Surgical drains are thin tubes used after surgery to remove extra fluid or blood from the surgical site and promote healing. Drains provide an exit for drainage and help prevent fluid buildup under the incision. While drains play an important role after surgery, there is a limit to how long they should remain in place. Leaving a surgical drain in too long can lead to increased risk of infection and other complications.
What are surgical drains?
Surgical drains, also called wound drains or drainage tubes, are soft, flexible tubes placed under the skin during surgery and left in place in the days following the procedure. The thin tubing exits the body through a small incision site and is connected to a bulb or container to collect and measure drainage.
Drains serve several purposes after surgery:
- Remove blood, fluid and debris from the surgical area
- Prevent fluid buildup (seroma) or blood collection (hematoma)
- Allow doctors to monitor amount and color of drainage
- Promote healing by eliminating dead space under incisions
- Reduce swelling and risk of infection
Different types of surgical drains may be used depending on the procedure and area of the body. For example:
- Jackson-Pratt drain – Round, flat drain used after procedures like lumpectomy, tummy tuck, lymph node removal.
- Blake drain – Round drain with holes along tubing, often used after mastectomy.
- Penrose drain – Flat, soft drain used after procedures on reproductive organs, bowel or rectum.
- Chest tube – Stiffer tube to drain air or fluid from chest cavity after heart/lung surgery.
How long should surgical drains stay in?
There is no set timeframe for how long surgical drains should remain in place after a procedure. The amount of time a drain is needed depends on several factors:
- Type of surgery performed
- Location of surgery on the body
- Reason drain was inserted
- Rate and color of drainage
- Patient’s overall health status
For many surgeries, drains stay in for 1 to 2 weeks after the procedure. However, each case is unique. Here are some general timelines for common surgeries:
| Surgery | Typical Drain Duration |
|---|---|
| Mastectomy | 1-2 weeks |
| Hysterectomy | 1 week |
| Cesarean section | 3-5 days |
| Knee/shoulder surgery | 2-3 days |
| Spinal surgery | 5-14 days |
| Abdominal surgery | 3-7 days |
The surgeon will determine when to remove drains based on the amount and quality of drainage. Typically, drains are taken out when drainage slows to about 25-50mL per day and the fluid is light yellow or clear.
Risks of retaining surgical drains too long
While surgical drains provide benefits after surgery, leaving them in too long can pose problems. Potential risks include:
- Infection – Long-term use of drains creates an opening where bacteria can enter the body and cause infection. This risk increases over time as the drain remains in place.
- Delayed healing – Drains can prevent incisions from fully closing and delay normal healing time after surgery.
- Scarring – The drain tract may scar or develop abscesses if the area doesn’t have time to properly heal.
- Pain – Prolonged drainage can cause discomfort and pain at the drain site and surrounding tissue.
- Blockage – Drain tubing can become clogged or blocked if left in place too long, preventing proper drainage.
- Accidental dislodgement – The longer a drain is present, the greater the chance it can be pulled out or dislodged accidentally.
For these reasons, surgical drains should be removed as soon as drainage has slowed enough that they are no longer serving their purpose. Leaving them in for convenience rather than medical necessity increases the likelihood of complications.
Signs a surgical drain has been left in too long
How can you tell if a surgical drain has been left in longer than needed? Watch for these signs:
- Drainage exceeds 100 mL per day after the first week
- Ongoing blood or cloudy fluid several days after surgery
- Thick yellow or green discharge, indicating infection
- Strong odor from the drainage
- Leaking around the drain site
- No fluctuation in drainage amounts over 3-4 days
- Severe pain or tenderness around the drain
- Redness, swelling or warmth at the drain site
- Fever or chills
If you notice any of these signs, contact your surgeon. Prolonged drainage, colored fluid or other symptoms may mean it’s time for the drain to be removed. Leaving it in despite signs of complication can allow infections and other problems to develop.
How are surgical drains removed?
Surgical drain removal is quick and straightforward. It can be done in your surgeon’s office without anesthesia. To take out the drain:
- The surgeon will use sterile gloves and supplies to minimize infection risk.
