CLINICAL PROCEDURE

WOUND DRAIN TUBE MANAGEMENT

TARGET AUDIENCE
All Peter Mac medical and nursing staff.

STATE ANY RELATED PETER MAC POLICIES, PROCEDURES OR GUIDELINES

Clinical Handover Policy
Wound Management Guideline
Hand Hygiene Procedure
Aseptic Technique Procedure
Care of Underwater Drainage Procedure
Care of Percutaneous Nephrostomy Catheters Procedure
Nursing Services Patient Health Assessment Guideline
Patient Identification and Procedure Matching Procedure
Observation and Response Chart Procedure

PURPOSE
This procedure aims to provide the target audience with best practice based evidence available,
along with expert opinion, in regards to the management of drain tubes within the hospital
setting.

PROCEDURE
Indication
Drain tubes can be inserted prophylactically to either prevent or remove the accumulation of fluid
in a wound. They can also be therapeutically inserted to evacuate an existing collection of fluid in a
wound. Fluid is removed in order to treat or prevent infection and promote wound healing and
patient comfort. Drain tubes can also be used to diagnose postoperative complications such as an
anastomotic leak or haemorrhage.
Types of Drainage Tubes
ExudrainTM A closed, active drain system, with a negative pressure of approximately
75mmHg and a reservoir of 100mL.

http://vitalmedikal.com.tr/yeni/index.php?option=com_content&task=view&id=9&Itemid=3

BellovacTM A closed, active drain system, with a negative pressure of approximately

90mmHg and a reservoir of 220mL.

http://surgery.astratech.com.au/Main.aspx/Item/459337/navt/68686/navl/83954/nava/83974

Surimex Fixvac A closed, active drain system, with a negative pressure of approximately
Vacuum System 338mmHg. It has a resevoir of 600mL. Please note: the bottle will only half
fill and therefore will need to be changed when half filled.
Jackson- Pratt A closed, active drain system, with a reservoir capacity of approximately
100mL, depending upon size used. There is an inverse relationship
between the negative pressure system and the fluid volume within the
collecting chamber. I.e. the more fluid in the collecting chamber, the less
pressure or suction applied.

http://www.boobisaweekendword.com/frequently-asked-questions-about-breast-cancer/

Free drainage A closed, passive drainage system, frequently attached to A4 urinary

closed drain drainage bag that can be emptied. These drains are often inserted post
robotic surgery.

http://www.redax.it/webdisk/articles/img-art-64-Drentech-bag2.jpg

Penrose An open, passive drain with collapsible walls. As there is no drainage bag
attached, a dressing or a transparent occlusive drainage pouch is required
to be placed over the exit site. Dressings need to be changed regularly
when exudate soaks through and it is recommended that a barrier cream
be used to protect surrounding skin.

http://loudoun.nvcc.edu/vetonline/vet121/wound_care.htm
Pig- tail A closed, passive drain, often inserted to drain a collection. A transparent
drainage pouch is usually applied over the exit site, or is attached to a
closed drainage bag. Pig-tail catheters are coiled post insertion through
the use of an internal string in the lumen, which is locked into place at the
external end of the drain. The coiling
of the catheter is required to be
released prior to removal to avoid
tissue trauma (see Appendix D)

https://www.cookmedical.com/products/ir_ultclm_webds/

Transparent A device used to collect fluid draining from an open drainage system.
drainage pouch Commonly used is the ColoplastTM bag.

http://www.eastin.eu/en-GB/searches/products/detail/database-rehadat/product-IW_091848.20

Documentation
Nursing staff are expected to document the colour and amount of drainage, the patency of the
drain tube, any dressing changes required throughout the shift and any variations to the insertion
site appearance. It is recommended that the ExudrainTM and BellovacTM drainage bags are changed
at midnight, or as per the treating team’s orders, and the 24 hour output recorded on the fluid
balance summary chart MR/66. Any changes in drainage output (including unexpected increase in
output and change in type/ colour of drainage) must be reported to the HMO and to the nurse in
charge and documented clearly. Documentation must be written in the patient’s progress notes
(MR/64), fluid balance chart and if applicable, the patients wound assessment chart (MR/65E).
The medical/ surgical team are required to document when a drain tube is to be removed or
shortened, or if they require variations to the current management of the drain tube in the
patients progress notes (MR/64).

