What is the proper use and management of a Penrose (percutaneous drainage tube) drain?

Penrose Drain: Proper Use and Management

A Penrose drain is a simple, soft, flat, flexible latex tube that provides passive drainage through capillary action and is primarily used for superficial wound drainage to prevent fluid accumulation and promote healing.

Definition and Physical Characteristics

• A Penrose drain is a soft, flat, flexible tube typically made of latex that provides passive drainage through capillary action rather than suction 1.
• These drains are available in various diameters (usually ¼ to 1 inch) and can be cut to the desired length for specific applications 1.
• