The stem
A woman has just had a mastectomy and axillary clearance. On the ward round the consultant points to this and asks you about it.
The equipment
The examiner’s questions
Question 1What is this, and what is it used for?Show the model answer
A closed suction drain, such as a Redivac drain. A thin perforated tube lies in the wound and is connected to a vacuum bottle. It removes blood and serous fluid to prevent a haematoma or seroma, for example after breast and axillary surgery, thyroid surgery, large hernia repairs and flaps.
Question 2How is it different from a passive drain?Show the model answer
It is an active drain: the vacuum pulls fluid out. A passive drain, such as a corrugated or Penrose drain, relies on gravity, pressure and capillary action, and drains into a bag or dressing.
Question 3How do you check it on the ward?Show the model answer
Look at the concertina indicator: when it is collapsed the vacuum is present. If it has expanded, the vacuum is lost or the bottle is full, and the bottle needs changing. Record the volume and the type of fluid daily: blood, serous fluid, or something unexpected such as chyle, bile or bowel content.
Question 4When is it removed, and what are the complications?Show the model answer
Usually when the output falls to a low level, commonly below about 30 to 50 mL in 24 hours, depending on the operation and the surgeon. Complications include infection, blockage, pain, loss of vacuum, and a fragment left behind if the tube breaks on removal.
After you answerThe teaching pointShow
A drain tells you what is happening inside the wound. A sudden increase in fresh blood is bleeding until proved otherwise.
The drawings were made for this site. The patients are written for teaching and are not real.