Classification of Drains:

Open vs. Closed Systems:

Open - Include corrugated rubber or plastic sheets
- Drain fluid collects in gauze pad or stoma bag.
- They increase the risk of infection
Closed - Consist of tubes draining into a bag or bottle.
- They include chest and abdominal drains.
- The risk of infection is reduced.
Active vs. Passive
Active - Active drains are maintained under suction
- They can be under low or high pressure
Passive - Passive drains have no suction
- Drain by means of pressure differentials, overflow, and gravity
between body cavities and the exterior.

2) Types of Drains
Jackson-Pratt drain
Jackson-Pratt drain, JP drain, or
Bulb drain, is a drainage device
used to pull excess fluid from the
body by constant suction.
The device consists of a flexible
plastic bulb -- that connects to an
internal plastic drainage tube.
The Jackson-Pratt drain used as
negative pressure vacuum, which
also collects fluid. As a low
negative pressure suction system,
it is designed so that intraabdominal contents such as the
omentum or intestines are not
sucked into the tube, minimizing
the risk of bowel perforation or
Ischemia

Penrose drain (open drain)

A Penrose drain is a surgical
device placed in a wound to drain
fluid. It consists of a soft rubber
tube placed in a wound area, to
prevent the buildup of fluid

Corrugated Rubber Drain (open

drain)
Rubber causes a tissue reaction
and the drain track caused by this
material persists longer than when
inert materials arc used. The drain
is fixed by a suture at the end of
the wound and a safety pin must
he placed through the end to
prevent the drain slipping inwards.
Corrugated rubber drains can be
used either for the wound or for
deep drainage.

Negative pressure wound therapy:

Negative pressure wound therapy Involves the use of enclosed foam and
a suction device attached; this is one of
the newer types of wound healing/drain
devices which promotes faster tissue
granulation, often used for large
surgical/trauma/non-healing wounds.

T-Tube
Kehr's T tube: a tube consisting of a
stem and a cross head (thus shaped
like a T). The cross head is placed into
the common bile duct while the stem is
connected to a small pouch (i.e. bile
bag). It is used as a temporary postoperative drainage of common bile
duct. Sometimes its used in ureteric
problems too.

Chest Tube (close drain)

Open (incisional) vs. close ( traocar
use), open is preferred (less risk in term
of intranl organ penetration by strong
trocar inserion).
Used as closed system under water
seal.

Used
to
drain;
haemothorax,
pneumothorax, chylothorax, pleural
effusion and epyema.
Put in the pleural space in the 4th
intercostal space (mid axillary or ant.
Axillary or between them for better
mobility of the patient ) above the
upper border of the rib bellow ( VAN
structure)

Pigtail drain
Pigtails are inserted percutaneously
(through the skin) by a radiologist. It
maybe inserted to allow, for example,
urine to drain directly from a kidney, if
the ureter is diseased or blocked. This
is called a nephrostomy.
Other conditions requiring the
insertion of
a pigtail drain include a blocked bile
duct that needs to be drained of bile, or
a pus-filled abscess. The type of fluid
that drains depends upon the reason
for its insertion.

Davol Drain
In soft, supple silicone with x-ray
opaque strip.
Designed to minimize tissue trauma
and discourage clogging.

 Drains have a triple lumen

configuration
to
increase
drain
versatility and effectiveness. Large
center lumen for maximum removal;
filtered air vent helps reduce risk of
infection. Third lumen permits irrigation
and instillation of medication. 0.3
micron antibacterial filter removes
virtually all bacteria from incoming air.
Suture
cuff
helps
fasten
drain.
Packaged 5 per box.

Redivac Drain (a close drain)

This is a fine tube. with many holes at
the end, which is attached to an
evacuated glass bottle providing suction. It
is used to drain blood beneath the skin,
e.g. after mastectomy or thyroidectomy,
or from deep spaces, e.g. around a
vascular anastomosis.

Endotrachial Tubes
Endotracheal tubes (ET Tubes) are
used to assist in airway management.
ET tubes may be placed when an
airway obstruction has occurred, or
when a patient is unable to breath
independently and needs mechanical
ventilation.
In the latter case, the ET tube
provides a route for the ventilator to
deliver oxygenated air.

Nasogastric Tubes
Naso-gastric tube; as the name implies a tube (available in different sizes and
types) passes through the nostrils (sometimes through oral cavity) to the

stomach, to the duodenum or even jejunum [i.e. nasoenteric; here by the action
or peristalsis].
- The ordinary NG tube measurement:
Extend the tube from the nasal orifices to the ear (lateral face) to the xiphi
sternum.
- Insertion; enquire about any previous nasal surgery, or trauma or difficulty in
breathing through a particular nostril check for nostrils patency, ask the patient
to blow his/her nose,
- During the insertion the tube has to point downward toward the xiphoid process,
once reach the nasopharynx, twist it to 180 degrees this minimizes the risk of
tube coiling at the back or the pharynx, lubricate the proximal end of the tube
with lidocain jelly, insert the tube through the nostril (sometimes one is wider
than the other), insert till u reach the nasopharynx, here u will face some
resistance twist the tube (as we said 180) and push, ask the patient to swallow,
the tube is now in the stomach.

