How to measure a surgical drain? A comprehensive guide

Millions of surgical drains are used annually to prevent fluid buildup, but monitoring their output is crucial for healing. Learning how to measure a surgical drain properly is a key part of post-operative care and empowers you to track your recovery progress.

Quick Summary

Accurately measuring surgical drain output requires a few simple steps: gather supplies, empty the fluid into a calibrated cup, record the volume, color, and consistency, and then re-establish suction. This process is typically repeated multiple times a day as directed by your healthcare provider.

Key Points

• Hand Hygiene is Critical: Always wash your hands with soap and water before and after handling the drain to prevent infection.

• Measure Accurately: Use a calibrated measuring cup and record the fluid in milliliters (mL) or cubic centimeters (cc), which are equivalent.

• Log Your Observations: Keep a detailed log of the date, time, volume, color, and consistency of the drainage for each measurement.

• Re-establish Suction: After emptying a closed-suction drain, you must squeeze the bulb flat before replacing the plug to restore the vacuum.

• Watch for Warning Signs: Monitor for sudden increases in output, changes in fluid appearance (cloudy, foul odor), or signs of infection around the drain site and contact your provider if observed.

• Understand Your Drain Type: Familiarize yourself with the specific type of drain you have (JP, Hemovac) and follow the specific instructions from your care team.

Understanding the Purpose of a Surgical Drain

Surgical drains are an essential component of post-operative care, designed to remove excess fluid, blood, or pus from the surgical site. This helps to prevent complications such as hematomas, seromas, and infections, promoting faster and more efficient healing. For patients managing a drain at home, understanding how to accurately and safely handle the system is paramount. The type of drain you have will depend on your specific surgery, but the general principles for measurement and care are similar across many closed suction systems like the Jackson-Pratt (JP) or Hemovac drains.

Preparing to Measure Your Drain Output

Before you begin, gather all the necessary materials. Having everything ready beforehand minimizes contact with the site and reduces the risk of contamination. A typical setup includes:

• A dedicated measuring cup with clear markings for milliliters (mL) or cubic centimeters (cc).
• A log or notebook and a pen to record your measurements.
• Clean gloves, if recommended by your healthcare provider.
• An alcohol wipe to clean the plug, if advised.
• Soap and water or hand sanitizer for proper hand hygiene.

Always perform thorough hand hygiene with soap and water before and after handling your surgical drain. This is the most critical step in preventing infection.

The Step-by-Step Measurement Process

Following a consistent and careful procedure for each measurement ensures accuracy and safety.

Step 1: Prepare the Drain

1. Wash Your Hands: Use soap and water to wash your hands for at least 20 seconds.
2. Clear the Tubing: If recommended by your provider, 'milk' or 'strip' the tubing to clear any clogs. To do this, pinch the tube near your body with one hand and slide the fingers of your other hand down the length of the tubing toward the bulb.
3. Position the Bulb: Unpin the drain bulb from your clothing and hold it upright over the measuring cup. Ensure the cup is on a clean, flat surface.

Step 2: Empty and Measure the Fluid

1. Open the Plug: Carefully remove the plug from the top of the collection bulb, keeping the opening pointed away from your face. The suction will release with a soft 'whoosh'.
2. Pour the Contents: Invert the bulb and gently squeeze the fluid into the measuring cup. Empty as much fluid as possible.
3. Observe and Record: Note the total amount of fluid in mL or cc. Also, observe and record the fluid's color and consistency. The drainage will typically change from dark red to lighter pink to a clear, straw-colored liquid over time.

Step 3: Reactivate the Suction

1. Squeeze the Bulb: While the bulb is still inverted and empty, squeeze it completely flat to remove all the air.
2. Replace the Plug: Keeping the bulb compressed, replace the plug securely. When you release your hand, the bulb should remain flat, creating the necessary negative pressure to pull fluid from the wound.

Step 4: Finalize the Process

1. Dispose and Clean: Pour the measured drainage into the toilet. Rinse the measuring cup with soap and water before storing it in a clean place.
2. Record Everything: On your log sheet, record the date, time, volume, and a description of the drainage for that specific drain. If you have multiple drains, measure and record each one separately.
3. Secure the Drain: Use a safety pin or tape to re-secure the drain to your clothing, ensuring there is no tension or pulling on the tube.
4. Wash Your Hands: Wash your hands one final time with soap and water.

Comparing Different Types of Drains

Feature	Jackson-Pratt (JP) Drain	Hemovac Drain	Penrose Drain
Mechanism	Closed-suction, low negative pressure created by a compressible bulb	Closed-suction, low-to-medium negative pressure created by a spring-like, circular device	Passive, gravity-fed drainage system (no active suction)
Reservoir	Soft, compressible bulb, often 100mL or 400mL in size	Round, accordion-style device with a spring mechanism	Open-ended tube; drains fluid onto an external gauze dressing
Measurement	Empty contents into a measuring cup and record mL/cc	Empty contents into a measuring cup and record mL/cc	Assess amount of saturation on the gauze dressing
Use Case	General surgery, breast surgery, cosmetic procedures	Joint replacements, major orthopedic or abdominal surgeries	Simple, superficial procedures
Key Action	Squeeze bulb flat to re-establish suction	Compress the spring-loaded reservoir to re-establish suction	Assess and replace dressing as needed, no re-suction

When to Contact Your Healthcare Provider

While monitoring your drain, certain signs could indicate a problem. It is important to know when to seek medical advice. Contact your provider immediately if you experience any of the following:

• A sudden, significant increase in drain output, especially if it returns to a bright red color.
• Drainage that becomes thick, cloudy, or has a foul odor.
• Signs of infection at the drain site, such as increasing redness, swelling, warmth, or tenderness.
• Fever of 100.4°F (38°C) or higher.
• Leakage from the drain insertion site.
• The drain falls out accidentally.
• The drain bulb fails to maintain suction after being properly reset.

For more detailed instructions and personalized advice, always follow the guidance provided by your surgical team. For general information, an excellent resource for patient information on JP drains is from Johns Hopkins Hospital.

Frequently Asked Questions

How often should I empty and measure my surgical drain?

You should empty your surgical drain at least twice daily, or more often if the collection bulb is half full. Follow the specific schedule and instructions provided by your healthcare provider.

What is the correct way to record surgical drain output?

Record the date, time, and volume (in mL or cc) of the drainage. Note the color and consistency of the fluid as well. If you have more than one drain, record the output for each one separately.

Is it normal for the color of the drainage to change?

Yes, it is normal for the color to change over time. The drainage is typically dark red or reddish-pink in the initial post-operative period and should gradually become lighter, eventually turning a pale yellow or straw color.

What should I do if my drain stops draining?

First, check for any kinks or clogs in the tubing. If instructed by your care team, you can try 'milking' the tubing to dislodge any blockages. If the drain remains clogged or stops draining, contact your healthcare provider.

What is the difference between a JP and a Hemovac drain?

Both are closed suction drains, but a JP drain uses a flexible bulb to create suction, while a Hemovac drain uses a spring-loaded, circular reservoir. The choice depends on the type of surgery.

What does it mean if the fluid smells bad?

A foul odor from the drain fluid is a significant warning sign that may indicate an infection. Contact your healthcare provider immediately if you notice this.

How do I ensure the suction is working properly?

After emptying the drain, you must squeeze the bulb flat before replacing the plug. When you release the bulb, it should stay compressed and not immediately re-inflate. This indicates the vacuum is correctly re-established.