Trouble Shooting
Nursing staff must report any problems they encounter with drain tube management to the nurse
in charge and covering HMO.
Problems which may be encountered during management of drain tubes include and are not
limited to: migration of drain tube, loss of suction, occlusion of the drain tube, increased drainage
output or abnormal or unexpected drainage fluid type, and inadvertent removal.
In the occasion that a drain tube has lost its suction, it is recommended that the dressing at the
drain tube insertion site be inspected and ensured that it is occlusive and no air leaks are present
prior to contacting the HMO.
Procedural Guidelines
To ensure best and safe practice, it is anticipated clinical staff in reference to these procedural
guidelines will avail themselves of related policies and procedures (as outlined above) with
highlighted reference to:
Patient Identification and Procedure Matching Procedure
Hand Hygiene Procedure
Aseptic Technique Procedure
 Emptying and recharging
ExudrainTM and BellovacTM
Please refer to Appendix A for manufacturer’s guidelines.
 Jackson-Pratt
 Don non- sterile gloves
 Using non- touch technique, kink tube proximal to bulb
 Release plug on bulb
 Squeeze contents into measuring container
 Ensure bulb remains compressed
 Replace plug
 Remove gloves and attend hand hygiene
Changing a drain bag
Please refer to Appendix A for manufacturer’s guidelines for Exudrain and Bellovac drains.
Please refer to Appendix E for manufacturer’s guidelines for Surimex drains. Please note that these
bottles will only half fill due to the exchange of pressure with fluid and therefore need to be
changed when half filled. This will also be evident when the vacuum indicator has risen to the top
as per Appendix E.

Removal of a drain tube

An order for removal of a drain tube must be documented in the patients progress notes (MR/64)
prior to removal. Patients, whose drains are to be removed in the community by community
nurses, must have an order for removal document with them (see Appendix B for order for
removal in the community).
In the case of accidental removal the patient’s medical/surgical home team must be contacted.
 Equipment
 Non- sterile gloves
 Sterile gloves
 Stitch cutter
 Sterile scissors
 Sterile dressing pack
 Normal saline for irrigation
 Gauze
 Eye shield
 Steri-strip (optional/ as required)
 Absorptive dressing
 Infectious waste bag
 Procedure
 Documented order by surgical/ medical team in patients progress notes, order for
removal in the community or documented clinical pathway, when applicable
 Explain procedure to patient
 Ensure analgesia as appropriate
 Position patient comfortably
 Hand hygiene
 Don non- sterile gloves and eye shield
 Remove suction (if required):
Exudrain and Bellovac drains: unclamp any clamps. Using surgical scissors, cut drain
tube just above the collecting chamber, to ensure suction is released.
Jackson- Pratt: to remove suction prior to removal, release cap on plug
Surimex drains: Clamp both the clamps (as per bottle change in Appendix E) for 30
minutes prior to removal
 If pig-tail drain insitu, please refer to Appendix D. It is important that the pigtail coil is
released prior to removal to avoid trauma.
 Remove outer dressing
 Dispose of gloves and attend hand hygiene
 Prepare sterile field with appropriate equipment
 Don sterile gloves
 Clean drain tube exit site with normal saline for irrigation
  Remove stitch
 Ensure patient comfort- breathing exercises recommended as distraction eg. Valsalvor
manoeuvre
 Remove drain tube in one steady motion
 If unexpected resistance met, stop procedure and inform HMO. If home team not
immediately available, insert sterile safety pin close to insertion site to avoid migration
and place a sandwich dressing at insertion site.
 Apply pressure with gauze
 Apply steri- strip, if required
 Apply desired absorptive, occlusive dressing
 Discard waste in infectious waste bag and place in infectious waste bin
 Remove gloves and attend hand hygiene
 Document drain output and procedure in patient progress notes and on fluid balance
chart
 Monitor dressing for excessive exudate post removal

