Surgical Drain Care After Cancer Surgery

A surgical drain is a soft tube left in place after an operation to carry away fluid that would otherwise collect under the skin. MedlinePlus describes a closed suction drain plainly. It "is placed under your skin during surgery. This drain removes any blood or other fluids that might build up in this area."

Cancer surgery makes this more likely than most surgery. When lymph nodes come out, or a wide area of tissue is removed, the body weeps fluid into the space left behind. That fluid can form a seroma, a pocket of clear fluid, or a hematoma, a pocket of blood.

A StatPearls review gives a second reason. Drains "help maintain proper tissue plane contact, which is essential for optimal healing, especially in grafting and reconstruction procedures." Put simply, the tissue layers have to sit against each other to knit. A puddle holds them apart.

Drains are not interchangeable. Emptying steps, whether the tubing may be stripped, and when the tube comes out are set by your surgeon and by the exact device you were sent home with. Keep the discharge sheet from the operating team where you can find it, and let it overrule anything general you read here, including this page.

MedlinePlus lists these across its bulb-drain and Hemovac drain instructions. Call the surgeon's office, not a routine clinic line.

• The tube falls out, or the stitches holding it are loose or missing.
• A temperature of 100.4°F (38°C) or higher. CDC's threshold for people with cancer is "100.4ºF (38ºC) or higher." The MedlinePlus drain pages use 100.5°F (38.0°C). Use the lower number. CDC adds that "fever may be the only sign that you have an infection."
• Drainage that turns cloudy or foul-smelling.
• Drainage that stops suddenly after it had been flowing steadily.
• Drainage that increases for more than two days in a row.
• The bulb will not stay collapsed. That means the suction has failed.
• Fluid leaking around the tube where it enters the skin.
• Skin that is very red at the exit site. A small ring of redness right at the tube is expected. Spreading redness is not.
• Tenderness and swelling that keep increasing.

Call 911 for trouble breathing, for bleeding you cannot stop with pressure, or if the patient is faint, grey or hard to rouse — do not drive yourself. MedlinePlus lists breathing difficulty among the reasons to call after cancer surgery. It also lists wound bleeding, and swelling of the arm on the operated side, which may be lymphedema.

CDC's list of infection signs adds more worth reporting the same day: chills and sweats, a change in your cough or a new cough, shortness of breath, and new onset of pain.

Ask for the name and write it down. The instructions differ.

StatPearls splits them into two families. "Closed systems consist of an outflow conduit and a collection chamber and may rely on gravity or negative pressure." That family includes Jackson-Pratt, Blake and pigtail drains, and negative-pressure wound vacuums. "Open drains, such as the Penrose, use capillary action and gravity for fluid removal," and suit shallow spaces.

Most people go home with one of two.

A bulb drain, often called a Jackson-Pratt or JP, is a thin tube ending in a soft round squeeze bulb.

A Hemovac uses a flatter round container with a stopper on top, which you press flat instead of squeezing.

Squeezing the bulb flat and capping it while it is flat creates the vacuum. The bulb then slowly fills out as fluid arrives. So the shape of the bulb is your signal that the drain is working.

MedlinePlus treats a squeeze bulb that "will not stay collapsed" as a reason to call. It usually means the seal has gone: a loose cap, a crack, or a shifted tube.

MedlinePlus gives the sequence for a bulb drain. Wash your hands. Open the cap without touching the inside of it. Pour the fluid into a measuring cup. Squeeze the bulb flat. Close the cap while it is still flat. Flush the fluid down the toilet. Wash your hands again. Then record the amount, the date and the time.

For a Hemovac the steps differ slightly. Unpin the drain. Remove the stopper, which lets the container expand. Pour the fluid into a measuring cup. Press the container flat. Replace the stopper. Pin it back on. Record date, time and volume.

How often? MedlinePlus says: "You may need to empty your drain every few hours at first. As the amount of drainage decreases, you may be able to empty it once or twice a day." Empty it before it fills.

Use the same measuring cup and units every time. Millilitres, written down. Not "about a third full." Your surgeon decides when the drain comes out based on those numbers, so the log is a medical record.

Clots block drains. MedlinePlus describes stripping, sometimes called milking. Grip the tube near where it leaves your skin. With the other hand, squeeze down the length of the tube toward the bulb. Release both ends. Repeat several times until fluid moves. Lotion or hand cleanser on your fingers helps them slide.

Only do this if your team has taught you to. Stripping pulls on the tube.

Watch two things: color and trend. The words teams use for color are defined in NIH's Nursing Fundamentals wound assessment table. Serous drainage is "clear, thin, watery plasma," and it is "normal during the inflammatory stage of wound healing." Sanguineous exudate "is fresh bleeding." Serosanguineous drainage "contains serous drainage with small amounts of blood present," which looks pink or light red, and is common in the early days.

Purulent drainage is the one that matters. It is "thick and opaque," and "can be tan, yellow, green, or brown in color." The same source is blunt about it: "It is never considered normal in a wound bed, and new purulent drainage should always be reported to the health care provider."

The trend should point down. Going from emptying every few hours to emptying once or twice a day is the expected direction. Two things break that pattern and both need a call: output climbing for more than two days, and output stopping suddenly. A sudden stop is not necessarily good news. It often means a blockage, while fluid keeps collecting inside.

MedlinePlus says to keep the area clean and dry. If your surgeon allows showering, wash with soapy water and pat dry. If not, clean with a washcloth, cotton swabs or gauze.

For dressing changes it describes using sterile gloves, cleaning with soapy cotton swabs, then taping on a fresh bandage. The Hemovac page is more specific about technique: "Use a cotton swab dipped in the soapy water to clean the skin around the drain. Do this 3 or 4 times, using a new swab each time."

Secure the tubing to your clothing with a safety pin or a drain belt. Its weight should never hang from the stitch.

MedlinePlus, writing about mastectomy, says: "You may go home with drains in your chest to remove extra fluid. Your surgeon will decide when to remove these drains, usually in a week or two." StatPearls notes drains are "typically removed when drainage decreases to a minimal level."

There is a reason not to leave them in longer than needed. StatPearls warns that "drains can also introduce pathogens into a sterile space, potentially resulting in localized or systemic infections."

Bring your log to every appointment. It is the evidence that decision rests on.

MedlinePlus also confirms that "it is OK to use your arm on the side of your surgery," with exercises as your provider directs. Report new arm swelling.

One rule holds throughout. Never cut the tube, never push it further in, and never pull it out yourself.

• MedlinePlus — Closed suction drain with bulb
• MedlinePlus — Hemovac drain
• MedlinePlus — Mastectomy: discharge
• NIH StatPearls (NCBI Bookshelf) — Suction Drains
• NIH NCBI Bookshelf — Nursing Fundamentals: Wound Assessment
• CDC — Watch Out for Fever (Preventing Infections in Cancer Patients)
• CDC — Know the Signs and Symptoms of Infection (Preventing Infections in Cancer Patients)