Drains & tubes used in surgery.pptx

Surgical tubes, Surgical drains

1. DRAINS AND TUBES IN ABDOMINAL SURGERY :

2. INTRO : A surgical drain is a tube used to remove pus, blood or other fluids from a wound. Drains are typically used after GI surgeries and are placed near the incision where drainage is expected. Drains are also a method of collecting drainage for measurement, keeping the incision and area surrounding skin dry while helping to prevent infections.

3. Substances that are normally drained are : Blood Bile Pus Urine Bowel anastomotic leaks Saliva Serum/lymph Pancreatic secretions

4. ADVANTAGES: Drainage of fluid removes potential sources of infections Drains guard against further fluid collections May allow the early detection of anastomotic leaks or haemorrhage. To reduce the risk of hematoma formation and break down of wound. To prevent an excessive amount of blood and fluid that collects in cavities of the body and around organs. Faster wound healing

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.

6. PRINCIPLES OF DRAINAGE Septic wound 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. Qualities of a good drain (Ideal drain ) Soft to firm -Minimal damage to surrounding tissues Smooth -Efficiently evacuate effluent and easy removal Sterile - not potentiate infection or allow introduction of infection from external environment Stable- Inert, non allergenic, not degraded by body Simple to manage by both patient and staff

8. TYPES OF DRAIN: Three types of drainage systems: Closed drainage system Open drainage system Suction drainage system

9. The closed drainage system: It 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.

10. The open drainage system : It is a tube or apparatus that is inserted into the body and drains out onto a dressing. Suction system : It uses a pumps or mechanical devices to help pull the excessive fluid from the body. Drains are often made from inert silastic material and they induce minimal tissue reaction.

11. Suction drain

12. ACTIVE DRAINS : They are maintained under suction. They can be under low or high pressure. Closed: Jackson pratt drain, hemovac drain. Open: sump drain. PASSIVE DRAINS(WITHOUT SUCTION): They have NO suction. Closed: NGT , Foleys catheter, T-tube Open: penrose drain, corrugated drain.

13. PASSIVE VS ACTIVE DRAINS PASSIVE DRAINS ACTIVE DRAINS

14. EXAMPLES : A jackson-pratt drain/bulb drain A penrose drain Redivac drain/ hemovac drain T-Tube drain Cigarette drain Corrugated rubber drain Pig-tail catheters Nasogastric tubes Urinary catheters

15. A jackson-pratt drain/bulb drain : It is a surgical drainage device used to pull excess fluid from the body by constant suction. Device consist of flexible bulb shaped thing that connects to an internal drainage tube. Commonly used in mastectomy.

16. A penrose drain: It consists of a soft rubber tube placed in a wound area to prevent the build up of fluid. It removes fluid from that area. it is a common passive drain.

17. Redivac drain/ hemovac drain: It is a closed drainage system. It works by suction that pulls the drainage from body into a collection tank.

18. Drainage of wound to prevent hematoma e.g.after thyroid surgery, repair of incisional hernia .

19. T-Tube drain: It is used mostly for patients who have undergone gallbladder surgery. This type of drainage resembles a T and drains into a collecting bag.

20. Cigarette drain: It is a drain made by drawing a small strip of gauze or surgical sponge into a rubber tube.

21. Corrugated rubber drain: The corrugations provide an increased surface area for capillary action of fluid and also serve as channels for fluid flow. Size: 250×250 mm, 400×25 mm sheets

22. Yeates drain Passive, open drain Parallel tubes . Side and end holes. Capillary action

23. a) Corrugated; b) Penrose; c) Yeates

24. Pig-tail catheters: It has a spiralled tip, which is straightened during insertion by means of a guide wire. Once correctly placed, the tip can be “locked” in curled position by means of a string in the lumen, which is placed under tension by turning a lock at external end of drain. This curled tip helps to prevent any accidental dislodging of drain. It can be used for drainage of collections in most locations including renal pelvis.

25. Used in Nephrostomy Pleural fluid drainage Intraperitoneal fluid drainage

26. Nasogastric tubes: Following abdominal surgery GI motility is reduced for a variable period of time. GI secretions accumulate in stoma and proximal small bowel and it may result in : Post-op distention and vomitting Aspiration pneumonia May increased risk of pulmonary complications Tubes are usually left on free drainage.

27. Urinary catheters: It is a form of drain, which commonly used to prevent urinary retention and monitor urine output. It can be inserted transurethral or suprapubically . Catheter may vary by following features: Material Length of catheter Number of channels Size of the balloon Shape of the tip

28. Foley’s catheter :

29. Problems of drains : MECHANICAL PROBLEMS Trauma to tissues Perforation or fistula formation Herniation of viscera Anatomical leak Flap necrosis PHYSIOLOGICAL PROBLEMS Bacterial colonization and sepsis Loss of fluid and electrolytes Pain Restricted mobility Pneumothorax DRAIN MALFUNCTION Migration Blockage Vacuum failure