Use of drains in surgery: a review

Headnote

Drains have been used in surgery for several years to remove body fluids thereby preventing the accumulation of serous fluid and improving wound healing. Drains may be classified as closed or open systems, and active or passive depending on their intended function. Closed vacuum drains apply negative suction in a sealed environment, producing apposition of tissues and thus promoting healing. Correct assessment of clinical indications might reduce unnecessary usage. This article will introduce the principles and practice of various types of drains and highlight the importance of understanding how surgical drains promote quality patient care.

KEYWORDS Drains / Closed drains / Open drains

Provenance and Peer review: Unsolicited contribution; Peer reviewed.

Introduction

Surgical drains are manufactured tubes that drain various bodily fluids and have been used in surgery for several years. Their application can be broadly classified as prophylactic and therapeutic. Drains have several functions. They remove body fluids thereby preventing the accumulation of serous fluid (seroma), and improving wound healing. Seromas are a good nidus for infection; they can cause discomfort and are alarming for the patient.

Indications for the use of a drain

Prophylactic

1) To remove excess blood and serum

2) To remove pus, blood, serous exudates, chyle or bile

3) To form a controlled fistula e.g. after common bile duct exploration

Therapeutic

1) To drain pus, blood, serous exudates, chyle or bile

2) To drain air from the pleural cavity

3) To drain ascites

Classification

Drains may be classified (Table 1) as closed or open systems, and active or passive depending on their situation and function. A closed drain is one in which the contents are not exposed to the atmosphere and these are further sub classified into vacuum and non vacuum varieties. An open drain communicates with the atmosphere. Closed drains encourage an anaerobic environment which may promote the growth of certain bacteria. An active drain is one which is driven by negative pressure. A passive drain is one that simply channels fluids.

A) Closed drains

1 Vacuum drains

Vacuum drainage system (Redivac®, J-Vac®, abdominal VAC® drains)

Vacuum assisted closure device (VAC®)

2 Non- vacuum drains

Robinson drain

Mallecot

Pigtail drain

Chest tube drains with an underwater seal

T-tube drain

B) Open drains

Corrugated drain

Penrose drain

Sump drain