Improving the Efficiency of Wound Drainage Catheters Raul Garcia-Rinaldi, MD, PhD, Houston, Texas W. W. Defore, Jr, MD, Houston, Texas 2. D. Green, RN, Houston, Texas Charles McBride, MD, Houston, Texas
Surgical procedures requiring extensive dissection can result in the accumulation of serum or lymphatic fluid under the skin flaps if improper drainage is used. This can result in considerable morbidity due to nonadherence of the skin flaps to the underlying tissue and/or infection. Previous attempts to prevent this complication have been the use of large pressure dressings and, more recently, the use of wound drainage catheters connected to small units capable of generating a negative pressure (Hemova@, Zimmer, Warsaw, Indiana). Although these two treatment modalities have reduced the incidence of fluid accumulation, [I], some cases are still seen. The causes of failure of the wound drainage systems usually can be traced to one or more of the following: (1) improper placement of the catheters; (2) use of catheters of an inadequate diameter; (3) loss of negative pressure in the system due to over-filling or accidental unplugging of the reservoir; (4) formation of clots within the drainage tubes. We have modified the most commonly used wound drainage system to further reduce the occurrence of fluid accumulation. Absolute hemostasis is stressed, and firm pressure dressings consisting of “fluffed” 4 X 4 inch gauze sponges and ElasFrom the Department of Surgery, Baylor College of Medicine. Ben Taub General Hospital and M.D. Anderson Hospital, Houston, Texas. Reprint requests should be addressed to Raul Garcla-Rinaldi. MD. PhD. Department of Surgery. Baylor College of Medicine, Texas Medical Cpnter, Houston, Texas 77025.
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toplast@, left in situ for three to four days, are utilized. The modification is shown in Figure 1. The largest drainage catheters suitable for the particular operation are utilized. One of the catheters is placed in the most dependent portion of the area of dissection, and the other is placed directly over the midportion of the operative field, extending into any recesses that may exist. Both catheters are sutured to the skin and firmly attached to a Hemovac Y connector. The length of the catheter
Wmmt!ql
Figure 1. ModMed wound drainage sysiem.
The Amerkan Journal ol Surgery
Wound Drainage
from its exit at the skin to the connector should be as short as possible to discourage intraluminal clot formation. The Y connector is in turn fit into a piece of soft rubber, 7 inches long and 0.5 inch in diameter. The rubber catheter is connected with standard suction tubing to a graduated reservoir and constant pressure of 80 mm Hg. Soft rubber tubing allows “milking” of the wound catheters in a manner analogous to that used with chest tube drainage systems. This allows more efficient removal of debris, loose tissue fragments, clots, or fluid from the drainage catheters, thus prolonging their usefulness. This “milking” maneuver should be carried out at least four times daily to prevent clotting of the catheters. In the few instances when clots cannot be removed from the drainage catheters by “milking” the soft rubber tube, they can be aspirated successfully with a small syringe, using sterile technic. The patients are allowed to walk four times a day for fifteen minutes, during which negative pres-
vohlme 130‘ 9eptembeJr1975
Catheters
sure is disconnected. The catheters are removed when the total output per twenty-four hours is 20 ml or less and never before the pressure dressing is removed. Summary We have modified the most commonly utilized wound drainage system to further reduce the incidence of postoperative accumulation of fluid under the skin flaps. This modification allows more efficient removal of debris, loose tissue fragments, and clots from the wound catheters and insures a constant negative pressure in the system. These maneuvers lengthen the usefulness and improve the efficiency of the catheters and have reduced the incidence of fluid accumulation, Reference 1. Surgery of the Breast (Southwick HW, Slaughter DP, Humphrey W. ed). Chicago, Year Book Medical, 1966, p 106.
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Surgical procedures requiring extensive dissection can result in the accumulation of serum or lymphatic fluid under the skin flaps if improper drainage is used. This can result in considerable morbidity due to nonadherence of the skin flaps to the underlying tissue and/or infection. Previous attempts to prevent this complication have been the use of large pressure dressings and, more recently, the use of wound drainage catheters connected to small units capable of generating a negative pressure (Hemova@, Zimmer, Warsaw, Indiana). Although these two treatment modalities have reduced the incidence of fluid accumulation, [I], some cases are still seen. The causes of failure of the wound drainage systems usually can be traced to one or more of the following: (1) improper placement of the catheters; (2) use of catheters of an inadequate diameter; (3) loss of negative pressure in the system due to over-filling or accidental unplugging of the reservoir; (4) formation of clots within the drainage tubes. We have modified the most commonly used wound drainage system to further reduce the occurrence of fluid accumulation. Absolute hemostasis is stressed, and firm pressure dressings consisting of “fluffed” 4 X 4 inch gauze sponges and ElasFrom the Department of Surgery, Baylor College of Medicine. Ben Taub General Hospital and M.D. Anderson Hospital, Houston, Texas. Reprint requests should be addressed to Raul Garcla-Rinaldi. MD. PhD. Department of Surgery. Baylor College of Medicine, Texas Medical Cpnter, Houston, Texas 77025.
372
toplast@, left in situ for three to four days, are utilized. The modification is shown in Figure 1. The largest drainage catheters suitable for the particular operation are utilized. One of the catheters is placed in the most dependent portion of the area of dissection, and the other is placed directly over the midportion of the operative field, extending into any recesses that may exist. Both catheters are sutured to the skin and firmly attached to a Hemovac Y connector. The length of the catheter
Wmmt!ql
Figure 1. ModMed wound drainage sysiem.
The Amerkan Journal ol Surgery
Wound Drainage
from its exit at the skin to the connector should be as short as possible to discourage intraluminal clot formation. The Y connector is in turn fit into a piece of soft rubber, 7 inches long and 0.5 inch in diameter. The rubber catheter is connected with standard suction tubing to a graduated reservoir and constant pressure of 80 mm Hg. Soft rubber tubing allows “milking” of the wound catheters in a manner analogous to that used with chest tube drainage systems. This allows more efficient removal of debris, loose tissue fragments, clots, or fluid from the drainage catheters, thus prolonging their usefulness. This “milking” maneuver should be carried out at least four times daily to prevent clotting of the catheters. In the few instances when clots cannot be removed from the drainage catheters by “milking” the soft rubber tube, they can be aspirated successfully with a small syringe, using sterile technic. The patients are allowed to walk four times a day for fifteen minutes, during which negative pres-
vohlme 130‘ 9eptembeJr1975
Catheters
sure is disconnected. The catheters are removed when the total output per twenty-four hours is 20 ml or less and never before the pressure dressing is removed. Summary We have modified the most commonly utilized wound drainage system to further reduce the incidence of postoperative accumulation of fluid under the skin flaps. This modification allows more efficient removal of debris, loose tissue fragments, and clots from the wound catheters and insures a constant negative pressure in the system. These maneuvers lengthen the usefulness and improve the efficiency of the catheters and have reduced the incidence of fluid accumulation, Reference 1. Surgery of the Breast (Southwick HW, Slaughter DP, Humphrey W. ed). Chicago, Year Book Medical, 1966, p 106.
373
