Silicone Drains

Bellovac
Exudrain

Wound Drainage at its Best

NURSING INFORMATION ON THE CARE OF SURGICAL WOUND DRAINS
About this booklet
This booklet has been compiled to guide you What is a wound drain?
through important aspects of surgical wound drain
care. A wound drain is a tube to remove unwanted pus,
blood, gas or other fluids (described collectively as
Our best attempt has been made to gather up-to- exudate) from a specific wounded body area eg after
date information and offer clinically supported surgery.
advice regarding products and their management.
Please remember to refer to your Hospital policy Wound drain tubes can be completed by connecting
and/or follow Clinician specific instructions. a reservoir to collect the exudate. This is called a
wound drainage system, and the various styles and
Throughout this booklet, there are numerous features will be detailed in this booklet.
learning opportunities relating to the following
areas of the National Safety and Quality Health
Standards:

Standard 1 - Governance for Safety and Quality in

Health Service Organisations

Standard 3 - Preventing and Controlling

Healthcare Associated Infections

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Wound Drains
Why are wound drains used?
Further to removing unwanted exudate from the wound site,
wound drains also:

• Promote tissue apposition which facilitates cavity

closure and wound healing and reduces bleeding or
exudate production.
• Allow clinicians to measure and assess exudate.
• Reduce infection risk from exudate build up.
• Reduces patient discomfort eg. haematoma.
• Monitor leakage eg. urine leak after urological
operations.

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Wound Drains
The components of a wound drain system Silicone wound drain tubes are commonly used for
(but not limited to):
As mentioned, a wound drain tube can be used on its
own or in combination with a wound drain reservoir. • Delicate areas eg Plastic, Reconstructive, ENT
surgery.
Stand-alone Wound Drain Tubes • High volume and/or viscous fluid.
• Extended in-situ placement eg Breast surgery.
Examples of wound drain tubes that can be used on
their own include the Penrose and Yeates drains. Round Fluted Flat Silicone
Drain Drain

Wound Drain Tubes with Wound Drain

Reservoirs
There are various types of wound drain reservoirs
When used in combination, a wound drain tube and a with differences including:
wound drain reservoir can create a wound drain
• Capacity of the reservoir
system. Typically, a wound drain tube is made from
• Size of the connection to a wound drain tube
either a PVC or silicone material. Silicone wound
eg FG10, FG14, Universal
drain tubes are softer and available in a wider range of
• Soft or hard reservoir
styles (ie round, flat, multi-channeled) than PVC
• Suction/Negative pressure level
tubes, offering advantages of increased drainage
• Ability to re-establish suction/negative pressure
performance and patient comfort. They are however,
• Infection control features eg one-way valves,
less tolerant to high pressure suction because of their
clamps
more subtle composition.
• +/- a changeable collection bag

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Open vs Closed wound drain systems
One way to classify wound drain systems is to consider whether it is open or closed.

Open Wound Drain System

An open wound drain system allows interaction The exudate is captured in a dressing or drainage bag.
between the wound/exudate and the external envi- When dressings are removed and wound drain reser-
ronment (and vice versa). These include Penrose and voirs are emptied into a collection dish, this creates an
Yeates drains. Drainage occurs when there is a pres- open wound drain system with risks including infec-
sure gradient between the cavity being drained and tion and splash hazard for the health care provider
the external environment. and patient1.

Yeates drain
Penrose drain

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Wound Drains
Closed Wound Drain System

A closed wound drain system has mechanisms in place to prevent the

interaction between the wound/exudate and the external environ-
ment. This may include built-in clamps, one-way-valves and collec-
tion bags to create barriers or contain the exudate. The system remains
closed even when re-vaccing and removing collected exudate (i.e.
exchanging the collection bag/reservoir).

