Surgical Drains: Care, Removal, and Frustrations

A surgical drain removes fluid that collects in the space where tissue was removed. The most common type after cancer surgery is a Jackson-Pratt, a soft tube leading to a squeezable bulb. Compressing the bulb with the stopper in place creates gentle constant suction. Letting fluid build up instead would cause swelling, pressure and a higher chance of infection, which is why the drain stays until output drops.

Emptying and recording is the part people find tedious and the part that decides when the drain comes out. Memorial Sloan Kettering advises emptying twice a day, morning and evening, and writing down the amount in millilitres and the color each time. Keep a separate column for each drain if you have more than one. Bring the log to every appointment. Without it, the decision to remove has nothing to rest on.

Color normally starts red, then turns pink, then a straw or amber color. Going back to bright red after it had lightened is worth reporting.

Clots and fibrous strands block the tube. Milking, or stripping, means pinching the tubing near the skin and sliding your fingers down toward the bulb to push the blockage along.

Only do this if your surgical team has taught you to, and do it the way they showed you. Stripping pulls on the tube where it sits under the skin, and some teams tell people not to do it at all. If nobody has shown you, call and ask rather than working it out from a web page.

A drain that suddenly stops draining is more often blocked than finished, so a sudden stop is worth a call either way.

Secure the bulb to a surgical bra, a wrap, a lanyard or a fanny pack. Never let it hang from the tubing, because the pull at the skin hurts and can dislodge it. Do not submerge the site until your team says the incision has closed; ask specifically whether you may shower and how to protect the site. Common frustrations reported by almost everyone are sleeping positions, getting dressed, showering, keeping the log, and the strangeness of carrying part of your own drainage around. A drain apron, a button-front shirt with inside pockets, and a lanyard around the neck in the shower are the practical fixes people mention most.

The usual signal is output falling to about 30 millilitres or less over 24 hours, per drain, often for two consecutive days. Cleveland Clinic notes drains usually stay in no longer than about two weeks, though this varies. Removal is done in clinic and takes seconds. Stitches holding it are cut, you are asked to breathe out, and the tube is pulled.

What people commonly describe is a strange internal pulling or burning sensation for a few seconds, more odd than painful, sometimes with a brief cramp. Some feel very little. Taking your usual pain medicine an hour beforehand is a reasonable thing to ask about. A dressing goes on and a small amount of leaking afterwards is normal.

Fluid can reaccumulate under the skin after removal, forming a seroma. That is common and is often drained with a needle in clinic if it is large or uncomfortable.

Ask your team for your specific fever threshold before you go home, since some give 100.4 degrees Fahrenheit and some 101.

• Call 911 or go to an emergency department if red streaks spread outward from the insertion site, or a fever arrives with shaking chills and you feel suddenly very unwell.
• Call your care team the same day if the skin at the site grows redder, hotter, more swollen or more painful, or the drainage turns thick, cloudy, milky, green or foul smelling, or you have a fever or chills.
• Call your care team the same day if the drain falls out, is pulled partway, or fluid begins leaking around the tube at the skin rather than into the bulb. If it has come out fully, cover the site with clean gauze and call rather than trying to reinsert anything.
• Call your care team within a day or two if output suddenly increases, or stays high for two days when it had been falling, or the color goes back to bright red after lightening, or the bulb will not stay compressed, or output stops completely and does not restart after milking.

• Cleveland Clinic - Jackson-Pratt (JP) Drain
• American Cancer Society - Recovering From Cancer Surgery