- Any sutures securing the drain will be cut.
- You may be asked to take a deep breath and hold it while the drain is removed.
- The surgeon will gently but firmly pull the tubing out through the incision.
- A small bandage will be placed over the opening where the drain exits.
- Slight bleeding or drainage may occur initially and will be monitored.
Some tips for drain removal:
- No special preparation is needed prior to the drain being taken out.
- Removal takes only a minute or two and is generally not painful.
- Small amounts of drainage may persist for 1-2 days after drain removal.
- Avoid strenuous activity for 2-3 days to allow for continued healing.
Recovering after drain removal
Once your surgical drain has been removed, you can expect:
- Moderate drainage – Some ongoing drainage is normal for 24-48 hours.
- Bruising or discharge – The insertion site may bruise and leak small amounts.
- Change in sensations – You may feel numbness or tingling around the drain area.
- Slight pain – Mild tenderness is common where the drain tubing exited.
- Relief – Most people feel immediate relief once the drain is out.
Notify your doctor if you have increased pain, foul-smelling discharge, heavy bleeding or other symptoms after drain removal. Once the drain is out, you can shower normally but should avoid soaking the incision for a few more days. Rest, proper wound care and gentle activity will all promote healing.
Caring for the drain site after removal
Proper care after drain removal reduces the risk of complications:
- Wash hands before and after caring for the site.
- Change the bandage as needed if drainage persists.
- Gently cleanse skin around the insertion site with mild soap and water.
- Watch for signs of infection like redness, swelling or foul odor.
- Avoid submerging the area in water for 1-2 weeks.
- See your doctor promptly if you notice bleeding or other problems.
With time and proper incision care, the small opening made for the surgical drain will fully close within a few weeks.
Can a drain be replaced after removal?
In some cases, a drain may need to be reinserted if complications arise after it’s been removed. Reasons a surgeon may replace a surgical drain include:
- Fluid buildup – Significant fluid accumulation (seroma) may require a new drain to remove it.
- Hematoma – A blood collection may need draining to prevent compression.
- Infection – An infected seroma may need a drain placed temporarily.
- Premature removal – If a drain is accidentally pulled out too soon, it may need replacing.
- Ongoing drainage – A persistently high output of fluid may warrant reinsertion.
To reinsert a surgical drain, the surgeon will:
- Clean and numb the area around the previous drain site.
- Reopen the existing incision where the original drain exited.
- Insert a new drain into the cavity and suture it in place.
- Attach external tubing and drainage bulb.
Replacing a drain adds additional discomfort and healing time. Following your surgeon’s instructions for care after the initial drain placement can help avoid the need for replacement.
Is it possible to be discharged from the hospital with a drain still in place?
It is very common for patients to be discharged from the hospital with a surgical drain still in place. As long as the drain is functioning properly and there are no signs of complication, going home with a drain is safe in most cases.
Being discharged with a drain comes with some extra steps and precautions:
- The surgeon and nurse will provide detailed instructions on caring for your drain at home.
- Supplies like extra dressings and anti-kink tubing will be sent home with you.
- You may need to keep a log of the time and amount of drainage.
- A follow-up appointment will be scheduled to monitor drain function.
- Keep the drain secured and protected from being dislodged or tugged.
- Avoid getting the dressing or tubing wet.
- Watch for signs of complication and report any issues promptly.
Having a good support system at home and clear instructions from your care team ensure safe at-home drain management. With proper care, most patients handle having a surgical drain in place for a period of time after being discharged without problems.
Conclusion
Surgical drains provide an important purpose after many operations, helping evacuate fluid and promote healing. However, leaving a drain in too long unnecessarily prolongs risks like infection, scarring and pain. Timing for drain removal will vary based on the surgery, drainage amounts, fluid color and other individual factors.
Signs a drain has been left in place too long include ongoing heavy drainage, thick or foul discharge, redness/warmth at the site or lack of fluctuation in amounts. Your surgeon will determine the optimal time to remove drains based on your postoperative progress. Once a drain is taken out, proper incision care helps ensure full recovery.