Drainage system in abdominal surgery

1. Drainage system in
abdominal surgery
A. Thangamani ramalingam
PT, MSc (PSY), MIAP

2. Drains & tubes

3. Definition
A surgical drain is a tube used to
remove pus, blood or other fluids from a wound.
A drainage tube is usually only used in extreme
medical situations when the patient is at greater risk
of having complications from a collection of fluid
around an organ, over the risk of inserting a
drainage tube.
used for short periods

4. WHY
To reduce the risk of haematoma formation
and break down of wound
an excessive amount of blood and fluid that
collects in the cavities of the body, and
around organs
faster wound healing or prevent infection

5. Disadvantages
Presence of a drain increases the risk of
infection
Damage may be caused by mechanical
pressure or suction
Drains may induce an anastomotic leak
Most drains abdominal drains infective
within 24 hours

6. Principles
Septic wounds should be drained
Aseptic wounds those having oozing vessels
or large area
Wounds with chances of more fluid collection
inside
Leaking wounds from anastomosis

7. Unless there is a definite
reason, the drainage
should be removed with in
48 hrs

8. Types of Drainage Tubes
Open or closed
Active or passive
Tube drains
Corrugated drains

9. Open drains
Include corrugated rubber or plastic sheets
Drain fluid collects in gauze pad or stoma bag
They increase the risk of infection
Closed drains
Consist of tubes draining into a bag or bottle
They include chest and abdominal drains
The risk of infection is reduced

10. Active drains
Active drains are maintained under suction
They can be under low or high pressure
Passive drains
Passive drains have no suction
Function by the differential pressure between
body cavities and the exterior

11. Types of drainage systems
The closed drainage system is a system of tubing or
other apparatus that is attached to the body to remove
fluids in an airtight circuit that prevents any type of
environmental contaminants from entering the wound
or area being drained.

The open drainage system is a tube or apparatus that is
inserted into the body and drains out onto a dressing.

Lastly the suction drainage system uses a pump or
mechanical device to help pull the excessive fluid from
the body.

12. Jackson-Pratt drain- closed
drainage system / uses suction
consists of a tube connected to a see-through
collection bulb. The bulb has a drainage port which
can be opened to remove fluid or air so that the bulb
can be squeezed to create suction. The drain is
placed below the area of the wound.
Common uses
Abdominal surgery
Breast surgery
Mastectomy
Thoracic surgery

13. Penrose drain-open drainage
A Penrose drain is a surgical device placed in
a wound to drain fluid. It consists of a soft
rubber tube placed in a wound area, to
prevent the build up of fluid.
It is named for the American gynecologist
Charles Bingham Penrose (1862–1925)

14.  Redivac drain/Hemovac drain is a closed/
suction drainage system
 Pigtail drain - has an exterior screw to
release the internal "pigtail" before it can be
removed
 Davol
 Chest tube
 Wound manager
 Cigarette drain

15. T-Tube drain
T-Tube drain is used for mostly for patients
who have undergone gallbladder surgery or
surgery of the surrounding tubes draining the
gallbladder. This type of drainage most
resembles a T and drains into a collection
bag.

16. Nasogastric tubes
Following abdominal surgery gastointestinal motility is reduced
for a variable period of time
Gastrointestinal secretions accumulate in stoma and proximal
small bowel
May result in:
Postoperative distension and vomiting
Aspiration pneumonia
Little clinical evidence is available to support the routine use of
nasogastric tubes
May increase the risk of pulmonary complications
Of proven value for gastrointestinal decompression in intestinal
obstruction
Tubes are usually left on free drainage
Can be also aspirated maybe every 4 hours
Can be removed when volume of nasogastric aspirate is reduced

17. IV lines
To maintain electrolyte balance
To ensure nutrition and hydration

18. Urinary catheters
A urinary catheter is a form of drain
Commonly used to:
Alleviate or prevent urinary retention
Monitor urine output
Can be inserted transurethrally or
suprapubically

19. The material from which they are made (latex,
plastic, silastic, teflon-coated)
The length of the catheter (38 cm 'male' or '22 cm
'female')
The diameter of the catheter (10 Fr to 24 Fr)
The number of channels (two or three)
The size of the balloon ( 5ml to 30 ml)
The shape of the tip

20. Special catheters
Gibbon catheters
Nelaton catheters
Tiemann catheters
Malecot catheters

21. Complications
Paraphimosis
Blockage
By-passing
Infection
Failure of balloon to deflate
Urethral strictures

22. breast drain

23. Abdominal incisions
Abdominal incisions are based on anatomical principles
They must allow adequate assess to the abdomen
They should be capable of being extended if required
Ideally muscle fibers should be split rather than cut
Nerves should not be divided
The rectus muscle has a segmental nerve supply
It can be cut transversely without weakening a denervated
segment
Above the umbilicus tendinous intersections prevent retraction of
the muscle

