Differences Between Blake and Jackson-Pratt (JP) Drains
Blake drains and JP drains differ primarily in their design, with Blake drains featuring a fluted silicone design with channels along the entire length, while JP drains are conventional drains with perforations only at the end, affecting their drainage capabilities and clinical applications.
Structural Differences
Blake Drain
- Typically 19F (French) in size
- Silicone-rubber construction
- Features 4 channels/flutes along the entire length of the drain
- Round or flat silicone design
- Continuous suction along the entire drain length
Jackson-Pratt (JP) Drain
- Typically 28-32F in size
- Conventional design with perforations only at the end
- Often made of polyvinylchloride (PVC)
- Connected to a bulb reservoir that creates negative pressure when compressed
Performance Characteristics
Fluid Drainage
- Blake drains may initially drain less fluid on the operative day but show similar drainage rates to conventional drains on subsequent days 1
- A study comparing 19F Blake drains with 28F conventional drains found no significant differences in the amount of postoperative drainage after lobectomy for lung cancer 2
- Blake drains require suction to obtain fluid drainage performance comparable to water-sealed conventional drains 3
Air Evacuation
- Blake drains show inferior air evacuation capabilities compared to conventional drains
- When air leakage occurs, Blake drains show insufficient air evacuation in 73% of cases versus 24% with conventional drains 3
- Experimental studies show that a 19F Blake drain has air evacuation performance equivalent to only a 12F conventional drain 3
- Blake drains require higher intrathoracic pressure for effective air evacuation
Clinical Applications
Blake Drain Benefits
- Better wound healing at drainage sites compared to conventional drains 2
- May allow greater patient mobility due to smaller size
- Associated with shorter hospital length of stay in some studies (4 vs 5 days) 1
- May reduce postoperative atrial fibrillation in cardiac surgery patients (11.3% vs 23.8%) 1
JP Drain Characteristics
- Bulb reservoir creates negative pressure through compression
- Evacuation method affects pressure generation (side-in evacuation: 87.4 cm H₂O vs bottom-up: 17.7 cm H₂O) 4
- Pressure decreases as fluid accumulates in the bulb (72.6 cm H₂O at 25 mL to 35.6 cm H₂O at 100 mL) 4
- Requires periodic emptying and re-compression of the bulb to maintain suction
Clinical Considerations for Drain Selection
Thoracic Surgery
- Blake drains may be insufficient for air evacuation after pulmonary resection 3
- Conventional drains are preferred when significant air leakage is anticipated
- For fluid drainage only, Blake drains may be adequate with proper suction 1
Abdominal and Other Surgeries
- Both drain types are used for removing blood, serum, lymph, urine, and other fluids 1
- Selection should be based on quality and quantity of drainage fluid, amount of suction required, and anatomical location 1
Important Caveats
- Drain selection should prioritize clinical outcomes including morbidity, mortality, and quality of life
- Routine drainage after many elective surgeries has been challenged, with evidence suggesting no benefit in terms of mortality, morbidity, infections, or anastomotic leaks 1
- Drains left in place for more than 3 days may become colonized with bacteria and yeast, complicating interpretation of culture results 1
- Early drain removal is recommended to reduce chest drainage time and length of stay 1
While both drain types are widely used in surgical practice, the choice between Blake and JP drains should be guided by the specific clinical scenario, with particular attention to whether air evacuation or fluid drainage is the primary concern.