Overview
Definition:
A Jackson-Pratt (JP) drain is a closed-suction medical device used in surgery to remove excess blood, fluid, and pus from a surgical site
Stripping involves compressing and releasing the reservoir to maintain negative pressure and facilitate drainage
Output interpretation involves analyzing the volume, color, and consistency of drained fluid to assess wound healing and detect complications.
Epidemiology:
JP drains are commonly used in various surgical specialties including general surgery, plastic surgery, orthopedic surgery, and cardiothoracic surgery, particularly after procedures involving significant dissection, potential for seroma formation, or infection risk
Their use is widespread, with incidence dependent on surgical complexity and patient factors.
Clinical Significance:
Proper management of JP drains, including effective stripping and accurate output interpretation, is crucial for preventing complications such as seroma, hematoma, wound dehiscence, and infection
It allows for early detection of anastomotic leaks or bleeding and guides the timing of drain removal, impacting patient recovery and hospital stay.
Indications And Contraindications
Indications:
Prophylaxis against seroma/hematoma formation after extensive dissections (e.g., mastectomy, abdominoplasty)
Drainage of infected collections
Postoperative management of anastomoses (e.g., gastrointestinal, vascular)
Following complex reconstructive procedures
To monitor for leaks or bleeding.
Contraindications:
Active uncontrolled infection at the drain site
Active bleeding requiring immediate surgical re-exploration
Patients with severe coagulopathy not corrected
Small, uncomplicated wounds where drainage is not anticipated.
Jp Drain Stripping Technique
Preparation:
Ensure sterile technique
Wash hands thoroughly and wear gloves
Prepare sterile gauze and a waste receptacle.
Stripping Process:
Compress the JP reservoir firmly with your fingers to expel air
While maintaining compression, quickly release the grip to create negative pressure, drawing fluid into the reservoir
Repeat this process until the reservoir is expanded and ready to collect drainage
Ensure the tube is not kinked during this process.
Frequency:
Stripping is typically performed every 4-8 hours, or as per surgeon's preference and institutional protocol
Increased frequency may be warranted if output is high or if the drain appears sluggish.
Troubleshooting:
If the drain is not draining adequately, check for kinks, blockages (e.g., by clots), or malposition of the drain
Ensure the reservoir is properly re-expanded
Consider if the surgical site is becoming too "dry" for further significant drainage.
Output Interpretation
Volume Assessment:
Record the amount of fluid drained in a 24-hour period
Normal postoperative drainage typically decreases daily
Significant changes (sudden increase or decrease) warrant investigation
Quantify output per shift (e.g., 8-hourly).
Color And Consistency:
Serosanguinous (pinkish, watery) is common early postoperatively
Sanguineous (bright red) suggests active bleeding
Purulent (thick, opaque, often with foul odor) indicates infection
Clear, colorless fluid may suggest a leak of cerebrospinal fluid (CSF) or bile, depending on the surgical site.
Reporting Thresholds:
A sudden increase in output (e.g., >100-200 mL in an 8-hour period) or output exceeding 200-300 mL in 24 hours may be concerning
Persistent high output beyond 3-5 days postoperatively may indicate a leak or excessive fluid collection
Specific thresholds vary by procedure and surgeon preference.
Red Flags:
Sudden cessation of drainage in the presence of swelling or pain
A sudden, large increase in output
Development of fever, increased white blood cell count, or wound erythema accompanied by changes in drain output.
Potential Complications And Management
Clogging And Blockage:
Causes include blood clots, fibrin, or kinking
Management: Ensure proper stripping technique, gentle manipulation of the drain, and consider flushing with sterile saline if persistent and ordered by the surgeon
If unresolvable, surgical revision may be necessary.
Infection:
Can occur at the insertion site or within the drained fluid
Management: Local wound care, appropriate antibiotics based on culture and sensitivity if infection is suspected, and close monitoring of systemic signs of infection.
Drain Dislodgement Or Migration:
Accidental removal or migration of the drain
Management: Assess the wound
If the drain is completely out and there is no concerning drainage or signs of collection, it may be left out
If partially out or if a collection is suspected, surgical reinsertion may be required.
Pain And Discomfort:
Can be related to the drain itself, negative pressure, or wound
Management: Adequate analgesia, ensuring the drain is not under tension, and gentle handling during stripping
Consider drain removal if no longer indicated and causing significant discomfort.
Drain Removal
Criteria For Removal:
Drain output less than 20-30 mL in a 24-hour period
Absence of purulence
Patient ambulating well
No signs of significant fluid collection on clinical examination or imaging.
Removal Procedure:
Typically performed by a surgeon or trained nurse
The drain is usually cut at the skin level, and then gently pulled out
A sterile dressing is applied to the site
Advise patient to keep the site clean and dry.
Post Removal Monitoring:
Monitor the drain site for signs of leakage, infection, or delayed fluid collection
Instruct the patient on wound care and to report any concerning symptoms like increased pain, swelling, redness, or drainage.
Key Points
Exam Focus:
Understand the mechanism of negative pressure in JP drains
Be able to interpret different drain outputs (color, volume) and relate them to specific surgical scenarios (bleeding, infection, leak)
Know the indications for drain removal and common complications.
Clinical Pearls:
Always ensure the drain is patent and not kinked before stripping
Document all drain outputs meticulously
Correlate drain output with patient's vital signs and clinical status
Early recognition of concerning drain output can prevent major complications.
Common Mistakes:
Failure to strip the drain regularly, leading to reduced efficacy
Misinterpreting drain output (e.g., benign serosanguinous fluid as alarming)
Inadequate documentation of drain output
Premature or delayed drain removal based on subjective assessment rather than objective criteria.