Surgical drains are used to monitor for a postoperative leak or abscess, collect normal physiologic fluid or to minimize dead space. Table 47-1 lists various types of drains, as well as their locations and indications. Although caregivers should know the location and purpose of drains, they should not manipulate surgical drains without input from the surgeon who placed them.
Table 47-1 Surgical Tubes and Drains ||Download (.pdf)
Table 47-1 Surgical Tubes and Drains
|Type||Location||Clinical Indication||Clinical Scenario|
|Chest tube||Pleural space||Pneumothorax||Trauma, cardiac surgery, malignant effusion|
|Nasogastric tube||Stomach||Intestinal decompression, gastric feeding||Small bowel obstruction, temporary dysphagia|
|Gastric tube (gastrostomy)||Stomach||Prolonged enteral access, or gastric decompression||Prolonged mechanical ventilation, malignant gastric outlet obstruction|
|Jejunal tube (jejunostomy)||Jejunum||Prolonged postgastric feeding in the setting of gastroparesis, gastric outlet obstruction, or high aspiration risk||Prolonged mechanical ventilation, malignant gastric outlet obstruction, recurrent aspiration pneumonia|
|Duodenal||Duodenum||Post gastric feeding in the setting of gastroparesis, gastric outlet obstruction or high aspiration risk||Mechanical ventilation, dysphagia, acute aspiration risk|
|Penrose drains||Peritoneal space, small surgical space||Used to maintain surgical tract for adequate drainage|
|Closed suction drains||Surgical space||Evacuate serous fluid or blood||Mastectomy, ventral hernia repair, plastic surgery flaps, gastrointestinal anastomoses|
|Prevent seroma formation|
|Jackson Pratt||Tissue apposition to improve wound healing|
|Hemovac||Drain gastrointestinal secretions|
|Vacuum-assisted closure device||Open wound||Accelerated wound closure||Open trunk or extremity wound|
- Although caregivers should know the location and purpose of drains, they should not manipulate surgical drains without input from the surgeon who placed them.
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 38 French and are typically placed between the fourth and fifth intercostal space in the anterior axillary line. However, location may vary according to the type of surgery. The tubes can be straight or angled. Angled tubes are used primarily to collect fluid and are usually placed near the diaphragm.
The tubes are connected to a collecting system with a three-way chamber (Figure 47-1). The water chamber holds a tall 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 left without suction on water seal. The third chamber is the collection chamber which should be marked at regular intervals to monitor fluid drainage.
Chest drainage collection systems. (Reproduced, with permission, from Hall JB, Schmidt GA, Wood LDH. Principles of Critical Care. 3rd ed. New York: McGraw-Hill; 2005: Fig. 95-4.)