Providing the evidence for surgical drain removal: A double blind randomised controlled trial

Abstract

Background

Surgical drains are essential for removing blood and other fluids after surgery or injury. Closed suction drains (CSD) use negative pressure to actively remove bodily fluids. Nurses remove the CSD on the ward; removal can cause discomfort and pain to the patient. A review of current practice identified two techniques to release the negative pressure, with no evidence to support either technique. We wished to determine which technique is associated with less patient pain, easier removal, and equivalent safety.

Methodology

A blinded randomised controlled trial with two parallel arms with a 1:1 allocation ratio. Adult patients undergoing abdominal general surgery requiring CSDs and the nurse removing the CSD were recruited. The drain removal technique was randomised to be: 1. clamping the CSD tubing for thirty minutes prior to removal, or 2. manual disconnection of the CSD from the suction device. The patient, the nurse removing the drain, and the research nurse were blinded to the technique. We investigated the patients' and nurses' responses to their CSD removal experience.

Results

A total of 128 patients participated, 63 underwent the clamping technique, whilst 65 underwent the disconnecting technique. The disconnecting technique was less painful on removal than the clamping technique, for delta pain measured with a VAS out of 100, 2.81 ± 33 (p = 0.034). Delta pain score was higher in patients with a Jackson Pratt catheter than a Blake catheter (p < 0.01). Ease of removal was similar between the techniques, but Jackson Pratts was more challenging for the nurse to remove over the Blake catheter (p=0.025). No complications were associated with either technique.

Conclusion

The disconnecting technique produced less pain at removal than the clamping technique. Surgeons should consider Blake catheters over Jackson Pratt catheters, as they cause less pain and are less challenging to remove.