You have just undergone surgery and are ready to be discharged from the hospital; however, you still have the drains and are concerned because you don't know how to manage them. JP (Jackson-Pratt) drains are typically used for different types of operations, including chest, lung, or, more commonly, abdominal and pelvic operations. You should always adhere to the instructions that the surgeon gives you at the time of discharge; the indications described in this article are to be considered as supplementary to and not a substitute for those of the doctor. Caring for a JP drain is not difficult, but if you are unsure, discuss it with the surgeon or medical team in charge of you.
Steps
Part 1 of 3: Learn about JP Drains
Step 1. Recognize the importance of the function performed by Jackson-Pratt Drains
After surgery, fluids may form inside the wound, which must be removed to avoid blood clots and abscesses; being able to monitor the leakage of liquids also allows you to promptly check the development of some complication. JP models exert gentle suction that draws fluids out of the wound; this action is carried out by a closed bulb system which generates suction when it is emptied of the air and sealed with a cap.
Although drains promote healing and drain fluids, they should not be left in place for too long, as they can cause complications
Step 2. Learn how to assemble the device
A JP drain consists of a system of three elements connected to each other which constitute a catheter; the tube has a flat portion with holes to collect the fluid. During the surgery, the device is sutured into the wound about 2-3 cm inside the cavity, usually with silk thread; the rest of the tube is outside the body and is connected to a bulb equipped with an airtight cap which guarantees suction. This is the element you need to open to empty the drain.
When using a JP device, you have to squeeze the bulb to create the suction that draws the liquid out of the wound; during emptying the bulb expands, since you have opened the cap that closes the system
Step 3. Prepare for your post-operative duties
Your surgeon or medical team will explain to you the important role you play in ensuring perfect wound healing. After the surgery, you must check that the incision heals as expected; every 8-12 hours (or as directed by your surgeon) you should check the amount and type of fluid that is being collected, pay attention to possible infections, and check that the drainage or the tip of the catheter does not move.
Since the bulb must generate some suction force to function properly, you must empty it when it is half full
Part 2 of 3: Emptying the Drains
Step 1. Gather all the material
Get all the items you need: the note chart, the thermometer, the graduated cup, several gauze pads, and a pair of scissors. Make sure there is a stable work surface and a source of water nearby; wash your hands thoroughly with soap and water.
For example, you can use a shelf in the bathroom
Step 2. Prepare the gauze and drains
Cut the bandages in half along the central area, to be able to wrap them comfortably around the devices; this way, you prevent the catheter from rubbing into the wound. Remove the bulb from your clothes and consider wearing a dress with pockets at the waist, such as a bathrobe, in which to put the bulbs once they are emptied.
Only cut as many gauze pads as there are drains applied to you, usually one or two. Leave the rest whole to clean the area
Step 3. Empty the bulb
Remove the cap and pour the contents into the measuring cup. Check the volume (in cc or ml) of the fluid you have produced and note the value on the table or sheet. Throw the liquid in the toilet and, once the bulb is empty, clean the cap with alcohol, squeeze the bulb and put the cap back on; in this way, a suction force is created inside the bulb, which should appear "dented". Do not try to rinse the inside of the drain.
Remember to write down any abnormal characteristics of the fluid (for example, if it is cloudy, brown, smells bad, or any other information that you think is useful for your doctor)
Step 4. Clean the site where the catheter is inserted
Remove the tape and gauze so that you don't exert any traction on the stitches. Look for any signs of infection (pus, warmth, redness, swelling) and report it on the card. Take a whole gauze pad and moisten it with alcohol; clean the drainage area by moving from the wound outwards, to avoid introducing bacteria; alternatively, you can make a circular motion in a clockwise direction from the center outwards. If you need to clean the skin a second time, use a new gauze and start over; let the area air dry.
If you notice any signs of infection (fever, chills, redness, pus, or swelling near the incision), call your surgeon
Step 5. Apply gauze to the wound
When the skin is dry, take a pre-cut bandage; keeping the flat part of the drain flush with the body, wrap the catheter with the gauze. Tape it down, making sure the tube does not rub or friction the wound. Empty the drain and wash the wound every 8-12 hours or according to the surgeon's instructions.
Put the bulbs at waist height or in any case at a lower level than the surgical cut; gravity helps fluids pour into drains
Part 3 of 3: Preventing Irritations and Complications
Step 1. Pay attention to drainage
Typically, the fluid is mixed with blood after surgery, but as time passes it should take on the color of straw and then become transparent; the liquid should never be cloudy or pus-like. Make a note of the fluid collected every 24 hours. Your doctor should give you a graduated plastic container to track the volume (in cubic centimeters or milliliters) of your secretions; check this value every time you empty the JP drain, usually every 8 or 12 hours. The amount of liquid should decrease over time.
- Probably, after the surgery, you will also be given a table or card on which to write down the time you empty the bulb and the amount of fluid.
- The devices are removed (by the physician) when the volume of fluid produced is less than 30cc every 24 hours.
Step 2. Inspect the incision site
It is important to maintain good communication with the surgeon and all medical staff who care for you. You must come to check-ups to monitor the wound healing process and possibly remove the drainage; on these occasions you must ask your doctor any questions or concerns you have. If you notice any of the symptoms described below, call your surgeon:
- The edges of the wound are red;
- The fluid is thick or there is pus;
- The incision or the entry point of the drain gives off a bad smell;
- You have a fever over 38 ° C;
- You feel pain at the wound.
Step 3. Keep the area clean
It is not easy to bathe or shower while holding a JP drain, but with the help of another person you should be able to gently wash the wound area. Ask the surgeon for permission before taking a shower or bath, especially if the incision is medicated with bandages. if you are allowed to wash, clean the affected area carefully using gauze or a small towel.
If you need other help, let your doctor know so that he can connect you with an association that offers home nursing services; in some cases, a nurse or healthcare professional may come to your home every day to give you sponging or to wash your hair. Alternatively, ask a family member to help you
Step 4. Securely secure the drain
You can use a safety pin and thread it through the plastic ring that sits above the bulb. Wear loose clothing, such as a loose shirt, and clip the drain to these using the brooch; in this way, you are sure that the bulb does not dangle and is not jerked by the wound. JP drains are more "comfortable" to hold when securely attached to clothing.
- You can also use a waist bag to hold around your waist to contain drainage.
- Avoid attaching the drain to your pants; you may accidentally detach it in case you forget it and pull down your pants.
Advice
- Ask someone for help during the first emptying of the drain. You may have some difficulty moving around, removing and replacing the bandages, and so on.
- Do not keep the bulb in your shirt pocket, because it is too high and the fluid cannot drain properly from the wound, consequently dilating the healing time; you should hold it lower than the incision site.
- Do not touch the spout opening with your hands or other objects, as you must not allow germs to contaminate the inside of the bulb.
Warnings
- If the drain bulb fills more than half in 12 hours, empty it before the scheduled time and write this down on the sheet. The bulb must be at least half empty to exert a certain suction force and remove fluids from the surgical site.
- Check the body temperature when you empty the drain and note the value on the card; if it exceeds 38 ° C, call the surgeon's office.
- Do not squeeze the bulb, unless the spout is open; otherwise, you would push the fluid back into the body increasing the risk of infection.
- Do not to attempt never to remove the drain by itself; since it was sutured into the wound, you need to let the doctor take it out.