25. Midline incisions are the commonest
approach to the abdomen
The following structures are divided:
Skin
Linea alba
Transversalis fascia
Extraperitoneal fat
Peritoneum
The incision can be extended by
cutting through or around the
umbilicus
Above the umbilicus the Falciform
ligament should be avoided
The bladder can be accessed via an
extraperitoneal approach through
the space of Retzius
The wound can be closed using a
mass closure technique
The most popular sutures are either
non-absorbable or absorbable
monofilaments
At least 1 cm bits should be taken 1
cm apart
Requires the use of one or more
sutures four times the wound length
Paramedian incision
• A paramedian incision is
made parallel to and approximately
3 cm from the midline
• The incision transverse:
o Skin
o Anterior rectus sheath
o Rectus - retracted laterally
o Posterior rectus sheath -
above the arcuate line
o Transversalis fascia
o Extraperitoneal fat
o Peritoneum
• The potential advantages of
this incision are:
o The rectus muscle is not
divided
o The incisions in the anterior
and posterior rectus sheath are
separated by muscle
• The incision is closed in layers
• Takes longer to make and
close
• Had a lower incidence of
incisional hernia (when sutures were
not so good)

26. Closure of incision

27. Ambroise Paré
(1520-1590)
Paré was an astute observer and brought many
innovations to surgery and wound care. One of the
most important concepts he introduced was that
wounds should be treated gently to reduce
inflammation and promote healing. For a significant
part of his career Ambroise Paré was a barber
surgeon in the army of the king of France. He
abandoned the traditional treatment of cauterizing
wound after his experience in the battle of Turin in
1536, when the French fought the Italians.

28. Ligature and suture materials
 Absorbable
 Non-absorbable

29. Absorbable materials
1. Catgut plain – used to suture mucous membrane of lips,
tongues superficial laceration of the genital area. They are easily
absorbed within one week.
2. Catgut chromic – used to suture fascia, muscles, or ligature of
blood vessels.It is usually absorbed within 30 – 45 days
3. vicryl – same as above. Takes at least 70 days for absorption.
Rapid vicryl is easily absorbed.
4. PDS – expensive, takes at least 5 – 6 months to be absorbed.

30. Absorbable suture materials are those that are broken
down. The original absorbable suture materials were
plain and chromic “cat gut,” which actually consisted of
processed collagen derived from the submucosa of
animal intestines. Plain gut is broken down
enzymatically after about 7 days. Chromic gut is
collagen treated with chromium salts to delay break
down. Chromic gut typically loses its strength after 2-3
weeks is completely digested after about 3 months.
 Now there are many synthetic absorbable materials
made from polymers (e.g., Vicryl and Monocryl).
These materials are broken down non-enzymatically
by hydrolysis; water penetrates the suture filaments
and causes breakdown of the polymer chain. As a
result, synthetic absorbables tend to evoke less tissue
reaction than plain or chromic gut.

31. Non-absorbable materials
1. Ethilon – most commonly used to close and
suture skin after surgery or trauma to the skin.
Cutting needles are usually used.
2. Prolene – used to suture nerve, tendon or blood
vessels. Preferable round body needles are used.
3. Silk and Linen – have similar properties. They are
very strong, but they are adherent to the tissues and
can caused reaction or infection.

32. Non-absorbable sutures are made of materials
that are not readily broken down by the body’s
enzymes or by hydrolysis. There are naturally
occurring non-absorbable materials e.g., silk, cotton,
and steel)
 synthetic non-absorbable materials (e.g., nylon and
Prolene, Mersilene). In some cases they are left in
place indefinitely (e.g., when used to close the
abdominal fascia), and in other cases they are
removed after adequate healing has occurred (e.g.,
nylon sutures to close a superficial laceration).

33. Other suture materials
1. Staples – to close wound under high
tension, like scalp, trunk and extremities.
2. Strips and tapes – used to close superficial
laceration on the face.
3. Derma bond – very expensive, ideal for
simple laceration, but fact around the edges
have to be removed.

34. Types of sutures/ METHODS OF METHODS OF
SUTURINGSUTURING
 Simple interrupted suture
 Vertical mattress
 Horizontal mattress
 Subcuticular
 Continuous

35. Needles
Needles may also be classified by their point
geometry; examples include:
taper (needle body is round and tapers smoothly to
a point)
cutting (needle body is triangular and has a
sharpened cutting edge on the inside)
reverse cutting (cutting edge on the outside)
trocar point or taper cut (needle body is round and
tapered, but ends in a small triangular cutting point)
blunt points for sewing friable tissues
side cutting or spatula points (flat on top and bottom
with a cutting edge along the front to one side) for
eye surgery

36. Types of knots
1Yarnknot
2Manrope knot
3Granny knot
4Rosebud stopper knot
5Matthew Walker's knot
6Shroud knot
7Turks head knot
8Overhand knot Figure-
of-eight knot
9Reef knot Square knot
10Two half hitches

37. Suture removal
sutures are normally removed after
Face and head ……………. 5 days
Legs and abdomen ………. 7 – 10 days
Back and soles …………… 10 – 14 days

38. When?
Face: 3-4 days
Scalp: 5 days
Trunk: 7 days
Arm or leg: 7-10 days
Foot 10-14 days
How?
Many patients are very apprehensive
about suture removal, so the first step is to
reassure the patient that the procedure is not
painful. The skin should be cleansed.
Hydrogen peroxide is a good choice for
gently removing dried blood and exudates.

40. THANK YOU