Drain tube dressings

It is recommended that an OPSITE Visible® Drain Tube dressing be used for all wound drain tubes
and sandwiched according to Appendix C. Drain tube dressings are indicated to be changed when
there is visible exudate on the dressing. Drain tube dressings are not to be reinforced when they
leak as this will macerate the surrounding skin. If the drain tube insertion site is producing a large
amount of exudate (i.e. two dressing changes required within a 24 hour period), notify the HMO
and use an alternative dressing product. Alternative dressing products may include Biotain®
Adhesive or a Coloplast® bag. There are a few ways in which to apply a Coloplast® bag to a drain
tube site. If unsure, please seek advice during business hours from the Stomal Therapy Nurses,
Practice Development Nurse or ward 6A ANUM.
In some cases, a Biopatch® may be use at the drain tube insertion site after surgery. The use of a
Biopatch® is based on surgical team preference; however there is no supporting evidence around
the use of a Biopatch® in reducing infection rates.

Taking a Drain Tube “Off Suction”

At times, the treating team may request that a drain tube (BellovacTM or ExudrainTM) be taken off
suction. The order must be written in the patient’s progress notes MR/64. Suction can be released
in the drain by:
1) Clamping the tube proximal to the collection chamber
2) Removing the drainage bag
3) Releasing the distal clamp. The collecting chamber should expand to indicate the pressure
has been released
4) Replacing the drainage bag
5) Releasing the proximal clamp
The drain tube must also be clearly labelled to ensure drain is left off suction.

Shortening Drain Tubes

The drainage tube may be requested by the treating team to be shortened. This procedure is to be
undertaken by the surgeon or registrar, not by nursing staff. Shortening of the drainage tube is a sterile
procedure and requires the use of surgical aseptic technique. It involves cutting the external tubing
proximal to the collecting chamber (leaving approximately 10cm). The stitches are then removed and the
drainage tube is withdrawn by 1- 2cm.To prevent the drain tube from dislodging or migrating back into the
wound, a sterile safety pin is required to be inserted into the drain. The remaining external drain tube is
then placed in a transparent drainable pouch (e.g. ColoplastTM bag). The safety pin must be monitored
regularly and replaced if signs of corrosion appear.
“Cut and Bag” a Drain tube
The surgical team may request that a drain tube be “cut and bagged” and if required, the order
must be documented in the patients progress notes (MR/64). This is a sterile procedure, requiring
the use of surgical asepsis and can be attended by nursing staff. The difference between
shortening a drain tube and “cut and bagging” a drain tube is that the drain tube is not withdrawn
and the stitches are left insitu when a drain is “cut and bagged”. The drain tube is cut proximal to
the collecting chamber, leaving 10- 15cm of length in the tube externally. A sterile safety pin is
then inserted into the drain tube to prevent migration and a transparent drainage pouch is applied
over the drain tube exit site. The safety pin must be monitored regularly and replaced if signs of
corrosion appear.
Surgical safety pins can be ordered through imprest (#7241243). Alternatively, ward 6A and
Operating Suite have some on stock.

Discharge Planning
If a patient is to go home with a drain tube, nursing staff are required to make a Hospital in The
Home referral for drain tube management in the community. The patient is required to go home
with an order for removal of drain tube form (see Appendix B), one week’s supply of required
equipment, including replacement bags and equipment for removal, and requires education on
how to empty and recharge the drain tube (if BellovacTM, ExudrainTM or Jackson- Pratt). They will
also require appropriate contact details to call in the case of troubleshooting the drain tube.

