Contributors: Larry Booth, David Scarff
Species: Feline | Classification: Techniques
Introduction Requirements Preparation Procedure Aftercare Outcomes Further Reading
Introduction
- To remove unwanted material from tissue spaces.
Uses
- Obliteration of dead space.
- Elimination of subcutaneous collection of fluid and gas.
- Provide prophylaxis against anticipated fluid or gas accumulations.
Advantages
- Easy to place and maintain.
- Cheap.
Disadvantages
- Increased infection rates compared with wounds not drained.
- Drain can act as a large foreign body.
Technical Problems
- Inappropriate use of drain.
Procedure
- Few minutes.
Decision Taking
Criteria for choosing test
- Large dead space.
- Subcutaneous collection of fluid.
- Potential for accumulation of fluid or air.
Requirements
Materials Required
Minimum equipment
- Skin suture instruments.
- Aseptic dressing.
- Skin suture material.
Minimum consumables
- Drain.
Flat drain
- Drain by capillary action and gravity.
- Drainage occurs outside lumen.
- Drainage efficiency is directly related to surface area of drain.
- Fenestration contra-indicated because decreases surface area and impedes flow.
- Soft latex, eg Penrose drain Drain: Penrose
.
Tube drain
- Rubber or plastic Drain: tube.
- Round with single lumen +/- side holes.
- Drip tubing may be used by cutting hole where plastic has been manually folded (>30% diameter of tube to prevent kinking).
- Advantages:
- Drainage inside and outside drain.
- Suction may be applied.
- Irrigation possible.
- Less interference with healing than Penrose drains.
- Disadvantage:
- Patient discomfort due to stiffness of material.
Preparation
Site Preparation
- Entry site: dorsal recess of wound or above wound.
- Exit site: below wound.
Do not place drain through primary incision or suture line.
Restraint
- Sedation or general anesthesia.
Other Preparation
- Prophylactic antibiotics (continue for at least 24 h after removal of drain).
Procedure
Approach
Step 1 - Incise skin
- Make stab incision below wound:
- Slightly larger than size of drain.
Step 2 - Place drain into wound
Drain placement through exit incision only
- Secure drain in the dorsal recesses of the wound using a penetrating suture tied on the outside of the skin and bring out of ventral exit incision.
- Use Chinese finger trap suture.
Drain placement through both entry and exit incisions
- Place drain into dorsal entry incision and bring out through ventral exit incision.
- Use Chinese finger trap suture.
May provide a portal for retrograde contamination.
Core Procedure
Step 1 - Dress drain
- Cover drain with sterile absorptive dressing to prevent ascending infections.
Aftercare
Immediate
Antimicrobial therapy
- Prophylactic antibiotics for at least 24 h after removal of drain.
Long-term
Follow up
Remove drain
- Capillary ooze only: remove within 24 h.
- Profuse serum discharge: remove within 3-4 days.
- Large areas of dead space: up to 10 days until dead space obliterated.
Prolonged use of drains may lead to discomfort, infection and cellulitis.
Outcomes
Complications
- Ascending infection.
- Cellulitis.
- Incisional dehiscence.
Reasons for Treatment Failure
- Inappropriate use of drain.
- Lack of sterility.
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
Other sources of information
- Manual of Canine and Feline Wound Management and Reconstruction. (1999) Fowler D & Williams J M (eds), BSAVA, Cheltenham.
- Small Animal Wound Management. (2nd edn) (1997) Swaim S F & Henderson R A, Williams & Wilkins, Baltimore.