Drain (surgery)

Drainage is a medical treatment method. It serves the derivation or the aspiration of morbid or increased body fluids or gases to restore a normal state.

In principle, a distinction internal to external drainage. In the former, are surgically (often minimally invasive) avoid physical obstacles created shorts ( anastomoses ) between hollow organs such as esophagus, stomach, intestine, or pent-up fluids ( cyst contents) in hollow organs (stomach or intestines ) are derived. In the outer drainage deriving from inside the body is carried out.

Designation

The individual forms of internal drainage are sometimes called by proper names, but often only after the involved organs (eg Pseudozystojejunostomie, gastrojejunostomy ).

In the outer drainage naming the individual forms is very inconsistent and not standardized. About the Name proper names of the inventors of each method ( Bülaudrainage, Blake drainage) or necessary for this resource drain ( Penrosedrain, Redon drain ), or the drained areas of the body (eg abdominal drainage, chest tube ) or underlying disease states ( wound drainage, Pneumothoraxdrainage, bleeding drainage) or the way to generate the suction ( Thoraxsaugdrainage, Kapillardrainage ) were used. Also, the type of access and at the same time the affected organ descriptive language constructs are common (eg Percutaneous Transhepatic biliary drainage, short PT ( C) D).

Active principles

At each outer and inner some drainage is required on the one hand one or more rubber flaps or a tube of rubber or synthetic material, the drain called or other self -absorbent materials, such as gauze or foam.

On the other hand it requires a pressure difference ( pressure gradient, suction) between the point of collection and the Auffangort, which can be produced in four different physical methods:

• Gravity drainage: The secretion accumulates regular way at the bottom of a wound, body or abscess cavity. A tubular drain with one or more openings derives the secretion from the lowest point in a deeper collection bag. An example of this would be the Robinson drainage.
• Kapillardrainage: The nature uses adhesion ( capillary ) to the Se - or excreta derive even up in a bandage. This principle is realized by simple gauze as a wick in a wound, the Penrose drain ( Mulldocht in a thin-walled rubber tube) or the Easy -flow drain ( a soft plastic tube with longitudinally ribbed or washboard -like shaped narrow inner lumen ). Applied this easy- Flow drainage eg after conventional cholecystectomy (gall bladder removal ), where the drainage is placed in the former gallbladder bed for deriving the resulting bleeding and / or bile secretion. Is suspected, however, that the presence of these drainage promotion or formation of the liquid provoked only (in the sense of a foreign body reaction ).
• Heber Drainage: Here, the principle of communicating vessels is used to initially Although upwards, but eventually dissipate Se or excreta in deeper collection bags or bottles. This is primarily for the derivation of Magen-/Darm-/Gallensekreten. The height difference between the liquid level in the reservoir and in the collecting vessel is an absolute requirement for proper function. The suction effect is small and is approximately equal to this difference described (in cm water column).
• Suction drainage: In this form of suction is basically generated externally. On the one hand, so-called vacuum bottle ( vacuum bottles), as for example in the Redon drainage or self-expanding bellows or plastic balls used (Jackson -Pratt drainage), on the other hand genuine suction pumps. The pull of the " vacuum bottle " is directly measurable and controllable, but only limited with further auxiliaries due to the limited bottle volume and decreases with increasing filling from. But there are also vacuum bottles, which are provided with its own hand pump and a pressure gauge. When Thoraxsaugdrainage (incorrectly called Bülau drainage ), for example, in pneumothorax occurs in the application after injury or surgery in the chest, a defined suction ( usually 15-30 cm water column) is generated either with an electrically operated pump or regulated with another suction pump.

Exterior drainage systems can be open, semi-open or closed: While in the first group, the liquid is drained into the Association, takes place in the second group a derivation in an open bottle or glued to the skin Adhäsivbeutel. Only in the third group, the secretion via the hose connection into a collecting bag or system with or without additional suction is derived air completed. Especially this last group meets all hygienic requirements.

Side effect

About drainages bacteria can enter the wound area, they are a risk factor for wound infections. The proximity of drains to vessels or bowel may rarely trigger Arrosionsverletzungen. The longer must spend a drainage in the wound, the more deformed the hose ends into the wounds and the removal may be associated with pain.

Objective

Even after the end can be divided two classes of external drainage:

• Preventive Drains: Drains Here are preventive and temporary, usually limited to 24 to 48 hours, is introduced because it is feared bleeding, for example, ( post-operative Redon drainage or bleeding )
• Curative ( healing ) Drains: For them is a therapeutic purpose, such as a derivative drainage abscesses.