Surgical drains 101: What to know about their use, care and removal

When you need surgery as a part of your cancer treatment, you usually know that you’re going to have something removed. But many patients are surprised to learn that something new may also be added — specifically, a drain. 

Drains are sometimes needed because the body generates fluid as an inflammatory response to surgical procedures. And, if you have excess fluid at a surgical site, that can lead to complications.  

Many patients — especially those treated with a mastectomy for breast cancer — are released from the hospital with one or more drains still in place. So, how should you care for them? How quickly can they be removed? And, how will you know if there’s a problem with yours? 

Read on, for insight into these questions and more. 

How many different types of surgical drains are there? 

First, you should know that surgical drains consist of two parts: the drain itself, which is implanted in the body, and the reservoir, which holds the collected fluid.  

When patients talk about drains, they’re usually referring to the reservoir. But there are four main types of surgical drains, which I explain below. 

Jackson-Pratt drain

The Jackson-Pratt drain is probably the most common type. It’s used in all kinds of surgeries to drain fluid from a surgical site.  

The drain itself is connected to a bulb reservoir, which you compress before attaching to create a constant low level of suction. The bulb comes in two sizes — 100 mL and 400 mL — and which one a surgeon chooses will depend on the amount of fluid they expect to need draining.  

Patients often go home with Jackson-Pratt drains and can learn to empty and reattach those themselves.  

Hemovac drain 

A Hemovac drain is similar to a Jackson-Pratt, but the design is a little different. It uses a round device with a spring-like mechanism to generate suction instead of a bulb.  

Hemovac drains are used primarily in major surgeries, such as a total pelvic exenteration or a total joint replacement when there’s extensive reconstruction. These surgeries tend to generate a significant amount of fluid, so this reservoir can hold up to 500 mL (about 2 cups). 

Penrose drain

The Penrose drain relies on gravity rather than suction for drainage. It is used mostly in sensitive areas like the head and neck, so you’re not putting any undue pressure on delicate structures that can’t withstand it. 

A Penrose drain also creates a larger opening for fluid to drain out of, so it’s ideal for abscesses and infected fluids, which tend to be thicker and not flow as easily. 

Chest tubes

Chest tubes are used exclusively in chest surgeries. So, they are considered a separate category.  

These are placed in the pleural cavity to drain fluid or air after any type of chest surgery. That could include surgery for esophageal cancer, lung cancer or thymic cancer. 

Are surgical drains painful? 

Most patients describe them as uncomfortable and awkward rather than painful. But we make every effort to keep you as comfortable as possible and remove them as soon as their job is done. 

How long do you have to leave a surgical drain in?  

Once a surgical drain has served its purpose, it can be removed. But when exactly that is depends more on the amount of fluid being generated rather than the amount of time that has passed.  

Each surgeon will have a slightly different threshold for determining the timing of a drain’s removal, based on the type of surgery you had and your particular situation. So, talk to your care team to find out what you can expect.  

How do you care for a surgical drain? 

It’s pretty simple. You’ll need to clean the area where the drain is coming out of you once a day with soap and water. You may also be asked to drain the fluid periodically and record how much was collected.  

A chest tube must have a dressing kept over it, too, and that dressing must be changed each time the area is cleaned. But your care team will give you instructions on all of this before you are discharged. 

Do all surgical drains have to be “stripped?” 

No. With a Penrose drain, there’s nothing to strip. You’ve just created a space for fluid to drain.  

But some drains can be pretty small in diameter. So, thicker fluids and fibrous material can occasionally clog them up. When that happens, you have to pinch the tubing to create some pressure and slide your hands down the tube to remove the clog, or “strip” it. This often occurs with Hemovac and Jackson-Pratt drains. Check with your care team before trying to strip any surgical drain yourself. 

Chest tubes can also get clogged. The process of clearing them out is called “milking” rather than stripping, though, because it’s not quite as forceful. We just kind of work the fluid down gently, so we don’t put any undue pressure on the chest cavity. We also don’t typically ask patients to do this themselves. 

How are surgical drains removed? 

We usually remove drains during a follow-up visit. It’s a very simple procedure. There’s normally a stitch or a suture holding them in place. So, we remove the stitch, slide out the drain and apply a dressing. 

How would I know if there’s a problem with my surgical drain? 

If you notice a major change in the amount or quality of drainage, that can be a sign of infection or internal bleeding. So, you’d want to get that looked at pretty quickly. Contact your care team right away if the fluid was clear, for instance, but now looks bloody, or if it starts to be thick or have an odor.  

Carla Patel is an advanced practice registered nurse in MD Anderson's Thoracic Center.  

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