A New Filtered Sump Tube for Wound Drainage Gerald 1. Golden, MD, Charlottesville, Virginia Thomas L. Roberts, III, MD, Charlottesville, Virginia George Rodeheaver, PhD, Charlottesville, Virginia Milton 1. Edgerton, MD, Charlottesville, Virginia Richard F. Edlich, MD, PhD, Charlottesville, Virginia
Drainage of purulent fluid from abscess cavities or of accumulated blood, bile, or pancreatic juice from the peritoneal cavity is essential for good surgical management. The degree to which such harmful fluids can be removed is directly related to the efficiency of the drainage system. Nonvented suction drainage creates a vacuum that causes tissue encroachment on the holes of the tubing, with impaired drainage and tissue damage. This problem can be resolved by an air vent within the tube that permits access of air to the area of drainage. The continuous circulation of air in a sump system improves the rate of drainage and patency of the system. Despite the advantages of vented drainage, we have been hesitant to use sump tubes for drainage of cavities or wounds because of the danger of retrograde contamination by particulate matter and bacteria passing through the air vent into the wound that contains a rich culture medium. This hazard has been eliminated by attaching a filter to the air vent lumen of the sump tube. The results of a clinical trial with this tube constitute the basis for this report.
From the Departments of Plastic Surgery and General Surgery, University of Virginia Medical Center, Charlottesville, Virginia. Reprint requests should be addressed to Richard F. Edlich. MD, Dapartment of Plastic Surgery, University of Virginia Medical Center, Charlottesville, Virginia 2290 1.
716
Material and Methods Description of Tube. A vinyl formulation is used in the construction of these tubes (Sherwood Medical Industries Inc., St. Louis, MO). The tube has been made soft and pliable to avoid injury to adjacent tissues. (Figure 1.) The length of the tube is 17 inches with staggered, equally spaced, elliptical eyes in the distal 5.5 inches of the tube. The outer diameter of the tube is that of a number 18 French. The tube has two lumens; the ratio of cross-sectional areas of the larger primary lumen to the venting lumen is 4:l. The larger lumen is connected to suction by a removable connector. The smaller lumen extends the length of the tube, penetrating its distal end, and provides an air vent for the “sump” effect. A removable filter is fastened to a pigtail that is solvent-sealed to the air vent’lumen. The filter has a two-staged construction. The first stage is a spun staple woven polypropylene fabric that removes any particulate matter in the air with a diameter larger than 4 I.C,whereas the second stage is a multifilament woven polypropylene fabric that prevents particles larger than 10 CLfrom passing through the air vent. After repeated tests, bacteria were not detected in air passed through this filter. The tube is engineered to permit removal of fluid from a hollow viscus via sump drainage using pressures of 20 mm Hg. The residual vacuum at the end of the tube is 19.1mm Hg in the vented tube with a filter and 18.5 mm Hg without a filter. The air flow through the filtered vented tube is 0.96L/min. Clinical Evaluation. The sump drainage tube with an air filter was evaluated in six patients subjected to ab-
The American Journal of Surgery
.
Filtered Sump Drain
Figure 1. Design of a new sump tube with an air f/Her.
T
f
5.0
recovered from closed suction drainage in the same patient during the forty-eight hour period. The quotient of this analysis was taken to indicate the efficacy of each drainage technic in the removal of fluids.
r
Results and Comments
PATIENT NO.
Figure 2, Clinical evaluafion. The efficiency of the two drainage technics was compared in each patient by dividing the total volume of fluid collected by sump drainage by the fluid recovered with closed suction drainage. dominal surgery. In four of the patients, the tube was used to drain the contents of an abdominal abscess. In the remaining patients, ,the tube was employed to drain collections of fluid from the gallbladder bed after cholecystectomy. A constant negative pressure (20 mm Hg) was maintained throughout the study. To assess the efficiency of the vented system compared with straight suction drainage, the sump vent was alternately clamped and unclamped at two hour intervals for fortyeight hours. The amount of drainage during each two hour period was carefully collected and measured using a small graduated Lukins tube. The efficiency of the two drainage technics was compared by dividing the total volume of fluid collected by sump drainage by the fluid
Volume
129,
June 1975
When sump drainage was employed, the volume of fluid removed was significantly greater than that removed by closed suction drainage (p < 0.05). (Figure 2.) The efficiency of sump drainage was 2.1 to 4.3 times greater than that of closed drainage. These results confirm the superiority of sump drainage for the removal of fluids from wounds or cavities. The benefits of sump drainage of wounds can now be realized without the risk of infection by airborne organisms. The attachment of a filter to the sump vent removes particulate matter and bacteria from the air before it passes into the wound. Summary A new filtered sump tube has been designed for drainage of collections of fluids from wounds without the danger of infection by airborne contaminants. A two-staged filter has been attached to the vent lumen that removes particulate matter and bacteria from the air that passes through the filter. A clinical evaluation of this _tube confirms the superiority of sump drainage as compared with closed suction drainage in the removal of fluids from wounds or cavities.
717
Drainage of purulent fluid from abscess cavities or of accumulated blood, bile, or pancreatic juice from the peritoneal cavity is essential for good surgical management. The degree to which such harmful fluids can be removed is directly related to the efficiency of the drainage system. Nonvented suction drainage creates a vacuum that causes tissue encroachment on the holes of the tubing, with impaired drainage and tissue damage. This problem can be resolved by an air vent within the tube that permits access of air to the area of drainage. The continuous circulation of air in a sump system improves the rate of drainage and patency of the system. Despite the advantages of vented drainage, we have been hesitant to use sump tubes for drainage of cavities or wounds because of the danger of retrograde contamination by particulate matter and bacteria passing through the air vent into the wound that contains a rich culture medium. This hazard has been eliminated by attaching a filter to the air vent lumen of the sump tube. The results of a clinical trial with this tube constitute the basis for this report.
From the Departments of Plastic Surgery and General Surgery, University of Virginia Medical Center, Charlottesville, Virginia. Reprint requests should be addressed to Richard F. Edlich. MD, Dapartment of Plastic Surgery, University of Virginia Medical Center, Charlottesville, Virginia 2290 1.
716
Material and Methods Description of Tube. A vinyl formulation is used in the construction of these tubes (Sherwood Medical Industries Inc., St. Louis, MO). The tube has been made soft and pliable to avoid injury to adjacent tissues. (Figure 1.) The length of the tube is 17 inches with staggered, equally spaced, elliptical eyes in the distal 5.5 inches of the tube. The outer diameter of the tube is that of a number 18 French. The tube has two lumens; the ratio of cross-sectional areas of the larger primary lumen to the venting lumen is 4:l. The larger lumen is connected to suction by a removable connector. The smaller lumen extends the length of the tube, penetrating its distal end, and provides an air vent for the “sump” effect. A removable filter is fastened to a pigtail that is solvent-sealed to the air vent’lumen. The filter has a two-staged construction. The first stage is a spun staple woven polypropylene fabric that removes any particulate matter in the air with a diameter larger than 4 I.C,whereas the second stage is a multifilament woven polypropylene fabric that prevents particles larger than 10 CLfrom passing through the air vent. After repeated tests, bacteria were not detected in air passed through this filter. The tube is engineered to permit removal of fluid from a hollow viscus via sump drainage using pressures of 20 mm Hg. The residual vacuum at the end of the tube is 19.1mm Hg in the vented tube with a filter and 18.5 mm Hg without a filter. The air flow through the filtered vented tube is 0.96L/min. Clinical Evaluation. The sump drainage tube with an air filter was evaluated in six patients subjected to ab-
The American Journal of Surgery
.
Filtered Sump Drain
Figure 1. Design of a new sump tube with an air f/Her.
T
f
5.0
recovered from closed suction drainage in the same patient during the forty-eight hour period. The quotient of this analysis was taken to indicate the efficacy of each drainage technic in the removal of fluids.
r
Results and Comments
PATIENT NO.
Figure 2, Clinical evaluafion. The efficiency of the two drainage technics was compared in each patient by dividing the total volume of fluid collected by sump drainage by the fluid recovered with closed suction drainage. dominal surgery. In four of the patients, the tube was used to drain the contents of an abdominal abscess. In the remaining patients, ,the tube was employed to drain collections of fluid from the gallbladder bed after cholecystectomy. A constant negative pressure (20 mm Hg) was maintained throughout the study. To assess the efficiency of the vented system compared with straight suction drainage, the sump vent was alternately clamped and unclamped at two hour intervals for fortyeight hours. The amount of drainage during each two hour period was carefully collected and measured using a small graduated Lukins tube. The efficiency of the two drainage technics was compared by dividing the total volume of fluid collected by sump drainage by the fluid
Volume
129,
June 1975
When sump drainage was employed, the volume of fluid removed was significantly greater than that removed by closed suction drainage (p < 0.05). (Figure 2.) The efficiency of sump drainage was 2.1 to 4.3 times greater than that of closed drainage. These results confirm the superiority of sump drainage for the removal of fluids from wounds or cavities. The benefits of sump drainage of wounds can now be realized without the risk of infection by airborne organisms. The attachment of a filter to the sump vent removes particulate matter and bacteria from the air before it passes into the wound. Summary A new filtered sump tube has been designed for drainage of collections of fluids from wounds without the danger of infection by airborne contaminants. A two-staged filter has been attached to the vent lumen that removes particulate matter and bacteria from the air that passes through the filter. A clinical evaluation of this _tube confirms the superiority of sump drainage as compared with closed suction drainage in the removal of fluids from wounds or cavities.
717