Closed wound drain systems are generally preferable to open systems

as they:
• Are associated with lower infection rates.2
• Reduce risk of contaminating staff and other patients.1
• Facilitate more accurate drainage output measurement.
• Have the potential to create a negative pressure ie. suction.3
• Protect the skin from irritating exudates.1
Minimise nursing time associated with high exudate outputs
•
Bellovac® Exudrain®
eg. dressing changes.4, 5

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Wound Drains
High suction vs Low suction vs Passive wound drain
reservoirs

Negative pressure can be created by manually expelling air from

an expansile collection reservoir or from machine
generated suction (eg wall suction outlet). The peak negative
pressure of wound drain reservoirs can be graded as follows:
300mmHg+
150-300mmHg (NB Equivalent to surgical suction)
LOW < 150mmHg
High vacuum drainage Surgical suction Mediplast low vacuum

Passive non-suction, also known as gravity draining, can also help 300-600 mmHg 100-300 mmHg drainage 25-115 mmHg

in wound drainage when the tip of the wound drain is inserted in High vacuum, as in pre-evacuated bottles, may easily cause tissue grab. Compare

the dependent part of the cavity whilst the collection reservoir is this with surgical suction, where great care is taken to avoid aspiration of tissue.

placed below the body. Note that the aid of gravity can vary
depending on the patient’s position.
There are many advantages to using low-suction and closed wound drain systems, like Bellovac and Exudrain:

• Efficient suction3
• Less blood loss4
• Better drainage collection5
• Earlier removal of drain6
• Less tissue aspiration7
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Key Summary Points
Choosing the right wound drain system

Consider:

• What and how much is being drained - to select the right size and pressure of wound drain system.
• Where is the drain located - as delicate/vital tissue require softer wound drain tubes and closed
systems.
• Wound drain tubes and wound drain reservoirs work best when they are compatible.
For example:
• Combining a FG15 wound drain tube from one manufacturer with a FG14 wound drain reservoir from
another manufacturer may cause difficulty with maintaining a firm connection, de-vaccing issues and
an increased infection risk.
• Silicone wound drain tubes are not designed to withstand the force of high pressure wound drain
reservoirs and may lead to tube occlusions and patient discomfort.
Wound drain systems should be:

• Simple to manage for both staff and patient

• Hygienic and effective at evacuating exudate
• Gentle on tissue
• Designed to not potentiate infection
• Easy to remove
• Cost efficient

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How to use a Bellovac

A. Emptying
A 1. Close the inlet clamp (above the bellows). B
2. Check that the outlet clamp is open.
1 3. Squeeze the bellows slowly, so that the fluid is
transferred into the bag. You may need to use 4
two hands. The valves in the bellows outlet and
bag prevent the fluid going back into the
3 bellows so it is safe to release the bellows and
squeeze again if this is easier.
B. Reactivating (restarting drainage)
2
4. Release the bellows and then open the inlet
clamp.
Check that the inlet tubing is not kinked or
bent – this can prevent the drain from
working properly.

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 C. Changing bags

1. Close the outlet clamp.

2. Unscrew the bag and seal it with the cap.
C 3. Attach a new bag by screwing it tightly to the
connector.
If you use Bellovac without a bag
At home, with the agreement of the Clinical Care
Team, Bellovac can be used without the bag.
However, when emptying the fluid in the bellows it
is recommended to connect a bag. Instructions:
1
1. Connect a bag to the bellows.
3
2 2. Emptying:
• Close the inlet clamp
• Check that the outlet clamp is open
• Squeeze the bellows
• Open the inlet clamp
3. Removing the bag:
• Close the outlet clamp
• Unscrew the bag and seal it with the cap
Disposal of bags
Seal the bag with the cap and place it in a suitable
container. The bag is then disposed of following
the instructions given by the hospital.
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How to use an Exudrain

A B
A. Emptying
1. Close the inlet clamp (above the bulb).
1 2. Check that the outlet clamp is open. 4
3. Squeeze the bulb slowly with one hand,so that
the fluid is transferred into the bag. The valves
in the bulb outlet and bag prevent the fluid
3 going back into the bulb so it is safe to release
the bulb and squeeze again if this is easier.
2

B. Reactivating (restarting drainage)

4. Release the bulb and then open the inlet
clamp.
Check that the inlet tubing is not kinked or
bent - this can prevent the drain from
working properly.

