The Best Way to Secure Post-Surgical Drains! by Mary Robinson Prody, R.N.

If you are having a mastectomy for breast cancer treatment, or reconstructive breast surgery, you will most likely have surgical drains in place when you go home. For most patients, the drains are a daunting obstacle on an already arduous trek.

AN EXPLANATION ABOUT DRAINS AND THEIR PURPOSE

The drains, known as Jackson-Pratt drains, are placed during surgery and play a very significant role in the outcome of the surgery and healing process. Fluid often builds up where a breast has been removed, and the fluid can cause a seroma (a pocket of fluid) bringing discomfort and delay in healing. Post-surgical drains, whether one or several, remove the fluid.

HOW DO THEY WORK?

One end of the thin flexible tube, usually 14-18 inches in total length, is inserted into the surgical site and extends out of the body. It is secured with one or two sutures to your skin. The tubing is connected to a soft round squeeze bulb that collects fluids from the surgical site.

The drainage needs to be emptied two-four times a day. In a process we call milking or stripping, the drainage tube is pinched at the insertion site with slight pressure in a downward slide to the bulb, to expel any tiny blood clots to keep the tube free flowing. You or your caregiver will record the drainage amounts, as this is how the surgeon determines when the drains are no longer needed.

The drain works mainly by suction, which requires the patient or caregiver to squeeze the bulb to recreate a vacuum once it is re-capped. As it fills with drainage, the flat bulb expands to original size. Gravity comes into play, and if the drainage bulb is not secured below the insertion site, drainage will potentially bypass the suction and leak out of the insertion site. Leakage means the drain is not functioning properly, which means it could irritate the surrounding skin and cause staining on clothing, or worse, lead to an infection.

GOING HOME WITH POST-SURGICAL DRAINS

If all of this sounds complicated and difficult, it can be! The normal anxiety of going home after surgery can be increased by the additional burden of managing drains. You have just had major surgery, are most likely taking pain medication, weakened from surgery, and tired. You are facing a diagnosis of cancer and the significant altered body status from your surgery. That is a lot to deal with.

DISCHARGE INSTRUCTIONS ARE ROUTINE FOR NURSES NOT FOR PATIENTS!

It is now time for discharge, and the nurse will be teaching you and/or a caregiver how to perform drain care at home. As a nurse, I think we may overestimate what patients and/or caregivers are expected to do on their own. Really, to them drains are a complete unknown, a medical device cared for by nurses and now — “I’ll show you how to do this.”

Discharge day is often frenzied. The patient not only gets a demonstration of drain care, but also is sent home with lengthy written instructions and needed supplies. Often things are explained too quickly or at the last minute. It’s a lot to absorb for both patient and caregiver!

One of the most challenging parts of having drains is managing the long tubes and the bulb(s), especially as they become weighted with drainage. If not secured properly, the tubes can become tangled; and the bulb(s) can move around or swing, causing discomfort at the insertion site in your chest.

SAFETY PINS CAN BE UNCOOPERATIVE AND PAINFUL

Once home, the struggling with drains begins.

In the hospital, nurses secure the bulbs with plastic or metal clips, or they are safety-pinned to your hospital gown. At home, you are not wearing a hospital gown (yay!). If the drain bulbs are pinned to clothing, they can be yanked during the act of toileting causing discomfort and, in the worst-case scenario, become accidentally dislodged.

If you were not given instructions, or have forgotten the importance of securing the bulbs below the insertion site, there is the potential complication of leaking and loss of maximum drain function.

The process of milking or stripping the tube(s) is one of the most worrisome tasks patients and or caregivers are instructed to do. Some of my patients refused to even do it for fear of pulling out the thin drain tube.

SLEEPING WITH DRAINS

Looking forward to going home and sleeping in your own bed might now be a worrisome endeavor, requiring a lot of thought and mechanics to keep those bulbs with drainage secure. Patients often worry about lying on them or rolling over them while sleeping. I have had patients who slept for weeks in a recliner, some who accidentally rolled on them resulting in spillage and needing to change sheets in the middle of the night, and many just plain fearful of these things happening.

A good night sleep is so very important in the healing process. The Prody® Drainage Bulb Holder II helps alleviate some of the stress allowing for a better shot at a restful night’s sleep.

SHOWERING WITH DRAINS

If your surgeon allows showering, how in the world does that work with one or several drains?

When my 80-year-old bilateral mastectomy patient told me she asked her surgeon how she could possibly shower with her two drains, he told her to take the shoelaces out of her shoes, tie them together hang it around her neck, and then safety-pin her drains to the laces during showering.

Yes, he said shoelaces!

It is astounding that a surgeon would recommend, and many hospitals, continue to use safety pins at all. In hospitals it is considered a sharps exposure with accidental pin pricks breaking skin, and in the home setting, patients can and have, not only pricked themselves but the actual drain or bulb causing loss of suction and rendering the drain ineffective, and a potential portal for infection.

