What is a drain?

A drain is a thin PVC tube, with many holes at the end, which
is placed in the cavity created when tissue is removed during
surgery. The tube is added in order to remove the fluid that
collects after an operation. The end of the tubing that is
outside your body will be attached to a plastic measuring
bottle similar to the one pictured on page 9 of this booklet.

Why do I need a drain?

Body tissues cut during your operation leak fluid after
surgery. If this fluid is not allowed to drain, it can collect
under the skin and potentially cause problems.

The principle reasons for having a drain to remove this fluid

are:

1. To allow the wound to heal.

2. To reduce pain, as the collection of fluid in a
closed cavity can cause discomfort.
3. To prevent a collection of fluid which is a
potential site for infection.
4. To minimise any bruising to the area.

How does the drain work?

Suction drainage: An active (vacuum) drain works by
gentle suction. When the suction in the bottle is active, the
red vacuum indicator on the top is in a downwards
(pressed) position.

The colour and amount of the fluid can be seen, which is

important for the surgeon. As the area heals the
amount of drainage collected lessens until it is low
enough for the drain to be removed.

Passive drainage: This relies on gravity to take fluid

away without additional suction.

As the area heals the amount of drainage collected

lessens until it is low enough for the drain to be
removed.

How long will I have the drain for?

This will depend on the type of surgery you have had
and your individual circumstances.

Following plastic surgery, drains are normally removed

once they have collected less than 30 to 40mls in 24 hours.
This process can take five to seven days but for some
operations it can be up to six to eight weeks. For breast
procedures the drain is usually removed within two weeks.

What are the risks?

You need to be aware of any potential problems. In most
cases there are very few complications. Some of the
complications can be:

Infection: An infection can occur around the entry of the

drain site at any time following surgery and you may need
treatment with antibiotics. Symptoms of an infection
include increased swelling, redness, fluid leakage, an
increase in your temperature and increased pain.
Seroma or collection of fluid at the wound/drain site:
There is a risk that fluid may pool beneath your stitch line
after surgery if the wound drains put in during the operation
are not working properly. If this happens a doctor may need
to remove the fluid by another method and remove the drain.

Tissue in growth: This is when tissue grows around the

drain and happens occasionally when the drain has been in
place for a while. This can mean when removing the drain it
may be a bit more painful.

There may be other risks specific to your individual case.

Your surgeon or nurse will discuss any further risks with
you. If you are concerned about any of these risks or have
any further queries, please speak to your consultant or a
member of the medical team.

Are there any alternatives?

Your surgeon has inserted your drain/s as part of your
surgical procedure and will advise on when it is best to
remove it/them based on the type and amount of drainage
and the surgery you have had. If they are removed too early
you could suffer a build up of fluid around your operation
site. If they are left in for too long there is an increased risk
of infection.

Will I feel any pain?

You may feel discomfort around the drain site and may need
medication to help ease this. Your surgeon will prescribe
regular medication to reduce the pain.
However, if you are in constant pain or get new pain you
should contact the staff (contact numbers on page 14).
Stiffness can occur if you restrict your movement because
you can feel the drains moving with you. It is normal to
feel them, as they are plastic tubes sitting under the skin,
so please try to move as normal.

How can I prepare for going home with my drain?

If you are clinically well and do not need to be in hospital
but you still need a drain, you will be offered the chance to
go home with it. This is quite normal so there is no need to
worry. The nurse looking after you will show you how to
care for your drain and give you a chart so that you can
monitor the output at home.

To go home with your drain/s you will need to meet the

following criteria:
 You have been shown how to measure your drainage
and change the drainage bottle and are happy to do
this independently at home.
 You are able to organise your own transport to and from
the hospital. This is because you may need to get back
to the hospital at short notice if you have any problems
or difficulties at home with the drain. Alternatively we
may be able to arrange for you to stay in the Simon
Patient Lodge at St Thomas’.
 You are able to attend the plastic dressing clinic on a
weekly basis or when the drainage is below 30mls.
 You have not had any problems with the drains while you
have been in hospital.
 You are aware and able to check for signs of
infection at the drain site.
 You can be visited daily at home by the district
nursing team if needed.
What do I need to do after I go home?
 Any time you need to check the drain site or change the
bottle you should always wash your hands with soap and
water and dry them on a clean towel, both before and
afterwards.
 At home you need to remember to pick the drain up
when you move around and be careful not to get the
tubing caught on any of the furniture, to prevent it being
pulled out.
 Do not raise the drain higher than your wound to
avoid the contents pouring back into the wound.

