Transcript A Simple Introduction of Drainage System

A General Introduction of
Drainage System
Mediliance Ltd
Oliver Hsu
Definition
• A drain is a tube used to remove
gas, pus, blood or other fluids
from a wound ,abscess or an area.
Objectives
•
Indication/Goal for Drainage
Why use a drain
• Types
What are the major type of drains and
how do they work
• Principle of use
Which drain to use
What are the complication
Types
What are the major type of drains
and how do they work
Passive
Open
Close
Suction
Strength
Active
Sump
PDC
Types
Concept of Open / Close
• Open system- Drain fluid collects in gauze
pad or stoma bag, they increase the risk of
infection
• Open system with filters
• Close System- Drain into a bottle or bag
Gas Closed system
Fluid Closed system
Infection Closed system
Types
Suction Strength
Types
Suction Strength
Tubing 4mm(~12 FR)
Drain 7.5mm
Types
Suction Strength
• Drains may be connected wall
suction,a portable suction device, or
they may be left to drain naturally
• 100 ml Reservoir: 0~90 mm/Hg
• Power suction : 0~ expected
• Chest tube drainage: -20 cm/H20
-20 * 0.7 = -14 mm/Hg (continuous)
Types
Collection Device
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Bulb
Bag
Vac
Bottle
Pleur-evac type
Vacuum tube
Others
Type
coating vs. un-coating
The Benefit of Coating- Clot Stop
• Clot Stop –A safe Antithrombogenic coating
• FDA approved lubricating properties- reacting
povidone with Isocyanates prepolymer
• The lowest affinity for platelets
• Provide surface with lowest coefficient of friction
available, can make insertion and removal easier
and trauma free, prevent clogging
• Long standing (Indwelling drain, above 10 days)
• Reduce the workload of stripping & milking
A minimalist Approach to the care of Indwelling
Closed Suction Drain
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Clot Stop CWV Drain- a total 73 patients 192 drains left
Abdomen 41, Chest/Breast 44, Back 10, other 4
Drain left in place on average over 10 days
3.6 days in inpatient, 7.0 days in outpatients averagely
5 major complications, 5 minor complications, 2
“unrelated to drain” wound complication
• A safe and efficacy simple approach to the management
of closed suction drains
- call the office when the drain output is less than 30 ml/day
- encourage to shower
- pat the drain exit site dry
Annals of Plastic Surgery V51, N6, Dec 2003,
Plastic Surgery, Northwestern University
Chest Tube (1)
• There are usually 2 types of tubes used :
PLEURAL AND MEDIASTINAL CHEST TUBES
Chest Tube (2)
• Pleural fluid gravitates to the most
dependent point, so the tube is placed at
the 4th to 5th intercostal space along the
mid-axillary line (figure 1).
• Mediastinal tubes placed to drain the
pericardial space are used to drain postoperative bleeding and pericardial
effusion that usually occurs after heart
surgery (figure 2).
CHEST DRAINAGE AS A
THERAPEUTIC INTERVENTION
• The purpose of a chest drainage unit is
to evacuate the air and/or fluid from the
chest cavity to help re-establish normal
intrathoracic pressure. This facilitates
the re-expansion of the lung to restore
normal breathing dynamics
• The need also arises following heart
surgery to prevent the accumulation of
fluid around the heart.
Pleural Chest Tube Drainage
• Chest Tube
Chest tube size: 8F ~40F
Coating Vs. Uncoating (anti thrombogenic
coating vs. heparin coating)
Newborn ~Pediatric: 8F~16F
Small bore Vs. Large bore (Pigtail vs. CT)
Pleural effusion or Pneumothorax are being
treated with small bore rather than large bore
Incidence of deep and superficial sternal infection
after open heart surgery –
A ten years restrospective study from 1981 to 1991
• 4137 adult patients
• The overall infection rate
was 1.33%, including
superficial wound infection
(SWI) (1.18%), and deep
sternal infection (DSI)
(0.145%)
• Suction drain with a vent
allow a better drainage
Eur J Cardio-thorac Surg, 1995, 9: 153~157
Department of Cardiovascular Surgery,
CHUV, CH-1011 Lausanne, Switzerland
A comparison between small bore and large bore
Small bore
Large bore
Incidence of
injury
Malposition
0.2%
1.4%
0.6%
6.5%
empyema
0.2%
1.4%
drainage
blockage
8.1%
5.2%
2003~2008, 17 facilities UK
The Fanning equation
• V= π^2 x r ^5 x P / f l
V= flow velocity
r= radius
l= length
p= pressure
f = friction factor
Some examples of an ideal size for drainage
• Primary Spontaneous Pnenmothorax(PSS)
: small bore (<= 14F) or 16~ 22 Fr.
• Stable Secondary Spontaneous Pnenmothorax
(SSP): 16~ 22 Fr.
• Unstable SSP and SSP on mechanical
ventilation : 22~24 Fr.
• Fluid within the pleural space especially if the
fluid is particularly viscous: >= 28 Fr.
• Pleural air and free flowing fluid will generally
drain from the chest without need of suction
Mediastinal Chest Tube Drainage
• New designed flat tube with 4 eye patterns to
be placed for pericardial space drainage or
mediastinal surgery drain
• Large inner diameter provide maximum
drainage
• w/o or with Clot Stop
• 5mm, 7mm, 9mm, 11mm- 4 sizes, including
pediatric size
• Easy to place, remains as positions
Postoperative mediastinitis after
cardiac surgery
• Prior to the development of modern
cardiovascular surgery, most cases of
mediastinitis arose from either esophageal
perforation or from contiguous spread of
odontogenic or retropharyngeal infections.
Rarely, primary infections of the mediastinum
developed as a result of penetrating trauma or
hematogenous spread of infection. However, in
modern practice, most cases of mediastinitis are
a postoperative complication of cardiovascular
or other thoracic surgical procedures (0.5~5%)
Postoperative mediastinitis after cardiac surgery
Author Daniel J Sexton, MD
Professor of Medicine
Duke University Medical Center
Mediastinal Sump Drainage
• Sump lumens create high flow rate to
accelerate fluid removal
• Does not permit pressure build up in the
mediastinum (Filtered Sump)
• Medication port with capped filter (Mills
sump, round configuration)
• Air Open system for Mediastinal Drainage
Drainage bag- Chest Drainage(1)
• The use of integral Heimlich flutter valve
has been advocated in patients with
pneumothoraces, especially as they permit
ambulatory or even outpatient
management.
• The use of a drainage bag with an
incorporated flutter valve and vented outlet
has been successfully used
postoperatively.
BTS guidelines for the insertion of a chest drain, Thorax 2003
Drainage bag- Chest Drainage(2)
• Drainage System
A chest drain should be connected to a
drainage system that contains a valve
mechanism to prevent fluid or air entering
the pleural cavity. This may be an
underwater seal, flutter valve or other
recognized mechanism.
BTS Pleural Disease Guideline 2010, BTS
Uresil Tru-Close Drainage bag
• Tru-Close Gravity drainage bag
Pleural Effusion, Malignant Pleural Effusion,
Drainage for Pleurodesis etc.
• Tru-Close Suction drainage bag
Pneumothoraces, Pleural Effusion, Malignant
Pleural Effusion, Pleurodesis, Postoperatively
drainage, Abcess drainage etc.
• It is appropriate for a patient who need a chest
tube for drain but doesn’t need suction to reexpanded his lung
• Home care consideration
Uresil Tru-Close Drainage bag
Malignant Pleural Effusion: Recent Advance and
Ambulatory Sclerotherapy
(Chest 1998; 113; 74S-77S)
• Pleurodesis using small-bore catheters
permits less expensive outpatient
ambulatory therapy, which is expected to
further reduce patient discomfort and
costly hospitalization.
Management of Malignant Pleural Effusion and
Pneumothorax
(Radiologic Clinics of North America, Volume 38, Issue 2, March 2000)
• Ambulatory Sclerotherapy: The catheter is
then connected to a Tru-Close 600ml bag
for gravity drainage. This bag is designed
to be emptied by the patient without
danger of backflow of air into the pleural
space.
Minidrainage in pneumothorax is expensive, but
still beneficial. Considerate for the patient,
reducing the number of hospitalization days
Lakartidningen, 2000 Aug 30; 97 (35): 3726-8 (article in Swedish)
• Tru-close, for the evacuation of pneumothorax, it
consists of small-bore plastic catheter combined
with a small box containing a flutter-valve. Ease
of insertion, safe function, stable fixation and
painless removal were feature found.
• The unit is expensive, but in case of simple
pneumothorax without fluid it would seem
possible to manage on an out-patient basis, thus
saving several days’ worth of hospitalization
costs
Exposure risk related to the management of three
wound drainage systems
(Am J Infect Control 1996; 24: 346-352)
• There are no contaminations with the TruClose system
• Analysis of satisfaction questionnaires for
the Tru-Close drainage system indicated
that nurses tended to be most satisfied
with the Tru-Close system’s protection
from exposure
Patient Experience of a Nurse Led
Therapeutic Pleural Aspiration Service
(Thorax 2010 65: A173)
Salford Royal NHS Foundation Trust, Salford, UK
• Fluid was removed using the TRU-CLOSE
suction drainage system.
• Overall the service was rated as excellent
by 100% of patients.
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