THERE MUST BE A SOLUTION

“HALF MY TEARS AFTER MY BREAST CANCER SURGERY WERE RELATED TO MY CANCER DIAGNOSIS, BUT THE OTHER HALF WERE RELATED TO THOSE DARN DRAINS.”

Because of my experiences, I began a search for a better method of drain securement. I found there was not only a universal or better method, I learned there were multiple make-shift methods including ineffective plastic clips that fall off when the bulb becomes weighted with drainage, lanyards, pocketed clothing, a Home Depot cloth tool belt, shoe laces, fanny packs, and the list goes on.

PASSION LEADS TO ACTION

Witnessing my patients’ struggles, frustrations, and unnecessary complications led to my development of the Prody® Drainage Bulb Holder II. It is a soft fabric belt that has easy-grip fasteners to secure up to four drainage bulbs.

Because it was developed by a nurse with knowledge and experience, it meets patients’ comfort needs, but also clinical needs to maximize drain function to decrease complications and improve the surgery outcome.

 (US Patent #11,090,184)

 

With the Prody® Drainage Bulb Holder II, each drain bulb is individually secured so there is virtually no movement of the drainage bulb or tubing. The individual securement decreases patient discomfort and prevents pulling or accidental dislodgement of the drainage tube. The belt with secured drain bulbs is discretely worn under clothing, not visible to others, but allows quick and easy visibility for you to determine when you need to empty.

The Prody® Drainage Bulb Holder II allows normal activities of daily living during the day, in bed at night, and in the shower — if your surgeon allows showering. If showering is allowed, you will need two belts — one for use while showering — and one for dry use. After showering, the wet belt will air dry and be ready for your next shower.

The Prody® Drainage Bulb Holder II is universal in size and gender — because men get breast cancer too!

The Prody® Drainage Bulb Holder II also comes in kit form, which includes all the components needed for drain care: two measuring cups, a Drainage Output Record Sheet — including patient education and step-by-step directions — and two belts, one for showering, (if allowed), one for dry use or in case one gets soiled.

The patented drain fasteners have also been incorporated into Abdominal Binders, with all the same benefits as the Drainage Bulb Holder II. Abdominal Binders are used in DIEP Flap, Tram Flap, Tummy Tuck, or reconstructive surgeries requiring compression.

MY MISSION CONTINUES

My passion and work to provide patients with a better post-operative experience with their drains continues as the need is still greater than I would like to report. It is very distressing there is still SO much being written and discussed on various forums about how to manage post-surgical drains — yet thank goodness for the ability to share needed information.

Drain management angst and frustration that often plague patients and or caregivers should not be as memorable as the cancer and surgery trek. That is hard enough!

The Prody® trio of Drain Care Products is used in over 300 national hospitals, but that leaves 4000 hospitals using safety pins and other make-shift methods to secure drains. I call nurses and patients who learn about the Prody™ Drainage Bulb Holder II products ambassadors as it is often they who inform their medical practitioners of their success with my products and how the products end up in hospitals.

One of those ambassadors of the Prody® Drainage Bulb Holder II is none other than Nancy Stordahl, creator of Nancy’s Point blog. Little did we know when we met, she would end up using the Drainage Bulb Holder II after her DIEP flap breast reconstruction surgery.

After all she endured, she took the time to write an article about how her drain management was improved using the Drainage Bulb Holder II with her four drains. She was even brave and bold enough to give us a post-surgery photo of herself with her four drains snugly secured in the Drainage Bulb Holder II.

As always, Nancy, #KeepingitReal!

Click on the above photo or HERE to read her review of the Prody™ Drainage Bulb Holder II

My goal is to have drain securement universal, with patients getting products to secure drains either before surgery or in the operating room after drains are placed — and getting rid of safety pins!

As a side note, drains are used in other surgeries aside from mastectomies including: Tram Flap, DIEP Flap, and implant/explant surgeries, as well as some GYN surgeries and C-sections. Others include: abdominoplasty, colon, liver, renal and some hernias, certain wound surgeries, orthopedic, and organ transplant surgeries.

Thus, the need is great.

For those searching for their own drain care products, the patented Prody™ Drainage Bulb Holder II products are available on https://promedicsproducts.com.

My hope is that such a search will not be necessary someday and that all patients will get needed products from their medical providers.

The Prody™ Drainage Bulb Holder II products have been recently improved with easy grip fasteners, making drain care easier for patients and clinicians. The products are patented (US Patent #11,090,184) so only available on Promedics Products website or through hospital distributors.

Note — Amazon Alert! Amazon is selling the original design without the improved fasteners and those are not as easy to use.

If you have a question or comment for me, ask away!

MARY’S BIO:

Mary Robinson Prody is a Registered Nurse trained in Minneapolis, MN. She worked as a Home Health Nurse for many years in Florida. She currently resides in Minnesota where she operates Promedics Products, a company she founded to provide comfortable and functional products to improve the quality of life, while preventing complications, in patients who have surgery requiring the use of surgical drains. Visit Promedics Products Facebook page. While you’re there, give it a like/follow!