Types of Nasogastric Tubes

LEVIN TUBE:
Single lumen, holes near tip
Prevents accumulation of intestinal
liquids and gas during and following
surgery. Prevents nausea, vomiting and
distention due to reduced peristaltic
action
.

SUMP: (SALEM)
Double lumen, radiopaque
1st lumen: suction of gastric contents
2nd lumen: blue extension (pig tail)
open to room air to maintain a
continuous flow of atmospheric air into
the stomach.
Controls the amount of suction
pressure placed on stomach walls.
Prevents injury, ulcers.
MOSS TUBE

 Tri-lumen
1st. lumen: Balloon anchors it in
the stomach
2nd lumen: Feeding tube
3rd lumen: Aspiration and lavage.

SENGSTAKEN-BLAKEMORE
Triple lumen
1st lumen: Inflates the balloon in
the
stomach to press against the
esophagogastric junction.
2nd lumen: Inflates the balloon in
the
esophagus to press directly against
varices.
3rd lumen: Used for aspiration
and lavage.

MINNESOTA TUBE:
4 LUMEN

NUTRIFLEX TUBE
Feeding tube: usually radiopaque.
Mercury weighted
Coated with lubricant
activated with gastric secretions to keep
tube supple and not injure stomach
lining

3)

Kinds of Sponges

ATRAUMATIC LINT-FREE SPONGES

Sinus Sponges
Helps prevent lateralization of the middle turbinate
Significantly reduces renewed ostiomeatal obstruction following FESS
(Functional Endoscopic Sinus Surgery)
Compressed configuration for easy insertion
Expands anatomically so antibiotics stay in contact with surgical site
Micro-pore size minimizes tissue growth
Clears clots and debris upon removal, leaving a clean, open cavity
Not made with natural rubber latex
Sterile
Nasal Sponges
Provides gentle, even support to aid in patient comfort
Absorbs post-operative drainage following nasal surgery, ethmoidectomy
procedures, or other endoscopic sinus surgeries
Fiber free to reduce risk of adhesions or active rebleeding upon removal
Quickly expands to control and absorb post-nasal discharge
Optional airway tube aids in patient comfort for better breathing and pressure
reduction
Sterile
Not made with natural rubber latex
Epistaxis Sponges

Provides quick and effective control of epistaxis

Provides unsurpassed patient comfort
Atraumatic removal prevents active rebleeding
Compressed configuration slides easily into nasal cavity
Quickly expands to absorb fluids while maintaining patient comfort
Sterile
Not made with natural rubber latex

Otology Sponges

Helps prevent stenosis of the external ear canal following otic surgery
Compressed configuration allows easy insertion into the ear canal
Keeps antibiotics in contact with the wound site through anatomical expansion
Fiber free to minimize tissue ingrowth
Not made with natural rubber latex
Sterile

OPHTHALMIC

Lint-Free Ophthalmic Sponges

Allows the ophthalmologist to perform completely lint-free fluid control

A variety of premium absorbent lint-free ophthalmic sponges
Extremely soft and fast-wicking
Not made with natural rubber latex
Sterile

Eye Spear/Fine Dissector

X-Ray Detectable
Designed for microscopic sponging in the ocular area, fine dissecting, and delicate
surgery
Fine-pore, cellulose fiber is virtually non-linting and extremely absorbent
Fiber is compressed and die-cut into a spear shape and attached to a small
plastic handle
Not made with natural rubber latex
Sterile
PVA Eye Spear

Designed to be used in Lasik surgery in addition to cataract surgery

Constructed of virtually lint-free polyvinyl acetal, causing less eye irritation
Absorbs up to five times more fluid than standard cellulose spears
Expands instantly in contact with fluids
Allow for gentle manipulation of delicate tissues
High tensile strength without breaking apart
DISSECTING

Rosebud Dissector

Excellent for blunt dissection and delicate surgery

Smaller and firmer than a Peanut or Round Dissector
Complete with the exclusive x-ray detectable radiopaque element
Count holder, per pack, enables easy sponge count
Not made with natural rubber latex
Sterile

Peanut Sponge

Excellent for delicate sponging and soft tissue dissection

Soft, round construction may be used as is, or folded
Complete with the exclusive x-ray detectable radiopaque element
Count holder, per pack, enables easy sponge count
Not made with natural rubber latex
Sterile

Cherry Sponge

Largest of the Dissectors

Very absorbent and ideal for general dissecting
Complete with the exclusive x-ray detectable radiopaque element
Count holder, per pack, enables easy sponge count
Not made with natural rubber latex
Sterile

Round (Hard) Dissector

Also known as the Beehive
Roundness and firmness make our hard dissectors beneficial for blunt dissection
and ideal for surgical procedures
Small hole in center of dissector makes it easier to grasp with forceps
Complete with the exclusive x-ray detectable radiopaque element
Count holder, per pack, enables easy sponge count
Not made with natural rubber latex
Sterile
Kittner (Blunt) Dissector