Measuring your drainage

1. You should measure the amount of drainage at
roughly the same time every day (approximately
8am).
2. Put the bottle on a flat surface. Measure the amount of
fluid in the bottle since the last measurement (24 hour
drainage) and also the total amount in the bottle (total
drainage). Record the volume of fluid on the chart on page
15 of this booklet.
3. Mark the level of the drainage (fluid level) on the white
stripe with indelible pen (e.g. a ballpoint pen or
permanent marker pen) on the side of the drainage bottle.
4. When the drain is less than 30mls, you will be
instructed to either call the plastic surgery dressing
clinic/outreach nurse (Monday to Friday) or Somerset
Ward (weekends and bank holidays) to report your
drainage and arrange removal. Contact details are on
page 14 of this booklet.
Example:

Date Time 24 hour Total drainage

drainage (mL) (mL)
Monday 8am 120 120
Day 1
Tuesday 8.15am 100 220
Day 2

The drain management chart for you to use can be

found on page 15 of this booklet.

Changing your drainage bottle

You will be sent home with spare drainage bottles.

There are three reasons why your bottle may need

changing at home:

1. The bottle is full.

2. The red vacuum indicator has completely expanded
showing that there is no suction (as shown on page 11).
3. The tubing has become disconnected.

Follow the steps on the next pages to change your bottle. A

nurse will demonstrate this with you before you go home.
1. Close the clip on the tubing. 2. Close the clip on
the bottle.

3. Disconnect the tube 4. Screw on the new

from the bottle, by unscrewing bottle. Make sure it is
the luer lock. on tightly as loose
connections can lead to
loss of suction.
5. Open the clip on the 6. Open the clip on
tubing. bottle. White tape
can be used to help
mark the drainage
output.

What should I do if I have a problem?

Usually patients who go home with drains do not have
problems managing their drains at home. However, there are
some situations that may occur that you should know how to
deal with.

1. What to do if the drain loses vacuum

When the suction in the bottle is active, the red concertina
like vacuum indicator on the top is in a downwards (pressed)
position. Occasionally the suction in the bottle stops and the
red vacuum indicator is pushed up (as shown in the pictures
on the next page).
Bottle with vacuum on Bottle with vacuum off
and working and not working
(vacuum indicator (vacuum indicator
pushed down/ expanded/no longer
compressed ). compressed).

This could be due to a leak around the drain site where it

goes into the skin. The area may need resealing. This can be
done by the district nurses or in the dressing clinic or ward.
Please make sure you take home some film dressing. Check
the connection valves on the bottle in case they have become
dislodged.

In some cases you may be asked to remove the suction before

re-connecting a new bottle but you will be told this before
you go home and a nurse will demonstrate this for you.
2. What if I accidentally remove the drain or it falls
out?
Do not panic. The site may leak fluid or start bleeding
slightly. With a clean towel or the gauze provided place this
over where the drain was and put pressure on the area for at
least 15 minute or until the leakage/bleeding stops. When it
stops cover the hole with a clean plaster. Contact the hospital
on the numbers provided.
If it continues bleeding for longer than 20 minutes, please
go to your local accident and emergency department
(A&E), but continue to press with a clean towel.

If you think that your drainage bottle has lost its

suction, or if it has fallen out, please telephone for
advice (see contact details on page 14).

3. What if the drain appears to be blocked?

Do not panic. Sometimes clots of blood/tissue can appear in
the tubing and will move along and end up in the bottle. If
you have any concerns please contact the plastic dressing
clinic (during working hours) or out of hours call Alan
Apley Ward, your GP practice nurse, or your district nurse
if they are visiting you at home.

4. You think you have an infection

Symptoms of infection include increased swelling, redness,
tenderness, fluid leakage, an increase in your temperature and
increased pain around the drain site or if the site begins to
smell. Please seek medical attention immediately by
contacting the plastic dressing clinic in working hours or out
of hours call Somerset Ward or your GP.
Will I have a follow-up appointment?
Once your drain output is less than 30mls in 24 hours and your surgical team is
happy, your drain will be removed. Drain removal is usually done by a nurse in
the plastic dressing clinic or on the ward. However, if you have some distance to
travel this is sometimes done by district nurses. Please do not arrange for your
district nurse to remove your drain without confirmation from your surgical team
that the drain can be removed.

How will the drain be removed?

The nurse will discuss the plan with you and gain your consent to do this
procedure. Please ask the nurse if you have any questions or concerns.

The nurse will remove the vacuum from the drain and then remove the dressing and
the stitch holding the drain in place. You will then be asked to take a deep breath as
the drain is removed. The area will be covered with an absorbent dressing. The
drain site may continue to leak until the area has completely healed. This will
require a simple dressing.

Depending on the type of surgery you had and your medical condition you will
still require follow up appointments with your consultant teams. Please check
with your nurse if you are not sure when these are.