The Use of DRAINS IN SURGICAL PRACTICE.pptx

The Use of DRAINS IN SURGICAL PRACTICE.pptx

1. USE OF DRAINS IN SURGICAL PRACTICE NWABUEZE SOMTOCHUKWU E.

2. OUTLINE Definitions PROPERTIES OF AN IDEAL DRAIN CLASSIFICATION OF DRAINS INDICATIONS OF DRAINS CARE OF SURGICAL DRAIN COMPLICATION OF DRAINS REMOVAL OF DRAINS COMMONLY USED DRAINS REFERENCES

3. DEFINITION A Surgical drain is a device used to divert fluid from a wound or body cavity. Drains do not directly result in faster wound healing / resolution of disease nor do they prevent infections however they drain body fluid which may accumulate and as such lead to disease progression or become a focus for infection. They may be used in cases of established or potential fluid collection.

4. PROPERTIES OF AN IDEAL DRAIN Firm, not too rigid. It should not be too soft as it may twist or kink or become blocked. Smooth Inert Not elicit tissue reaction Resistant to decomposition or disintegration Wide and patent enough to prevent easy blockage. Yet not to wide to counteract capillary action It should be non electrolytic, non carcinogenic and non thrombogenic when used in vascular surgery.

5. CLASSIFICATIONS OF DRAINS Open vs Closed System Open Closed Active vs Passive Active Passive

6. OPEN Communication with external environment. Corrugated rubber or plastic sheets Increased risk of infection [Very short duration] Penrose drain SumP Drain CLOSED Consist of tubes draining into a COLLECTING SYSTEM [bag or bottle] with no communication with the exterior. They include chest and abdominal drains. T he risk of infection is reduced. Redivac drain

7. active Drains maintained under SUCTION LOW OR HIGH PRESSURE SUCTION MAY BE CLOSED OR OPEN Redivac vs sump BENEFITS EFFCICIENT FLUID REMOVAL CAN BE PLACED ANYWHERE PREVENT BACTERIAL ASSENSION DISADVANTAGES TISSURE INJURY DRAIN CLOGGED BY TISSUE passive No suction pressure. Drains by A COMBINATION OF Pressure difference Overflow GRAVITY MAY BE CLOSED OR OPEN T he risk of infection is reduced. Redivac drain BENEFITS Minimal tissue injury No extra energy required

8. INDICATIONS DIAGNOSTIC Identify fluid accumulation Nature and volume of accumulating fluid PROPHYLACTIC Prevent accumulation of fluid in body cavity Prevent accumulation of fluid in dead spaces created by wounds. THERAPEUTIC Draining already accumulated fluid Draining unwanted accumulated fluids

9. DIAGNOSTIC ▶ PERITONEAL DRAIN Anastomotic leak/Missed perforation Bile leaks Hemorrhage ▶ T- TUBE C H OLANGIOGRAM FO R RETAINE D GALL STONES IN COMMON BILE DUCT

10. PROPHYLACTIC ▶ P O S T T HYROIDE C TOMY ▶ POST MYOMECTOMY ▶ THO R A COTOMY ▶ SP LENE C TOMY ▶ PANCRE A TECTOMY ▶ ESO P H A GEA L R ESECTION ▶ C A R D IOTHO R A C I C PROCE D URES

11. THERAPEUTIC ▶ TENSION PNEUMOTHORAX ▶ PLEURAL FLUID ▶ ABSCESS CAVITY ▶ SEROMA ▶ ACUTE URINARY RETENTION ▶ ACUTE SUPPORATIVE ARTHRITIS ▶ INFECTED CYST

12. MONITORING AND PALLIATIVE DIAGNOSTIC THERAPEUTIC PROPHYLACTIC PALLIATIVE ASCITES HYDROCEPHALUS.

13. CARE OF SURGICAL DRAIN ▶ INTR A O P ERATIVE CA R E ▶ SECU R IN G A SURGI C A L D R AIN ▶ P O S T OPERATIVE CA R E

14. A. INTRA OPERATIVE CARE ▶ PLACED SUCH THAT THEY TAKE THE SAFEST ,SHORTEST ROUTE POSSIBLE. ▶ SHOULD REACH THE DEEPEST, MOST DEPENDENT PART OF THE CAVITY OR WOUND. ▶ TUBES SHOULD REMAIN FREE OF KINKS,DEBRIS AND CLOTS. ▶ SHOULD BE SECURED WELL TO AVOID FALLING OFF OR ITS MIGRATION INTO THE CAVITY OR EROSION OF SURROUNDING TISSUE. ▶ DRAIN SHOULD BE LOWER THEN THE INCISION AT ALL TIMES.

15. B. SECURING A SURGICAL DRAIN DRAINS HAVE BEEN SECURED USING VARIOUS TECHNIQUES AND MATERIALS. ▶ ROMAN GARTER TECHNIQUE WHICH USES SILK TO SECURE THE DRAIN. ▶ USES OF NYLON SUTURES. ▶ SAFETY PIN. ▶ DRAIN CLIP. ▶ ADHESIVE.

