What is the procedure for removing an abdominal drain?

From the Guidelines

Removing an abdominal drain requires careful technique to prevent complications, and the procedure should be guided by the most recent and highest quality evidence, which recommends removal when there is resolution of signs of infection, catheter output <10 to 20 cc, and resolution of the abscess on repeat imaging 1. To remove an abdominal drain, gather supplies including clean gloves, sterile gauze, scissors, and an adhesive dressing.

• Assess the patient's pain level and administer appropriate analgesia 30 minutes before the procedure if needed.
• Wash hands thoroughly and don clean gloves.
• Remove any securing sutures by cutting them with sterile scissors, being careful not to cut the drain itself.
• Stabilize the skin around the drain site with one hand to provide counter-traction.
• With the other hand, grasp the drain firmly and remove it in a smooth, steady motion following the natural curve of the drain. The removal should be done during exhalation when intra-abdominal pressure is lowest.
• After removal, immediately cover the site with sterile gauze and apply gentle pressure to prevent fluid leakage.
• Observe the site for excessive drainage, bleeding, or signs of infection.
• Apply an occlusive dressing and instruct the patient to keep it dry for 24-48 hours.
• Document the procedure, including the condition of the drain site, character and amount of drainage, and the patient's tolerance of the procedure. This careful approach minimizes the risk of infection, tissue trauma, and ensures proper wound healing after drain removal, as supported by the principles of managing intra-abdominal infections 1. However, the decision to remove the drain should be based on the latest guidelines, which emphasize the importance of resolving the underlying infection and abscess before removal 1, and considering the use of percutaneous drainage or other interventions as needed 1.

From the Research

Procedure for Removing an Abdominal Drain

The procedure for removing an abdominal drain involves several steps to ensure safe and effective removal.

• Preparation is key: Nurses should be familiar with the monitoring and management of surgical drains, as well as the process involved in their removal 2.
• Timing is important: The drain should be removed at the earliest safe time after operation 3.
• Patient preparation: Patient preparation for safe removal of surgical drains is essential to prevent complications such as haemorrhage, tissue inflammation, retrograde bacterial migration, and drain entrapment 2.

Considerations for Removal

• The decision to remove the drain should be based on the patient's condition and the presence of any complications 3.
• The type of drain used may also influence the removal procedure, with closed drains being preferred for their efficiency and reduced risk of complications 3.
• There is limited evidence on the specific procedure for removing an abdominal drain, but it is generally agreed that it should be done by a qualified healthcare professional 2.

Potential Complications

• Complications such as haemorrhage, tissue inflammation, retrograde bacterial migration, and drain entrapment can occur if the drain is not removed properly 2.
• Antibiotic therapy may be necessary to prevent or treat infections related to the drain 4.
• The use of prophylactic drainage in abdominal surgical procedures is still a topic of debate, with some studies suggesting that it may not be necessary to prevent surgical site infection 5.