Dr. Li's Guide to Getting Drains After Surgery
- Are essential to prevent fluid build-up after surgery
- Need to be emptied and their (fluid) output needs to be recorded
- Output color changes from pinkish red to pale yellow
- Can be uncomfortable, especially if accidentally pulled on
- Are usually removed once the drain output is consistently low
Although getting drains after surgery may seem daunting, hopefully this article will ease your recovery. I will go over the basics of drains, drain care, and what you should expect based on my decades of experience. Something which has helped my own patients and other patients tremendously has been our Seecret Apron, a surgical drain pouch. I have designed our Seecret Apron to make your post-surgery life easier and less painful. While I will touch more on our Apron later, here are the ins-and-outs of getting drains after surgery.
What is a drain?
After surgeries that create a space, such as a mastectomy (removal of the breast) or axillary lymph node dissection (removal of the glands under your armpit), your surgeon will leave a drain or two. Typically, my patients will need two drains after a same-day breast reconstruction with implants. While there are differing types of drains, they all serve the same purpose; they prevent fluid from building up and potentially causing an infection, otherwise known as an abscess. Fluid travels through the clear plastic drain tube, goes outside of your body, and into a bulb. The suction bulb is clear and made of soft plastic, with a stopper at the top.
How does a drain work?
Essentially, it works as a vacuum. First, the bulb needs to be squeezed to generate a negative pressure within it. This pressure will gently and slowly pull out the fluid from your surgical area. The drain is usually stitched to your skin to prevent it from being accidentally pulled out.
Daily Drain Care
Remember, even though the drain is supposed to remove fluids to prevent infections, it can be a potential source of infection. As a result, you must perform meticulous hand hygiene when you, or someone else, is handling your drains. This includes washing hands thoroughly with soap and water and wearing gloves. You must also regularly strip the drains, by securing where the drain exits the body and milking any fluid in the tubing out towards the bulb. The bulbs should be emptied 2-3 times a day or when they are half full. As they fill up with fluids, they will get more heavy and the suction pressure will be reduced. When you empty the drains, be sure to measure your fluids in milliliters, using the little cup usually provided by the hospital. Don’t forget to record both the volume and color of your drains in your drain output chart. Just in case, I always tell my patients to take a picture of their drain output chart before coming for their follow-up visit. Without this chart, your surgical team may not be able to remove your drains!
How to minimize ‘drain pain’
There is no doubt that surgical drains cause some of the most stress and discomfort during the recovery period. One of the main reasons is that they can get pulled on, despite being attached by a single stitch to the skin. After a few days, the skin around the drain exit site can get irritated and may turn red. Occasionally these sites can get infected – you might see yellowish drainage. You should contact your surgical team to let them know. If left untreated, this local infection can potentially travel and infect other areas, resulting in more surgery.
There are a couple of ways you can minimize the pain and discomfort from ‘drain pain’. Firstly, you should secure your drain – either pin to your clothing, or even better, wear a garment that can hold the drains safely – such as our Seecret Apron. This allows you to keep the drains in one place safely. By keeping them supported with an Apron, you will be able to avoid accidental pulling around the skin or even having the drain pulled out accidentally. Also, by having the tubing a little slack, you will have less pressure on the skin exit site, leading to less skin irritation and pain.
Occasionally the stitch securing the drain can get loose or even come out prematurely. If this happens, try and secure the drain as best you can and contact your surgical team. The risk is that the drain’s tube can move in and out of the drain's exit site, possibly bringing infection from the outside in. Usually your surgical team will evaluate you and may remove (if the output of fluids is low enough) or try to re-secure the drain. Another trick that has helped my patients is to use gauze and tape to support the drain right below the exit site on the skin. However, with repeated taping, the skin may get traumatized from the tape’s adhesive
How should my drain fluids look after surgery?
As each day progresses after your surgery, the volume of the fluid will go down and the color of the fluid will change. Usually the fluid will change from being more red, to a pinky red, to eventually a yellow color. You may see bits of fat or small stringy clots in your fluids– this is normal. If the color changes from yellow to bright red, you should contact your surgical team. If you are doing too much with your arms, such as housework, the drain output may go up. In general, the longer the drain stays in, the higher the risk of infection.
When will they be removed?
Typically I remove drains if they are producing less than 30cc for two consecutive days. However, this is ultimately down to your surgical team and their preferences. I prefer not to remove both drains at the same time. After mastectomy and implant reconstruction, I usually remove the first drain on day 7 after surgery, and the 2nd drain on day 10 – 14. Removal is performed in the clinic by my plastic surgery team and involves cutting the stitch and pulling out the drain. Afterwards a small dressing will be placed over the exit site. The hole from your drain tube should close and heal within 48 hours.
Hopefully, this answered all your basic questions regarding drain care. If not, feel free to reach me directly through our contact form or leave a comment below!
-- Dr. Li