Thursday, November 12, 2009

How to Take Care of Your JP Drain at Home (Jackson-Pratt Surgical Drain)

It's not unusual to be sent home from the hospital after surgery with a surgical drain still in place. Typically a nurse will have taught you (or your loved one, if you’re squeamish) how to take care of  the drain at home and they probably gave you some paperwork with instructions.  Sometimes, however, such teaching is given after surgery when the patient is groggy or in pain and family members are tired and ready to just get on the road towards home.  The instructions may get lost in the shuffle of paperwork you were handed at discharge.  For this reason I wanted to make a blog entry that includes some basic information about the JP drain and includes links to patient education sheets from reputable physicians and hospitals.

About the Jackson-Pratt (JP) Drain . . .

The JP drain is a soft, pliable bulb drain that is either tunneled directly into a surgical incision, or more often into another smaller "stab" incision right next to the main incision. The purpose of the JP drain is to allow the large surgical incision to heal well by draining blood and thin serous material that can build up behind fresh incisions.

The bulb part of the JP drain is connected to the surgical incision by means of a long plastic tube that’s sutured in place on the skin where it enters the body. When the bulb is compressed (squeezed together), it provides constant suction that draws any accumulating fluids such as blood, pus, or other thin drainage from the incision, through the tube and into the bulb. On a regular basis (at least once a day), the fluid that is collected in the bulb is emptied by opening the small plug in the top and squeezing the fluid into a measuring cup.  While the empty drain is still unplugged, the drain is squeezed together to remove as much air as possible so it is mostly “flattened.”  Then the plug is recapped. The flattened bulb gently expands as it again slowly suctions fluid from the incision.

Keep Track of the Amount of Fluid . . .

The amount of fluid, date and time, and any ususual details about the fluid (color, thickness, clots, smell) is written on a paper for the doctor to review at your appointment, then the drainage is emptied into the toilet and flushed away.  Keeping track of the amount of fluid emptied from the bulb is important. This information allows the physician to know if the wound is healing according to schedule . . . or if there are complications that require further attention such as an unusual amount of blood coming from the wound, a foul smell to the discharge, or an unusually large volume of fluid. When the drainage falls to a certain level, usually a few days after surgery, the drain is easily removed by a physician or nurse at the doctor's office.

I’m by no means an artist, but I’m including a couple of my own sketches here. The websites (at bottom) often include great drawings or photos of the drains and their care, but of course they have  copyrights to their art and photos so I’ll give you just a basic idea.

Parts of the JP Drain
Drain reservoir bulb—about the size and shape of a large lemon or (in my mind) a hand-grenade. Made of soft flexible semi-transparent silicone with an attached drainage tube that is sutured into a slit on the body near the surgical incision. In order to collect drainage from the tubing, the bulb plug must be opened, air is squeezed out until the bulb appears mostly flat. While still squeezing the bulb flat, the plug is replaced. As the bulb fills with fluid, it may expand. The bulb is emptied at least daily or when full and the drainage is measured and recorded and reported to the physician.

Drain aperture—the hole with a plug, this is where you empty the drainage that is collected. It reminds me of a beach-ball plug and works exactly the same way.

Drain tubinghollow tubing made of a soft semi-transparent silicone. It’s connected to the drain reservoir bulb. Sometimes the tubing may accumulate drainage that becomes a clot which blocks the drainage.  This can be cleared by a gentle pinching motion of the tubing just above the clot, away from the body and towards the bulb, it is usually recommended to “milk” the tubing in this way when needed to keep it draining freely.

Surgeries that result in a drain . . .

. . . includes just about any that may result in a large incision, for example, breast surgery, thyroid operations, weight loss surgery, abdominal surgeries, and operations on the kidneys or bladder.  There are other types of surgical drains as well, but the JP is one of the most common.

Keep the JP Drain from Pulling on the Incision

To keep the weight of the drain from pulling on the incision, a flap of tape is applied near the bulb. A safety pin is pinned through this tape flap and then pinned to the patients clothing in such a way as to take up the slack of the tubing. (If you have more than one drain, they will each be numbered for easy reference on the tape flap.)  Be careful not to poke a hole through the tubing of your drain!

I don't seek advertising or any funding for my blogging, but I do point out commercial products that may be helpful to my readers.  Here are two products that I came across created by patients in order to more comfortably manage their JP drains post-operatively.
Links to Reputable Websites with Instructions on JP Drain Care (including log sheets to record drainage).  Most of these include log sheets you can copy to record your drain output . . . or you can just write it on a piece of notebook paper--that would be just fine, too, as long as you include the date/time/amount (and drain number if you have more than one.)

Youtube Videos
Youtube doesn't have many videos about care of the JP drain.  I'm surprised.  I did find two amateur videos posted there by breast cancer patients who are demonstrating emptying their JP drains at home.  These brave ladies are doing a service by posting their experiences to help others.  I applaud their willingness to do so and want to include links to their videos here.  These are not professional videos, but they give you a glimpse of other people at home with their JP drains in real life:
  • An amateur video in which Deborah demonstrates emptying and measuring the contents of her four surgical drains.  Note: Deborah is wearing a brassiere, but does have some skin of her upper torso (not breasts) exposed. I know my blog readers come from all walks of life, so if exposed female flesh is offensive to you, this is not a video for you.  I think it is interesting to see how the output of each of Deborah's drains varies slightly in amount, color, and consistency.
  • Sylvia Soo demonstrates emptying of her two JP drains.  This amateur video starts out SLOW and very playful, but if you hang in there for a few seconds, Sylvia comes on camera to show how she cares for her two drains. She does a good job of demonstrating “milking” the drain to remove clots and measuring the drain “output.” Sylvia is completely covered by clothing in this video, so not to worry if bare skin offends you.   

. . . ..(All rights reserved, Carolyn Cooper, MPH, RN, 2009) . .

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