As a surgical assistant, proper wound care and drainage monitoring are critical aspects of my role. Understanding the expected characteristics of drainage from Jackson-Pratt (JP) drains helps me provide quality care to my patients in the postoperative period. In this post, I’ll discuss what normal and abnormal JP drain output should look like, along with nursing care and troubleshooting tips.
What is a JP drain?
A Jackson-Pratt drain, also known as a JP drain, is a closed-suction drain system used after surgery. It consists of a plastic bulb that is connected to tubing that is inserted into the surgical wound site. The purpose of the JP drain is to prevent fluid accumulation by allowing wound drainage to be removed from the body and collected in the bulb.
Some key features of JP drains:
- They are inserted during surgery by the surgeon and sutured in place.
- The tubing is made of soft, pliable plastic to minimize discomfort.
- The bulb provides gentle, continuous suction to facilitate drainage.
- They are transparent to allow easy monitoring of the color and amount of drainage.
- They typically remain in place for several days after surgery until drainage slows.
Expected JP drain output
The amount and type of JP drain output depends on the type of surgery performed. Here is what normal drainage typically looks like for common surgeries:
Abdominal surgeries:
- Up to 100 mL of serosanguineous fluid in the first 24 hours
- Decreasing daily output down to 5-30 mL/day before drain removal
- Fluid is typically red or pink at first, slowing turning yellow, amber or straw-colored
Orthopedic surgeries:
- Up to 400 mL of blood-tinged fluid in the first 24 hours
- Decreasing to 30-100 mL/day before drain removal
- Fluid is initially red, becoming pink then yellow over 1-3 days
Mastectomy:
- Up to 100 mL of serosanguineous drainage daily
- Fluid color change from red to pink/yellow over 3-5 days
- Drain stays in place until output is 20-30 mL/day
These values are general guidelines – acceptable drainage can vary based on the type of procedure, patient factors, surgeon preference and clinical presentation.
Assessing JP drain output
To properly care for patients with JP drains, I routinely:
- Measure and record output from each drain separately
- Note output characteristics: color, consistency, odor
- Assess the surgical site for signs of infection
- Empty and strip drains as directed to maintain suction
- Report any abnormal findings immediately
Monitoring drainage color provides clues about the healing process. Here is a general guide:
| Drainage Color | Indicates |
|---|---|
| Red | New blood |
| Pink | Serosanguineous fluid mixed with blood |
| Yellow/amber | Serous fluid |
Signs of abnormal JP drainage
While caring for post-op patients with JP drains, I watch closely for any deviations from normal. Signs of abnormal drainage include:
- Excessive drainage: Output greater than expected based on surgery type
- Prolonged excessive drainage: High outputs persisting longer than typical
- Sudden increase in amount: Unexplained spike in drainage volume
- Change in color: Unanticipated color change, especially to brown, green or tan
- Thick consistency: Drainage is purulent, chunky or has clots
- Foul odor: Unpleasant or unusual smell
- Leakage: Fluid around insertion site or wet dressings
- Non-functioning drain: Bulb not expanding, kinked tubing
Any of these findings could signify potential complications such as bleeding, infection, leakage or drain malfunction, and should be reported to the surgeon right away.
JP drain troubleshooting
To resolve common JP drain problems, I use these troubleshooting techniques:
Excessive drainage/leakage:
- Check for kinks and open connections
- Consider excess activity/movement
- Assess dressings for saturation
- Notify surgeon for evaluation
No drainage/suction loss:
- Check tubing for kinks
- Assess bulb filling to confirm suction
- Empty bulb fully and strip tubing
- Encourage patient coughing/deep breathing
- Milk tubing to dislodge clots
- Notify surgeon if still no output
Pain/discomfort at insertion site:
- Use non-adherent dressings around sutures
- Consider suture sensitivity to drainage
- Try redirecting/securing tubing for relief
- Use prescribed analgesic medication
- Consult surgeon if pain persists
Addressing small troubleshooting issues promptly helps avoid more significant problems before drain removal.
JP drain removal
JP drains are typically removed when:
- Drainage slows to 20-30 mL/day
- Drainage becomes serous fluid
- No signs of leakage or infection are present
- Removal is ordered by the surgeon
To remove a JP drain:
- Confirm physician order for removal
- Explain procedure to patient
- Position patient comfortably
- Use sterile gloves and dressing supplies
- Remove anchoring sutures
- Instruct patient to take deep breaths and exhale
- Gently but swiftly pull drain from insertion site
- Apply occlusive dressing over site
- Inspect drainage tubing for completeness
- Measure and record final drain output
- Educate patient on signs of complications
The drain site should close spontaneously within a few days. Signs of infection or poor healing may require intervention. Patient teaching for discharge care is vital for prevention of complications.
Conclusion
Assessing and managing JP drains is an important responsibility. Monitoring output characteristics, troubleshooting problems promptly, and proper drain removal technique helps promote positive surgical outcomes.
Knowing expected drainage volumes, colors, and timeframes allows me to distinguish normal vs. abnormal findings. Addressing subtle changes early prevents more serious complications. My attention to detail and willingness to ask questions makes me an asset to the healthcare team and improves patient safety.
