Optimal Use of Surgical Drains: Evidence-Based Strategies

Background: Closed-suction drains are a widely-used tool to reduce the incidence of seroma whenever potential spaces are surgically created. However, few studies have examined the parameters that affect drain efficacy. Methods: An in vitro model was created to assess the effects of tubing length, tubing size, tubing type, fluid viscosity, fluid clotting, evacuator type, evacuator squeeze method, evacuator fill and evacuator pressure on the performance of closed-suction drains. Results: Fluid flow rate through the drain increases with increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing negative pressure, decreasing fluid viscosity, and the use of perforated rather than fluted drains. Bulbs generate more effective suction when squeezed "side-to-side" than when squeezed "bottom-up", and evacuators were only able to generate half the maximal negative pressure when 25% full or greater. Stripping the drain tubing helped relieve obstruction due to clotting. Conclusions: Our findings have practical clinical implications for surgeons hoping to maximize the efficacy of closed-suction drains. Through this comprehensive review of the literature and in vitro analysis of relevant variables that affect drain function, the performance of closed-suction drains can be optimized by increasing intracavitary tubing length, decreasing extracavitary tubing length, increasing tubing diameter, increasing the pressure differential, using perforated drains, squeezing bulbs "side-to-side", stripping drain tubing frequently, and evacuating containers whenever they are 25% full. Disclosures: Dr. Janis is a consultant for LifeCell, Bard and Daiichi Sankyo, has received prior honoraria from Pacira and KCI, and receives royalties from Thieme Publishing. Drs. Khansa, Khansa and Meyerson have no relevant financial disclosures. Corresponding author: Jeffrey E. Janis, MD, FACS, Professor and Executive Vice Chairman, Department of Plastic Surgery, The Ohio State University Wexner Medical Center, 915 Olentangy River Rd, Columbus, OH 43212, Phone: (614) 293-8566, Fax: (614) 293-9024, Email: jeffrey.janis@osumc.edu ©2018American Society of Plastic Surgeons

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