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Definition of Terms
Surgical drains are tubes placed near surgical incisions in the post-operative patient, to remove pus, blood or other fluid, preventing it from accumulating in the body. The type of drainage system inserted is based on the needs of patient, type of surgery, type of wound, amount
of drainage expected and surgeon preference.
This guideline is designed to ensure a standard approach to care and management of surgical drains (as listed below) through evidence based practice.
Note:This guideline does not relate to the care and management of Chest Drains (UWSD) or drains inserted post cardiothoracic surgery. For further information on these drains please follow this link to
Chest Drain Management Nursing Guideline or
Pleural and mediastinal drain management after cardiothoracic surgery Nursing Guideline.
Assess drain insertion site for
signs of fluid or air leakage, redness or irritation to the skin. Document site
condition and notify treating team and AUM if any concerns.
Assess if drain is secured with suture or tape, document on LDAs.
Assess patency of drain. Ensure drain is located below the insertion site and
free from kinks or knots. Document amount and type of fluid in drain
bottle/receptacle on LDAs.
Monitor patient for signs of
sepsis; if the patient is febrile, has redness, tenderness or increased ooze at
the drain site, this could be a sign of infection, the treating team must be
notified and blood cultures may need to be obtained.
Drain patency and insertion site should be observed at the beginning of your
shift and before and after moving a patient. If applicable, ensure suction is
maintained. A blocked drain tube can lead to formation of haematoma, increased
pain and risk of infection.
Drainage needs to be documented at a minimum 4 hourly and more frequently if
output is high.
Regularly discuss removal plan with treating team. Drains
should be removed as soon as practicable, the longer a drain remains in situ,
the higher risk of infection as well as development of granulation tissue
around the drain site, causing increased pain and trauma upon removal.
Pain Assessments should be
completed and documented regularly whilst the drain is in situ. Appropriate
analgesia should be provided when necessary, particularly prior to removal.
Please refer to the pain assessment and management guideline for more information.
If suspecting infection, notify
treating medical team and ask if a swab of the insertion site or sample of any
ooze should be collected for pathological investigation.
Educate patient/parent to ensure
the drain is below the site of insertion but not pulling on the patient.
Educate the patient/parent that there is a risk of dislodgement therefore requiring
increased care when moving. Patient should be aware that moving whilst drain is
in situ will cause some pain, but this can be minimised with regular analgesia.
The patient should be encouraged to mobilise with supervision when appropriate.
suction be lost when using vacuum drainage systems (i.e. Redivac), the treating
doctor should be notified. When the Redivac™ drain is
changed (to ensure suction reapplied) ensure “standard aseptic technique” is
utilised, please refer the Aseptic
Technique Policy for more information. This procedure must be approved by AUM or treating doctor.
Assess the patient including all
drains and attachment sites prior to mobilising, ensuring drains are secured and
will not dislodge/pull on patient.
When appropriate, patient mobilisation with a drain should be encouraged
to reduce risk of DVT.
Reassess drains post mobilising to ensure dislodgement of drains has not
At all times, ensure drainage tube is not entangled with other leads (IV
tubing, O2 leads, etc.) as this could lead to inadvertent removal of the tube.
If leakage occurs at a surgical drain site, please notify the AUM and treating team and consider the following:
If drainage is minimal, ensure the drain is not blocked, if blocked, notify the treating team and AUM.
If the drain is suspected to have
moved position, the drain should be secured and the treating team notified.
In the event a drain has been removed or dislodged, a sterile dressing should
be applied and the treating team notified immediately.
If the drain is suspected to have receded into the patient, the treating team
should be notified and imaging (x-ray, etc.) should be performed. Link to Policy
& Procedure: Surgical Wounds – Procedure for Missing/Non Intact Drains
Ensure plan for removal of drain
tube is discussed with and ordered by the treating team in the patient’s
progress notes on EMR.
Inform patient/parent about removal process and possible associated pain.
Discuss and plan for procedural
pain management and non-pharmalogical interventions to minimise pain and
distress throughout procedure, assess analgesic requirements first and then
consider the need for procedural sedation; please refer to the procedural sedation ward and ambulatory
areas at RCH
procedure for more information. If using analgesia ensure it is given 30-45
minutes prior to procedure to ensure it has taken peak effect. Please refer to
the procedural pain management guideline for more information.
The following should be completed using a “Standard Aseptic technique” please
refer the Aseptic Technique Policy for more information:
Using standard aseptic technique,
clean around the site and remove any sutures. Pinching the edges of the skin
together, rotate tubing from side to side gently to loosen, then remove the
drain using a smooth, but fast, continuous traction. Tie off any purse-string
sutures and apply occlusive dressing.
Pigtail drains must be uncoiled prior to removal, failure to uncoil a pigtail
drain can cause severe pain and/or tissue damage. To uncoil the pigtail drain
the catheter/string should be cut to release the string that creates the
If required, cut the tip of the
tube for cultures.
Document removal of drain and that it is intact/not intact in progress notes as
well as amount of drainage in the flowsheets.
If there is resistance and no
movement of the drain tube despite gentle side-to-side rotation and a firm pull
do not proceed further and notify the treating team/surgeon.
There should be no excessive
force when pulling the drain tube, doing so can lead to serious complications
such as drain tube fractures or internal tissue damage.
If the tube fractures during
drain removal and remnants of the tubing is left within the patient contact the
treating team immediately.
The surgical fellow should order
an immediate X-ray of the drain tube site.
The patient should be prepared
for theatre, inform the parents and consider the need to keep the child nil by
mouth in anticipation for surgical removal of the remaining drain tube.
The whole drain unit should be
kept in the patient’s room until surgical review and will need to be kept for
collection to enable quality review.
The piece of drain tubing that
remains in the patient will also be kept once surgically removed to allow for
appropriate follow up of the incidents cause.
A VHIMS must be completed by the
nurse delegated to remove the drain.
In theatre, previous surgery is
checked on EPIC regarding the LDA’s flowsheet of the drain that was
inserted at that operation. NB. There can be multiple drains.
After removal of retained drain,
instrumentation nurse to superficially clean visible blood /serous fluid
off the retained drain.
Instrumentation nurse to measure
length of retained drain before placing in a yellow top container.
-Surgery is completed as planned.
Scout RN to record length of
retained item on patient’s UR label on container.
Retained item's lot number and
expiry that has been recorded in EPIC is to be transcribed onto the yellow
top container with patient’s UR label.
Scout RN to record in
EPIC retained items details. Also check LDA's flow sheet for removal
of drain/line details and update in comments section that residual item has
been removed and record length with date and time stamp.
Yellow top container to be kept
together with the remaining drains until critical review process is completed
and VHIMs documentation finalised.
Post op X-ray to be reviewed by
surgeons and open disclosure to family to be undertaken by surgeons.
Link to Policy
& Procedure: Surgical Wounds – Procedure for Missing/Non Intact Drains
Link to aseptic technique policy
Monitor site for signs of
infection, obtain swabs or samples if required.
Monitor and mark dressings to ensure minimal leakage, replace dressings as
required to minimise risk of infection. Excessive leakage should be reported to
AUM or surgeon.
Dressing should be removed when wound has healed (3-5 days).
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The development of this nursing guideline was coordinated by Emily Gard, RN, Platypus, and approved by the Nursing Clinical Effectiveness Committee. Updated March 2020.