Flushing a Pigtail Drain Tube

In some cases, the home team may request that a pigtail drain tube is flushed with normal saline
to maintain patency of the drain. This needs to be documented on the inpatient medication chart
MR61, with amount, type of solution and frequency of flushing. An aseptic non touch technique
approach should be adopted when flushing pigtail drain tubes and can be attended by nursing
staff. It is recommended that a Coloplast™ bag with a window should be the drainage pouch of
choice with pigtails drains, as this allows ease of access to the catheter for flushing. Once the drain
is flushed, it is recommended the instilled solution then be withdrawn and discarded.
DEFINITIONS

Open drainage Open drains require either regular dressing changes or an occlusive and
transparent drainage pouch (for example a ColoplastTM bag) to be
applied over the exit site, as they are not confined within a closed
system (see below definition: Closed drainage). All open drains are
passive drains.
E.g. Penrose drain
Closed drainage Closed drainage systems are connected to a drainage bag, where the
drainage fluid is contained within the drainage system. Closed drainage
systems can be either passive or active drains.
E.g. ExudrainTM
Passive drainage Passive drainage relies upon gravity and capillary action within the
wound to assist drainage of the accumulated fluid. It does so via a
concentration gradient, travelling from an area of high concentration of
fluid to an area of low concentration of fluid.
E.g. Penrose, pigtail
Active drainage An active drainage system relies on negative pressure, or suction to
remove the accumulating fluid. When the collecting chamber of the
drainage system fills up, the negative pressure is exchanged for fluid,
and therefore as the collecting chamber fills, the suction decreases.
E.g. ExudrainTM, Jackson- Pratt
Prophylactic drainage The insertion of a drain tube to prevent the accumulation of fluid in a
wound post a surgical procedure.
E.g. An ExudrainTM inserted post an axillary clearance
Therapeutic drainage The insertion of a drain tube to remove an existing collection of fluid in
a wound.
E.g. A pigtail drain inserted to drain a collection in a cellulitic groin.
Removal of suction Release of negative pressure within a closed drainage system. This is
done prior to drain tube removal in order to decrease trauma to
surrounding internal body structures.

RESPONSIBILITIES

Nursing Responsible for the assessment, care and management of the patient
with a drain tube including pre and post management, removal of the
drain tube and discharge education and planning. Assessment and any
intervention of all drain tubes are required to be documented in the
patient progress notes MR/64 and variances to patients care reported
to the treating team. Assessment of drains should be conducted at
frequent intervals, including in association with routine post
anaesthetic observations (every 30 minutes for the first four hours), as
a part of the nurses rapid patient assessment, during bedside handover
 and in association with routine vital signs assessments (refer to
Observation and Response Chart guideline 9.1.1.51 for frequency of
observation required).
Medical Responsible for the overall monitoring of the drain tube, providing
nursing staff with directions to care such as removal and shortening of
the drain tube, and responding to changes recognised in the
presentation of the patient with a drain tube, including
troubleshooting.

KEY PERFORMANCE INDICATORS

Measure of incidents logged via VHIMS relating to the management of drain tubes to be
conducted, investigated and acted upon accordingly by individual wards/departments as relevant.

REFERENCES
 Durai, R. & Ng, P.C.H. (2010). Surgical Vacuum Drains: Types, Uses, and Complications. AORN
Journal. 91(2):266- 271. Retrieved from CINAHL on the 27th of October, 2012.
 Farrell, M. (Ed.). (2005). Smeltzer & Bare’s Textbook of medical- surgical nursing. (1st Ed.).
Sydney: Lippincott.
 McConnell, E. A. (2001). Clinical Do’s & Don’ts: Emptying a closed- wound drainage device.
Nursing, 31(7): 17. Retrieved from CINAHL on the 27th of October, 2012.
 Ngo, Q.D., Lam, V.W.T., & Deane, S.A. (2004). Drowning in Drainage? The Liverpool Hospital,
Department of Surgery, Sydney, Australia.
 NHMRC. Australian Guidelines for the Prevention and Control of Infection in Healthcare.
(2010). Retrieved from the NHMRC website on the 19th of February, 2014:
http://www.nhmrc.gov.au/guidelines/publications/cd33
 Peninsula Health. (2010). Clinical Practice Guideline, Nursing, Wound Drain Tubes
(Shortening and Removing). VIC.
 Pudner, R. (2010). Nursing the Surgical Patient. (3rd ed.). London: Elsevier.