Can be used as a longitudinal or folded sponge for dissection

Constructed of high quality cotton twill
Complete with the exclusive x-ray detectable radiopaque element
Count holder, per pack, enables easy sponge count
Not made with natural rubber latex
Sterile
TONSIL & ADENOID

Single-Strung Tonsil Sponges

Constructed with a 15, white, memory-free cotton string

Covered with gauze and cotton filled for maximum absorbency
Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Double-Strung Tonsil Sponges

Constructed with a No. 3 blue thread for ease of retrieval

Covered with gauze and cotton filled for maximum absorbency
Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Round Adenoid Sponge

Designed to control hemorrhaging following adenoid surgery
Gauze-cotton filled with a No. 3 blue thread

 Complete with the exclusive x-ray detectable radiopaque element

Not made with natural rubber latex
Sterile
SURGICAL GAUZE
Flat Stick Sponges

Pre-folded with the edges tucked in

May be used with a Forester clamp for deep stick sponging
Excellent for absorption
Ideal for prepping prior to surgery
Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Round Stick Sponges

Can be used as a prep sponge for surgery

Complete with the exclusive x-ray detectable radiopaque element
Sterile
Not made with natural rubber latex

Triangle Sponge

Ideally shaped for sponging

May be easily rolled or folded for dissection or used as a prepping sponge
Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile
STERILE

Sterile Cotton Balls

Ideal for prepping, wound cleaning, and perineal care
Not made with natural rubber latex
Sterile

Double-Strung Cotton Balls

Constructed with a 15 blue silk thread for ease of retrieval

Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Sterile Rayon Balls

100% pure medical grade

Virtually lint-free, uniformly shaped, and soft
Sterile
Not made with natural rubber latex

MISCELLANEOUS
Double-Strung Cylindrical Sponges

Highly absorbent
Designed for tonsil, adenoid, and nasal surgery
Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Dental Rolls

Highly absorbent
Designed to keep the area dry, absorbing saliva and moisture
Available in regular and quilted
Not made with natural rubber latex
Sterile

Ear Wicks (Cellulose)

Atraumatic and virtually lint-free

Designed to meet the surgeons need in otolaryngology surgery
Compressed and die-cut of highly absorbent fine-pore cellulose fiber
Not made with natural rubber latex
Sterile

Tracheotomy Sponge

Made of highly absorbent 4 x 4 12-ply gauze sponge

Ideal around any drainage area to protect from chafing
Not made with natural rubber latex
Sterile

Bronchial Sponge

Highly absorbent cotton

Complete with the exclusive x-ray detectable radiopaque element
Not made with natural rubber latex
Sterile

Nasal Plugs

 Ideally shaped for easy insertion and comfortable use following surgery
Not made with natural rubber latex
Sterile
NEUROLOGY
Neuro Sponges in Patties & Strips
High-quality rayon fibers prevent disintegration and linting, reducing the risk of
granulomas
Very pliable when wet, allowing patties and strips to conform to irregular contours
X-Ray detectable element is secured on one side of pad
Locator string attached to the patties increases visibility and assists in
identification
Patties come with counting card in each pack
Also available with extended counting card
Not made with natural rubber latex
Sterile
LAPAROTOMY GAUZE
Cotton Lap Sponges

Consists of 100% cotton

X-ray detectable
Pre-washed consisting of 24/20 gauze
Wrapped in CSR and placed in peel pouch for easy sterile presentation
Manufactured in Mexico, a NAFTA partner country
Not made with natural rubber latex
Sterile

Lap Sponges

Pre-washed consisting of 24/20 gauze

Economically priced for a variety of uses
Consists of 100% cotton
X-ray detectable
Not made with natural rubber latex
Sterile

GAUZE
Vaginal & Perineal Packing
Pre-washed, 4-ply gauze
Vaginal packing complete with the exclusive x-ray detectable radiopaque element
Folded and packaged in peel pouch

 Not made with natural rubber latex

Sterile

1) Methods of Hemostasis
MECHANICAL METHODS

Digital pressure direct pressure, e.g. Pringle maneuver

Tourniquet
Ligation
Suturing
Preventive hemostasis
Clips
Bone wax
Other

THERMAL METHODS
Low temperature
Hypothermia eg. stomach bleeding
Cryosurgery
o Dehydratation and denaturation of fatty tissue
o Decreases the cell metabolism
o Vasoconstriction
o
High temperature
Electrosurgery electrocauterization
Monopolar diathermy
Bipolar diathermy
Harmonic devices
Laser surgery coagulation and vaporization for fine tissues
Electrocoagulation
Electrofulguration (A)
Electrodessication
Electrosection

CHEMICAL WITH BIOLOGICAL METHODS

VASOCONSTRICTION

COAGULATION

HYGROSCOPIC EFFECT
Absorbable collagen
Absorbable gelatin

Microfibrillar collagen
Oxidized cellulose
Oxytocin
Epinephrine
Thrombin
QuikClot

Bicol University
College of Nursing
Legazpi City

Assignment in
Skills Laboratory

Mary Mae B. Buella

(III-C)

Professor
Rosario M. Ludovice
Clinical Instructor