How to restore function to a non-functioning Jackson-Pratt (JP) drain?

Restoring Function to a Non-Working Jackson-Pratt (JP) Drain

When a JP drain stops draining fluid, first check for obstruction by flushing it with normal saline (10 ml is typically adequate for a small bore drain). 1

Initial Assessment of a Non-Functioning JP Drain

When a JP drain suddenly stops draining, follow this algorithm:

1. Check for kinking or external obstruction

   • Inspect the entire visible length of the drain
   • Pay special attention to the exit site where kinking commonly occurs, especially in mobile patients 1
   • Reposition and redress the drain if kinking is identified

2. Check for internal blockage

   • If no external obstruction is found, internal blockage is likely
   • Thick pus or blood clots are common causes of internal blockage

Flushing Technique to Restore Function

If blockage is suspected:

1. Prepare for flushing:

   • Gather sterile normal saline, a 10-20 ml syringe, and sterile gloves
   • Use aseptic technique to prevent introducing infection

2. Flushing procedure:

   • Carefully flush with normal saline (10 ml for small bore drains) 1
   • Apply gentle pressure - avoid excessive force
   • Some practitioners recommend leaving urokinase in the drain temporarily for persistent clots, similar to its use in blocked central venous catheters, though evidence doesn't show this is superior to saline 1

3. After flushing:

   • Reestablish suction by compressing the bulb and replacing the cap
   • Observe for return of drainage function

Additional Management Steps

If the drain remains blocked despite flushing:

1. Imaging assessment

   • Consider imaging (ultrasound or CT) to check drain position and assess remaining fluid 1
   • Contrast-enhanced CT is most useful for evaluating anatomical details such as locules 1

2. Decision making

   • If significant fluid remains in the cavity and the drain cannot be unblocked, the drain should be removed and replaced 1
   • If minimal fluid remains, removal without replacement may be appropriate

Proper Drain Maintenance to Prevent Blockage

To prevent future blockages:

1. Regular emptying

   • Empty the JP bulb regularly before it becomes completely full
   • Maintain proper suction by fully compressing the bulb when recapping

2. Proper positioning

   • Ensure the drainage system remains below the level of insertion site 1
   • Avoid kinking by using proper dressing techniques

3. Stripping technique

   • For persistent sluggish drainage, manual stripping of the drain may help prevent clot formation 2
   • Hold the drain near the insertion site with one hand
   • With the other hand, pinch the tubing and slide fingers down toward the collection bulb

When to Consider Drain Removal

A permanently blocked drain that cannot be restored to function should be removed if:

1. Clinical resolution has occurred (improved patient condition, decreased fluid output) 1
2. Imaging confirms absence of significant remaining fluid 1

If significant fluid remains, replacement with a new drain may be necessary 1.

Pitfalls and Caveats

• Never apply excessive force when flushing a drain as this may damage tissues
• Never clamp a bubbling chest tube (if JP is used for pneumothorax) as this can lead to tension pneumothorax 3
• Be aware that sudden cessation of drainage more commonly indicates obstruction rather than resolution of the fluid collection 1
• Ensure proper securement of the drain after manipulation to prevent accidental dislodgment 3