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 C. Changing bags
1. Close the outlet clamp.
C 2. Unscrew the bag and seal it with the cap.
3. Attach as new bag by screwing it tightly to the
connector.

If you use Exudrain without a bag

At home, with the agreement of the Breast Care Team,
Exudrain can be used without a bag. However, when
1
emptying the fluid in the bulb it is recommended to connect
a bag. Instructions:
3
2 1. Connect a bag to the bulb.
2. Emptying:
• Close the inlet clamp
• Check that the outlet clamp is open
• Squeeze the bulb
• Open the inlet clamp
3. Removing the bag:
• Close the outlet clamp
• Unscrew the bag and seal it with the cap

Disposal of bags
Seal the bag with the cap and place it in a suitable container.
The bag is then disposed of following the instructions given
by the hospital.
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13
14
Common questions - and answers
What to do if…

…the area around the catheter feels swollen and …the bellow/bulb is fully expanded and half full,
warm: but it cannot be squeezed and fluid cannot be
This can occur during the healing process, but it is transferred to the bag:
always a good idea to check that the wound has not 1. Check that the outlet (lower) clamp is open and
been infected. There may be a need to aspirate (remove) try again.
a build up of fluid which has not been able to escape 2. Replace the bag with a new one and try again.
through the drain. 3. Gently shake the bellows/bulb. There might be a
clot obstructing the outlet. Shaking will loosen the
clot.
…the bellow/bulb is becoming fully expanded but
very little or no fluid is being collected:
This may indicate that the catheter has been partially
pulled out of the wound.

...The fluid coming out is now semi-transparent, but

for the first few days it was red:
This is quite normal and shows that the wound is
healing well. There is no more blood coming from the
wound, only tissue fluid and lymph.

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Trouble Shooting:

Fluid can stop flowing through a drain if: fluid

production ceases; cavity being drained is completely
evacuated and collapsed; drain holes are blocked (by
tissue, blood clots etc); drain lumen is blocked (by blood
or fibrin clots etc); drain is kinked; suction pressure
source is inactivated or disconnected

Points to Remember:

• When the reason is gone, the drain should be gone.

• Understanding the reason will assist with the care of a drain.
• A drain should not exit a body cavity through the surgical incision.
• A drain should reach the skin by the shortest safe route.
• Size and length must be appropriate.
• Drains must be inserted away from delicate tissues eg nerves, vessels and anastomotic sites.
• A drain should be firmly secured at its exit site (eg with braided suture) and at one other point
(eg with adhesive tape). A drain should be secured at its exit site according to Hospital policy
or Surgeon instructions.

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Key Competencies (with a Bellovac and Exudrain):

Describing open and closed wound drain systems

Understanding high, low and passive wound drain reservoirs
Describe what one-way valves do
Identify the 3 one-way-valves
Understanding the role of the blue clamps
List the 3 times you clamp a Bellovac/Exudrain
Can you identify PVC and Silicone drain tubes
How to remove suction
How to remove a Bellovac/Exudrain

References:
1. Zerbe M, Mc Ardie A, Goldrick B. Am J Infect Control 1996;24(5):346-52.
2. Dougherty SH. Simmons RL. The biology and practice of surgical drains. Part 1. Gerr Probl. Surg.1922; 29: 559-623
3. Loder P, Smith G et al. Aust. NZJ Surg 1987;57:531-5.
4. Morgan-Jones RL, Perko MMJ, Cross M. The Knee 2000;7:149-50.
5. Giordano G, Abib A. Presented as a poster at Chirurgie de la Hanche – Hip Surgery Developments Future prospects, Sep 1999
6. Van Heurn LWE, Brink PRG. Br J Surg1995;82:931-2.
7. Gerngoss H, Marquardt K. Chirurg1992;63:447-53.
Other acknowledgements: Ngo Q, Lam V, Deane S. Drowning in Drainage - The Liverpool Hospital Survival Guide to Drains and Tubes. 2004

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Notes:
Notes:
 Also available -
Early Discharge with Exudrain Drains (EDWED)
Early Discharge with Bellovac Drains (EDWBD)
Wound Drains
Smooth Operators

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