FURTHER INFORMATION
Practice Development Nurse, Ward 6A

AUTHORISED BY
Ruth Griffiths, Operations Director of Inpatient Services

AUTHOR/CONTRIBUTORS
Bethany Stewart, PDN Ward 6A
APPENDIX A - BELLOVACTM AND EXUDRAINTM

1. Set up

2. Collection

Please note as per picture above: The clamp below the collection chamber does not need to be
closed unless changing drain tube bag over. However, it is common practice to be kept closed in
between emptying the chamber and this is also acceptable practice, It is important to note that
the clamp above the collection chamber (and closest to the patient) is left open to allow drainage.
It is only closed when emptying collection chamber into the drainage bag as per above picture.
3. Bag exchange

Retrieved from the Wellspect Healthcare website with permission on the 17th January, 2014 :
http://surgery.wellspect.com.au/Library/230650.pdf
APPENDIX B: ORDER FOR REMOVAL

Insert patient label here

Dear community nurses,

Procedure: _______________________________________________________________________
Date of procedure: ______________
Dressing instructions: Attach wound management tool MR/65E
Remove suture/ staples on: _____________
Drain management
 Surgical drains can be a source of ascending infection, therefore particular attention must be
paid to their management and removal
 Please record output from drain per 24 hour period- i.e. Select a fixed time to measure
output and if possible measure output at that time each day.
 Record output in table below:
Output in millilitres
Date & Time Drain 1 Drain 2 Drain 3 Drain 4

 Please remove drain when output is less than 30mL in a 24 hour period OR
Output is less than: ___________________________
 For breast drains with implants/ expanders in situ, the drain tube should be in place for no
longer than 2 weeks from date of procedure, regardless of output.
 Please notify the treating team if there is any unexpected change to drain tube management
including dislodgement or infection
Next Peter Mac appointment:_______________
Thank you,
Doctor signature: _____________________________________
Contact information: Ward contact:
Patient Services manager: 8559 5005
HMO:
APPENDIX C- HOW TO APPLY THE OPSITE VISIBLE DRAIN DRESSING

1. Detach the two film securing strips from the dressing. Place
1
them on a clean, dry surface and retain for use in steps 6 and
7.

2
2. Remove the protector paper and centre the dressing over the
drain insertion site.

3. Position the dressing so the drain tube comes through the

3
aperture in the middle of the dressing. Adhere the dressing to
the skin around the drain insertion site. Remove the two
remaining protector papers and adhere the film to the skin.
Ensure the edges of the dressing along the aperture are
aligned.

4. Remove the printed transparent carrier by lifting the

4
non‑adhesive edge and pulling diagonally until removed.
Steady the drain with your other hand.

5. Separate the two film securing strips. Remove protector 5

paper from one of the strips and apply over the aperture,
adhering the top portion of the strip to the underside of
the drain. Remove printed carrier.

6
6. Remove protector paper from the second strip and apply
strip horizontally over the drain so it adheres to the top
of the drain and exposed adhesive of the other strip.
Adhere second strip to skin and dressing. Remove
printed carrier and mould film around the drain tube to
complete application.
Used with permission from Smith & Nephew™ SN8642 A3 (04/2011)
APPENDIX D: HOW TO RELEASE PIGTAIL DRAIN

1. Stabilise the Mac- Loc catheter hub assembly with

one hand and position a small blunt object (such as
a small pair of forceps) into the Mac- Loc release
notch.

2. Pry upward against the release notch until the

locking cam lever is free.

3. Removed drainage tube as per guidelines

Used with permission from COOK Medical

APPENDIX E: SURIMEX FIXVAC WOUND DRAINAGE SYSTEM
A. How to change/ replace bottle
1. Clamp the bottle

2. Disconnect bottle 3. Connect new bottle

 4. Release the clamp

The bottle is now ready for use

B. Detecting bottle vacuum

Vacuum is present Vacuum is no longer present and bottle requires
changing

Used with permission from Surimex