Jackson-Pratt drains, also known as JP drains, are small plastic tubes used after surgery to help drain fluid from the surgical site and promote healing. Knowing what the normal drainage amount should be for a Jackson Pratt drain can help patients and healthcare providers monitor progress and watch for potential complications.
What is a Jackson Pratt Drain?
A Jackson-Pratt drain, or JP drain, is a soft, flexible plastic tube that is placed under the skin near the surgical site to help drain excess fluid and prevent fluid buildup. The drain consists of the tubing, which has holes along its length to allow fluid in, and a plastic bulb at the end that expands to create gentle suction and promote drainage.
The drains are often used after major surgeries like joint replacements, bowel resections, mastectomies, and lymph node removal. They help remove blood, fluid, and debris from the surgical site that can otherwise accumulate and cause swelling, infection, and other complications.
The fluid drains out through the tubing into the attached bulb. The bulb is compressed and emptied periodically to keep the suction going. JP drains are often left in place for several days or more after surgery until drainage slows to an acceptable amount.
What is Considered Normal Drainage?
The normal drainage amount for a Jackson Pratt drain can vary based on the type of surgery performed. However, there are some general guidelines:
- Joint replacement surgeries: 25-100 mL per 8 hours
- Bowel resection: 50-150 mL per 8 hours
- Mastectomy: 30-60 mL per 8 hours
- Axillary lymph node removal: 20-60 mL per 8 hours
Drainage is typically highest in the first 24-48 hours after surgery and then gradually decreases over several days. It often starts out bloody and then becomes lighter, straw-colored fluid over time as the wound heals.
Here are some examples of normal daily drainage amounts by postoperative day:
| Postoperative Day | Normal Drainage Range |
|---|---|
| Day 1 | 100 – 300 mL |
| Day 2 | 60 – 250 mL |
| Day 3 | 30 – 150 mL |
However, each patient’s fluid drainage can vary significantly based on the type of surgery, extent of dissection, any bleeding complications, and other factors. Close monitoring is important.
Signs of Excessive Drainage
While some drainage is expected, excessive drainage can sometimes indicate potential complications that may need medical attention. Some warning signs of excessive JP drain output include:
- Drainage over 100 mL per hour for 2 consecutive hours
- Sudden large increase in drainage amount
- Drainage remains bright red or bloody several days after surgery
- Foul-smelling drainage
- Persistent high drainage >100 mL per 8 hours several days after surgery
It’s important to monitor the color, consistency and smell of the drainage in addition to the volume. Any concerning changes should prompt a call to the surgeon to evaluate if any intervention is needed.
Factors Affecting Drainage Amount
There are many factors that can influence the expected drainage amount from a Jackson Pratt drain including:
- Type of surgery – More extensive surgeries typically result in more drainage.
- Individual variation – Each patient’s body responds differently to surgery.
- Medications – Blood thinners, anti-inflammatory drugs, chemotherapy and some herbal supplements can increase bleeding and drainage.
- Obesity – Excess adipose tissue can increase fluid accumulation and drainage.
- Smoking – Smoking impairs wound healing and can lead to more drainage.
- Comorbidities – Conditions like diabetes, vascular disease and prior radiation therapy can all impact drainage.
- Surgical complications – Hematoma, infection, lymphocele and poor wound healing can all increase fluid drainage.
Due to these many factors, monitoring drainage trends over time is more important than comparing to an absolute “normal” value. Any concerning changes should be reported to the care team.
Caring for JP Drains
Properly caring for Jackson Pratt drains can help facilitate appropriate drainage and healing. Here are some tips for JP drain care:
- Anchor and secure drains to prevent dislodgement. Follow any anchoring techniques shown by your care team.
- Record drainage amount, timing, color and consistency every time the drain is emptied. Alert your care provider about any concerning changes.
- Empty drains regularly, usually around every 8 hours. Gently compress bulb to create suction. Don’t leave bulbs compressed between emptying.
- Clean around drain exit sites daily with soap and water. Observe for any redness, swelling or drainage from the skin puncture sites.
- Avoid knocking or pulling on drains to prevent accidental removal or tissue injury.
- Keep drain sites uncovered so they can be monitored. Don’t cut or shorten drain tubing.
- Notify your care provider if the drain accidently gets dislodged or pulled out.
Following surgeon’s orders for activity restrictions, wound care and medications is also important for proper healing while drains are in place.
When Can JP Drains be Removed?
Jackson Pratt drains are typically removed when the drainage output decreases to an acceptable level, often around 30 mL or less over a 24 hour period. This usually occurs several days to a week after surgery.
Some general guidelines for JP drain removal include:
- Joint replacement – Remove when output is
- Bowel resection – Remove when output is
- Mastectomy – Remove when output is
- Axillary lymph node dissection – Remove when output is
However, the exact timing of drain removal depends on the surgeon’s assessment of the wound, drainage trends and fluid analysis if obtained. Drains are sometimes left in longer if drainage remains high or concerning.
Potential Complications
While JP drains provide essential benefits after surgery, they also carry some risks including:
- Dislodgement – Accidental removal can disrupt healing and may require drain replacement.
- Obstruction – Clots or tissue can obstruct flow and require drain flushing or replacement.
- Migration – Drains can shift position within tissue and even perforate organs in rare cases.
- Infection – Bacteria can be introduced through the drain tract.
- Fluid imbalance – Excess fluid removal can cause low blood volume and electrolyte abnormalities.
- Fistula formation – A persistent abnormal tract may remain after drain removal in some cases.
Proper placement, anchoring, monitoring and timely removal help reduce the risks of JP drain complications. Alert your care team to any concerns.
Conclusion
Jackson Pratt drains play an important role in recovery after major surgery. Expected drainage varies by surgery type but often starts high around 100-300 mL per day and tapers down over several days. Concerning changes in color, consistency or abrupt increases in volume should prompt evaluation. With proper care and monitoring, JP drains effectively facilitate postoperative healing until removal criteria of around 30 mL per 24 hours are met. Awareness of expected drainage volumes and prompt attention to any warning signs can help optimize recovery.