Surgical drains are used to monitor for postoperative leaks or abscesses, collect normal physiologic fluid, or to minimize dead space. Table 45-1 lists various types of drains, with their indications for use. This chapter will review the most common types of surgical drains, and the basic care of these drains from a hospitalist perspective.
TABLE 45-1Surgical Tubes and Drains ||Download (.pdf) TABLE 45-1 Surgical Tubes and Drains
|Type ||Location ||Clinical Indication ||Clinical Scenario |
|Chest tube || |
|Trauma, cardiac surgery, thoracic surgery, malignant effusion, empyema |
|Nasogastric tube ||Stomach ||Intestinal decompression, gastric feeding ||Small bowel obstruction, ileus, temporary dysphagia |
|Gastric tube (gastrostomy) ||Stomach ||Prolonged enteral access, gastric decompression ||Prolonged mechanical ventilation, gastric outlet obstruction |
|Jejunal tube (jejunostomy) ||Jejunum ||Prolonged postgastric feeding, gastric outlet obstruction, high aspiration risk ||Prolonged mechanical ventilation, malignant gastric outlet obstruction, recurrent aspiration pneumonia |
|Duodenal tube ||Duodenum ||Postgastric feeding, gastric outlet obstruction, high aspiration risk ||Mechanical ventilation, dysphagia, acute aspiration risk |
|Penrose drain ||Peritoneal space, small surgical space ||Used to maintain surgical tract for adequate drainage || |
|Closed suction drain (eg, Jackson Pratt, Hemovac) ||Surgical space ||Evacuate serous fluid or blood, prevent seroma formation, tissue apposition to improve wound healing, drain GI secretions ||Mastectomy, ventral hernia repair, plastic surgery flaps, gastrointestinal anastomoses, orthopedic surgery |
Chest tubes are placed in the pleural space to evacuate air or fluid. They can be as thin as 20 French or as thick as 40 French (for adults). Chest tubes are typically placed between the fourth and fifth intercostal spaces in the anterior axillary or mid-axillary line, however, location may vary according to the indication for placement. The tubes can be straight or angled.
The tubes are connected to a collecting system with a three-way chamber. The water chamber holds a column of water which prevents air from being sucked into the pleural space with inhalation. The suction chamber can be attached to continuous wall suction to remove air or fluid, or it can be placed on “water seal” with no active suction mechanism. The third chamber is the collection chamber for fluid drainage.
Indications for a chest tube include pneumothorax, hemothorax, or a persistent or large pleural effusion. Pneumothorax and hemothorax usually require immediate chest tube placement. Chest tubes are also commonly placed at the end of thoracic surgeries, to allow for appropriate re-expansion of the lung tissue.
A chest x-ray should be obtained after any chest tube insertion to ensure appropriate location. Chest tubes are equipped with a radiopaque line along the longitudinal axis, which should be visible on x-ray. Respiratory variation in ...