16. C. POST OPERATIVE CARE THE POST OPERATIVE CARE DEPENDS ON THE TYPE,PURPOSE AND LOCATION OF THE DRAIN. ▶ SKIN AROUND THE WOUND MUST BE KEPT CLEAN,AND DRY TO PREVENT INFECTION AND SKIN IRRITATION. ▶ METICULOUS SKIN CARE AND ASEPTIC TECHNIQUES MUST BE OBSERED DURING APPLICATION AND CHANGE OF DRESSING OVER DRAIN. ▶ GAUZE DRESSING ARE USED AROUND AND OVER DRAINAGE TUBES. ▶ TO PROTECT THE TUBE ▶ ABSORB SOME AMOUNT OF DRAINAGE. ▶ ASSIST WITH THE STABILIZATION OF THE TUBES. ▶ PROTECT FROM EXTERNAL CONTAMINATION. ▶ AN ACCURATE MEASUREMENT AND RECORD KEEPING OF DRAINAGE OUTPUT. ▶ DRAIN CONTAINER SHOULD BE EMPTIED AT LEAST ONCE A DAY.

17. WHEN TO DISCONTINUOUS A SURGICAL DRAIN ▶ ONCE THE D R AIN A G E H A S STO P ED. ▶ IT S OUT P U T H A S B ECOME <2 5 -5 ML/DAY. ▶ THE DRAIN HAS STOPPED SERVING THE DESIRED FUNCTION.

18. COMPLICATIONS. ▶ IMM E DIATE. ▶ PAIN ▶ IRRITATION ▶ BLEEDING ▶ PERFORATTION OR INJURY TO ADJACENT STRUCTURES. ▶ E A RL Y . ▶ OCCLUSION ▶ LEAKING AROUND DRAIN ▶ DISPLACEMENT ▶ INFECTION ▶ LOSS OF FLUID,ELECTROLYTES AND PROTEIN

19. COMPLICATIONS…. ▶ LATE. ▶ PRESSURE/SUCTION NECROSIS OF BOWL OR VESSEL. ▶ FISTULA. ▶ S CA R . ▶ HERNIA. ▶ COMPLICATIONS DURING REMOVAL. ▶ PAIN ▶ INFECTION(CELLULITIS/ABSCESS) ▶ INJURY TO ADJACENT STRUCTURES. ▶ RETAINED OR FRAGMENTATION OF TUBE. ▶ COMPLICATIONS OF EARLY TUBE REMOVAL

20. CONCLUSIONS. ON THE VALUE OF SURGICAL DRAINS ARE.. ▶ WHAT PURPOSE WOULD A DRAIN SERVE IF PLACED? ▶ WH A T TY P E OF DRAI N S H OU L D B E U S E D? ▶ HOW LONG S HOULD T H E DRA I N B E LEFT I N P L AC E ? THE USE OF DRAINS IN SURGICAL PRACTICE HAS BEEN CONTENTIOUS OVER THE YEARS. THE ESSENTIAL QUESTIONS A SURGEON NEEDS TO ANSWER WHEN DECIDING ONCE THESE QUESTIONS ARE CAREFULLY AND ADEQUATELY ANSWERED EACH TIME A DRAIN IS USED, THE EFFECTIVENESS AND ADVANTAGE CAN BE MAXIMIZED WITH MINIMAL PROBLEMS.

21. CONCLUSIONS. ON THE VALUE OF SURGICAL DRAINS ARE.. ▶ WHAT PURPOSE WOULD A DRAIN SERVE IF PLACED? ▶ WH A T TY P E OF DRAI N S H OU L D B E U S E D? ▶ HOW LONG S HOULD T H E DRA I N B E LEFT I N P L AC E ? THE USE OF DRAINS IN SURGICAL PRACTICE HAS BEEN CONTENTIOUS OVER THE YEARS. THE ESSENTIAL QUESTIONS A SURGEON NEEDS TO ANSWER WHEN DECIDING ONCE THESE QUESTIONS ARE CAREFULLY AND ADEQUATELY ANSWERED EACH TIME A DRAIN IS USED, THE EFFECTIVENESS AND ADVANTAGE CAN BE MAXIMIZED WITH MINIMAL PROBLEMS.

22. REFERENCES Burkitt , G., Quick, C. and Gatt , D. (1995) Essential Surgery, 2nd edn . Churchill Livingstone, UK. Cuschieri , A. and Grace, P.A. (2003) Clinical Surgery. Blackwell, Oxford. Ellis, H., Calne , R. and Watson, C.J.E. (1998) Lecture Notes on General Surgery, 9th edn . Blackwell, Oxford. Forrest, A.P.M. and Carter, D.C. (1990) Principles and Practice of Surgery, 3rd edn . Churchill Livingstone, Edinburgh. Grace, P.A. and Borley , N. (2006) Surgery at a Glance. Blackwell, Oxford.

23. THANK YOU

24. COMMONLY USED DRAINS

25. REDIVAC OR HEMOVAC Active and Closed Drain A high negative pressure drain system. Pressure of about -71mmHg to -171mmHg. It comprises a fine tube of varying sizes, with multiple fenestrations. Tube is attached to a collecting system which is also the negative pressure generator. USED Orthopaedic surgeries Wound drains post Mastectomy and Thyroidectomy