Integumentary: Emptying closed drains

Now, as a nursing assistant, you may help provide care to clients that have some type of wound drain. You can be asked to empty a closed drain system or monitor wound drainage, meaning that you’ll have to check the amount as well as the characteristics of the fluid, including its color, clarity, and odor.

That’s important to make sure that the wound is healing properly and that there isn’t any complication, like a wound infection.

Before we talk about how to assist with wound drains, we need to go over what wound drainage and drains are. Throughout the course of healing, many wounds normally generate plenty of fluid; this is known as drainage.

Depending on the type and dimensions of the wound as well as the presence of an infection or bleeding, the type and amount of drainage may vary.

There are four types of wound drainage: serous drainage, which is thin and clear; sanguineous drainage, which is bright red blood; serosanguineous drainage, which is basically thin and clear but also has a red or pink color; and purulent drainage, which is thick and yellow, green, tan, or brown in color.If drainage is left to build up inside the wound, it could lead to tissue swelling, which will disrupt the process of healing.

Therefore, if the amount of drainage produced is large, a healthcare professional should usually insert a wound drain, which would channel that fluid out of the wound.

Now, there are two main types of wound drain systems: open and closed. An example of an open drain system is the Penrose drain, which consists of a soft, rubber tube that lets fluid flow out of the surgical site and directly onto a dressing or gauze bandage.

A sterile pin is often attached to the outer portion of the drain to keep the tubing from slipping back into the wound. However, the thing with these drainage systems is that they allow pathogens to easily sneak into the wound and possibly lead to an infection.

In contrast, a closed drain system uses a vacuum to withdraw fluid into a reservoir container or pouch. Examples include Hemovac, which drains fluid into a bottle and can hold up to 500 milliliters of drainage, and Jackson-Pratt, where smaller amounts of drainage, ranging from 100 to 200 milliliters, are collected into a bulb-shaped device.

With these types of drains, the risk of infection can be significantly reduced.Now, when emptying a closed drain system or monitoring wound drainage, there are some common care tips you need to remember.

First of all, closed drain systems are typically emptied and monitored at least once every shift, whenever the drainage container is about half-full, or according to your facility’s policy.

When caring for a client’s wound drain, make sure you do not pull or tug on the tubing. When you are finished, secure the tubing again and make sure that it doesn’t have any kinks and that the client is not lying on top of it.

You also need to make sure that the reservoir container is placed below the level of the wound to prevent the drainage from flowing back in.

At all times, respect the client’s privacy and modesty by remembering to close the room’s door, all window covers, and ensuring the client is properly covered.

At the same time, make sure to take the proper safety measures to protect yourself from possible exposure to the client’s body fluids or blood.Before emptying a closed drain, check with the care plan and the nurse to find out the location, number, and type of drains and drainage containers the client has and what kind and amount of fluid each of them is expected to drain.

You should also find out if the nurse has any concerns about the client you should know about. You can then gather the supplies you’ll need, including an alcohol wipe; a graduated measurement container or graduate; a safety pin; and personal protective equipment, or PPE for short, like gloves, gown, goggles, or a face shield.

So, start by practicing hand hygiene and putting on your PPE. Raise the bed to a height that’s comfortable to work with.

Lock the wheels and lower the bed rail on the side you’ll be working on. Place a towel in your work area to protect the client's clothes and bed linens.

Position the graduate on the client’s bed. You can then unclamp the reservoir container from the client’s gown and open the plug on the pouring spout to break the vacuum and let the reservoir inflate with air.

Make sure to do that facing away from you so that the fluid doesn’t accidentally splash back onto your face. Next, gently tilt the reservoir in the direction of the plug and pour the drainage into the graduate.

Be sure to avoid touching the drainage port with the graduate. After all contents have drained into the graduate, for a Hemovac, use your one hand to flatten the reservoir container.

For a Jackson-Pratt, gently squeeze the bulb. This will help remove all air and re-establish the vacuum.

With your other hand, clean the plug with an alcohol wipe, reclamp it into the pour spout, and secure it on the client’s clothing with a safety pin.

Use the graduate to measure and record how much drainage has been collected before emptying the contents into the toilet or disposing of it according to your facility’s policy.

Finally, return the side rails to the raised position, adjust the height of the bed, make sure that the wheels are locked, take your PPE off, and practice hand hygiene.

It’s also important to recognize signs, symptoms, or situations where you should notify the nurse immediately. These include changes in the color, clarity, or odor of the drainage; the presence of blood in or around the drainage collector; drainage not flowing freely through the tubing; complaints of pain, burning, or irritation related to the drain; redness, swelling, or discharge from the drain insertion site; drain leaks; or if the drain has become disconnected.

After the procedure, make sure to document the date and time along with your observations. Alright, as a quick recap… Wound drains are commonly used to allow fluid generated during the wound healing process to drain out of the wound.

Open drain systems, like the Penrose drain, let drainage flow directly onto the wound dressing, while closed drain systems, like Hemovac or Jackson-Pratt, use a vacuum to withdraw fluid into a reservoir container or pouch.

Frequent monitoring of a closed drain system is important to make sure the wound is healing properly and that there are no complications.

Emptying a closed drain should be done each shift, whenever the reservoir is about half full, or according to your facility’s policy.

After every procedure, remember to report any unusual signs or symptoms to the nurse and document the date and time