Drains are used when the surgeon anticipates that the patient will have a fluid collection after their patient’s procedure. They are commonly placed in patients undergoing mastectomies and/ or axillary dissections. In the instance of mastectomy, there is a large surface area between the subcutaneous tissue, the area beneath the skin, and the breast tissue. These raw surfaces can leak fluid, like one gets with a burn. The drain will pull this liquid out and assist in closing the space created by the surgery.
Drains will exit the body, usually near incisions. The drains will be attached to a collecting system. Frequently the collecting system is called a bulb or grenade, because of its appearance. The bulb or grenade has a cap that allows the liquid to be emptied. Air can also be squeezed out, so that a vacuum or suction is created to help draw liquid from the surgical site to the collecting system.
Patient will need to monitor the amount of output from their drains. Some surgeons will send a measuring container home with the patient for this task. Other surgeons will have their patients use the markers on their patient’s drain bulbs or grenades. A flow sheet will be provided at time of discharge. This record is brought to follow-up office appointments to help determine when the drain(s) can be removed. If reconstruction is performed, the plastic surgeon usually decides when the drains can be removed, otherwise the breast surgeon will make the decision.
It is important to keep the drain site clean to prevent infection. Washing hands before and after emptying the drain is key. It is important not to immerse the drain site in water, such as in a bathtub, hot tub or pool. The drain exit site may be covered with a dressing, dependent on the surgeon’s preference.
“Stripping the drain” or working little clots through the tubing may be done to prevent the drain from plugging up. This is done by firmly pinching the tubing near to where it exits and with the other hand pinching the tubing and working the fluid down to the collecting system. There is also a stripping device that is commercially available. The surgeon and nurses will instruct patient and caregivers in this technique.
Drain bulbs can be pinned to clothing to help prevent tension on the tubing and inadvertent drain removal. There are also special camisoles available to hold drains.
Drains are typically removed at a follow-up appointment with the surgeon, usually when the drain output is less than 25-30 cc in a 24 hour period. Patients and their caregivers should ask their surgeon about their specific drain care instructions and output required for removal.