Principles of Wound Drainage

Question 1

Advantages of wound drain placement

Answer 1

• elimination of dead space
• removal of unwanted materials (ex. exudate, hemorrhage, hematoma, seroma)
• decrease infection
• contaminated wounds
• incomplete debridement

Question 2

Indications for wound drainage placement

Answer 2

• soft tissue trauma
• oncologic surgery
• abdominal cavity– focal sites of infection, peritonitis
• thoracic cavity–pleural effusion or free air (pneumothorax)

Question 3

Types of drainage systems

Answer 3

1. passive
2. suction
3. sump
4. combination (ingress-egress)

Question 4

Passive drains

Answer 4

• function via gravity, overflow, capillary action
• can only be placed in places that permit draining via gravity (ex. ventral abdomen)
• inert, nondegradable and incite minimal tissue reaction
• must be covered after application

Question 5

Suction drains

Answer 5

• semisolid tube attached to continuous or intermittent suction
• ideal for deep wounds or for those wounds where dependent drainage is not possible
• advantages: collect fluid for cytology, keeps patient dry, estimate amount of fluid drained/day, reduce ascending infection

Question 6

Sump drains

Answer 6

• ≥ 2 lumens– 1º for drainage, 2º to prevent drain collapsing
• advantages: does not rely on gravity alone, suction can be applied, can combine separate ingress flushing system, reduce ascending infection

Question 7

Combined drains

Answer 7

• advantages: permits instillation of an irrigating solution and separate drains for removal/wound drainage/irrigating solution

Question 8

Rules of drains

Answer 8

1. Always use aseptic technique
2. Require frequent bandage changes
3. NEVER try to drain against the forces of gravity
4. NEVER exit a drain through the wound or surgical incision
5. NEVER prematurely remove a drain
6. NEVER allow patients to remove their own drains
7. Firmly attach all drains to the ski
8. Never use a drain to flush a wound unless an adequate ingress-egress drainage system has been established
9. NEVER expect drain placement to replace surgical debridement or hemostasis of a wound
10. Use abdominal suction drains to treat diffuse septic peritonitis or consider “open drainage”