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 Surgical 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

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.