Surgical Drain

Aka: Surgical Drain, Jackson-Pratt Drain, JP Drain, Surgical Drain Stripping, Surgical Drain Removal

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II. Indications

  1. Drains are placed within surgical wounds to remove excess fluid, blood or pus
    1. Decrease risk of infection, edema and generally decrease healing time

III. Mechanism

  1. Surgical Drain components (e.g. Jackson-Pratt Drain or JP Drain)
    1. Drain tubing with optional absorbent material on one end (placed in wound bed)
    2. Suction/Squeeze Bulb or spring reservoir serves as a collection device

IV. Management: Low Output Drain

  1. Consult surgical team if available
  2. Review drain history
    1. Placement date and indication (e.g. surgical procedure, complications)
    2. Logged drain output per day
  3. Evaluate drain site
    1. Skin entry site (e.g. signs infection, local edema)
    2. Evaluate drain tubing for integrity (e.g. holes, plugging)
    3. Evaluate collection bulb
      1. Empty the collection bulb, and squeeze the bulb to recreate vacuum effect
      2. Replace bulb if bulb does not hold suction (e.g. perforation, lack of seal)
  4. Strip the drain (to remove debris that may be obstructing flow)
    1. Secure the drain at skin entry site with non-dominant hand (ensuring it does not displace)
      1. Exercise caution to avoid dislodging the drainage tube
      2. If drainage tube is dislodged, do NOT attempt reinsertion
    2. Start at the skin end of drain tubing
      1. Apply Alcohol swab folded over the tubing (lubricating jelly may be used as an alternative)
    3. With dominant hand, squeeze the tubing (with interposed Alcohol swab) between thumb and index finger
      1. Slide your fingers with the Alcohol swab along the tubing toward the collection bulb
    4. Repeat the procedure until no further debris is visualized in the collection tubing
  5. Consider drain removal if output consistently <30 ml/day
    1. See below
    2. Discuss with surgical team if available

V. Management: Surgical Drain Removal

  1. Indications
    1. Consistently <30 ml/day output for at least 24 hours AND
    2. Other causes of low output drain are excluded (see above) AND
    3. Surgical team agrees with removal (if available for Consultation)
  2. Contraindications
    1. Active infection with persistent fluid collection (e.g. abscess)
      1. Consider imaging (e.g. CT) to evaluate residual fluid pocket and tube positioning
      2. Consult surgery or Intervention Radiology for additional management
  3. Benefits
    1. Removal of non-functioning drains reduces risk of infection, pain and ADL barriers
  4. Technique
    1. Position patient to minimize tension or Muscle resistance at drain entry site
    2. Cut and remove Sutures securing drain
    3. Release collection bulb suction
    4. Apply gauze (e.g. folded 4x4 pad) to the drain entry site at skin
      1. Apply gentle pressure with one hand to the gauze throughout drain removal
    5. Remove the drain
      1. Use slow, steady force to remove drain
      2. Have patient try to relax if resistance is met
      3. Stop if significant resistance is met
        1. Consult surgery for possible adhesion to deeper tissue
      4. Apply dressing to the drain entry site
        1. Anticipate some small continued drainage at the entry site for 1-2 days
        2. Significant drainage (e.g. higher volume, pustular) should prompt return or reevaluation by surgeon
  5. Complications of drain removal
    1. Retained Foreign Body
    2. Seroma development

VI. References

  1. Warrington (2026) Crit Dec Emerg Med 40(6): 20-1

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