. Remove the stopper from the collection container and empty the fluid into a measuring cup.
5. Once it’s empty, squeeze the container at the same time you replace the stopper. This last step creates the air pressure inside the drain to pull the fluid out.

Logging drainage (color and amount)

You’ll need to record information about your drainage, including what the fluid looks like. Wound drainage changes color as it’s healing. It goes from sanguineous (bloody), serosanguineous (mix of blood and clear fluid) to serous (mostly clear fluid). This color progression is a sign you’re healing:

• Dark red (mostly blood)
• Lighter red or pink (blood and clear fluid)
• Pale yellow (straw-colored) or clear (mostly clear fluid)

You should also note how much drainage you’ve lost. Losing less fluid each day is a sign you’re healing.

• For a Penrose drain, record when you changed the dressing and how saturated the gauze was.
• For a JP drain or Hemovac, record when you emptied the drain and how much fluid was in the collection container. Refer to the measuring cup, where you emptied the fluid.

How long should surgical drains stay in?

It depends on the type of surgery you had, how much drainage you have and other factors. Some people wear them for 24 hours or less, while others need a drain for up to five weeks.

Your wound should drain less and less as it heals. Keeping track of how much fluid you’re losing can let your surgeon know when it’s safe to remove it.

Before leaving the hospital, ask your healthcare provider how long you’ll likely have drains.

Surgical drain removal

You may feel slight discomfort or a pulling feeling when your provider removes a surgical drain. Here are the general steps for removing it:

1. Your provider cleans the area with antiseptic.
2. They cut the suture (stitch) that’s holding the drain.
3. They gently pull the tubing out. You may feel pulling or tugging when this happens.
4. Finally, they cover the area with a bandage to stop any bleeding that may occur.

You’ll have a tiny hole in your skin where the drain was. It can take several weeks to fully heal, and you may have tiny scar from the drain.

When should I call my healthcare provider?

Contact your provider if you notice signs of infection, including:

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or more
• Redness, swelling, warmth or increased pain at the wound site
• Red streaks coming from the site
• Drainage from the site that’s smelly, green or thick

You should also call if the drain stops working or if you notice signs of a complication. Contact your provider if:

• Your stitches come loose
• The tube slips out of your wound
• Your drainage increases for two days straight (it should be decreasing)
• The fluid color returns to being red after being pink, pale yellow or clear (this is a sign you’re bleeding)
• Fluid starts coming out of the incision site (closed system drains)
• The drain suddenly stops pulling fluid out (closed system drains)

Call if you’re unsure whether you’re caring for your wound or drain properly. It’s always better to ask than risk an infection.