A drain, a drain...... What's in a drain ?

Ahhhhhh........ The JP Drain. Loved by some, hated by most. These little buggers can make recovery and life in general difficult. Generally, you will have drains placed during surgery. You may be lucky enough to have one or more removed before you leave the hospital. You will most likely leave the hospital with at least one. Here;s a little bit about drains and how to care for them.

The Jackson Pratt Drain (JP Drain) is a common drain that is used for TRAM Flap or other reconstruction procedures. One is pictured below:

The white tube will be inside the body, up to the tapered end, which will be stitched in place during surgery.

Before you head to the hospital, you might want to consider a camisole that has pockets to place drains. These camis are not the most attractive things on earth, but trust me, if you forget to attach the bulb once or twice and feel the pull on your tube, you will be wishing you had one. Here is an example of what they look like. They run about $45-70 each. Your insurance may cover the cost. You also may be able to buy one at a medical supply store.

If you are good with a sewing machine, check out this pattern using a T-shirt. You could probably even make one with an over-sized tank top and some Velcro. The important thing is to make sure that it is easy to open and close from the front. My doctor suggested bringing a few sizes of sports bras to the hospital, but I felt much more comfortable in the cami. Due to the swelling, you may not even want to wear a bra for a few weeks, unless you are leaving the house. I was more comfortable wearing an over-sized shirt or a tank with a built-in bra (Confession- it was a maternity one, so the extra space was nice).

Another option is to wear jackets with pockets inside. Pants can be tricky if you have a drain in the groin area. You should wear pants that are loose enough so that they do not put pressure on the drain. You also need to be able to pin the "grenade" to your pants or tuck it into a pocket. Underwear is the next issue. I solved this problem by taking an old pair of underwear and cutting out a circle large enough that would allow me to move the bulb through the underwear. Just be careful when you remove the underwear. It is easy to forget that the drain is still attached and you may pull on it by accident.

When you are at the hospital, your nurse will care for your drains. She will show you how to strip your drains and measure the fluid. You will want to record these amounts and show them to your doctor when you go for your appointments. The amount that you are draining will help your surgeon to decide when to remove your drains. Usually, they will not remove the drain until you are draining 30mL or less per day.

Here is a video on how to strip drains and measure your drainage. 




The video shows a purple-colored liquid, but obviously, you can expect your fluid to be in the yellow-orange-reddish-pink range. If your drainage is any other color or if you drain blood or puss, call your doctor immediately. If you see any small, stringy "worm-like" tissue particles, don't worry. That is normal.

This is NOT normal:

I woke up one morning and was like "What ?" After a quick call to the doctor's office, I was told to not worry about it, a piece from the connection between the bulb and tube had come out. This piece allows the drainage to come out of the tube, but keeps anything from going back in. At my next visit, the nurse switched out the bulb for a new one and I was good to go. I joked that she gave me a shiny new bulb for Christmas, but she wasn't amused.

When you are ready to have a drain removed, be prepared. It may be a little painful, but it is over quickly. It is over within seconds, but it is a bit uncomfortable. So, hang in there and think about how great it will be once that thing is removed.

Drains are usually removed once the amount that you are draining has decreased to a certain level. As I was told by my nurse, it is not "normal" to be draining a large amount at 4,5,6 weeks after surgery, but some people do. There is no explanation or anything that can be done. However, the JP needs to come out.

This is referred to as "Converting to a Penrose Drain". Basically, the bulb and tube are removed, but the white tube is kept in place. You will continue to drain, but you will be unable to collect the fluid and measure it. It is quite a bit messier than the JP Drain, but it does get rid of the tube, which is a plus. Each week, the doctor will "back out" the drain, meaning, he will remove the stitches and pull on the tube, removing a section. He will then restitch the tube. The area may become a bit irritated. Call the doctor if it is hot, red or if any puss come out. It is important to try and keep the area clean and dry, which can be difficult. It is not ideal to go through this, but it does buy you some time if you are still draining heavily. If the doctor removes the drain too early, the area may close up and the fluid may build up under the skin and cause a seroma.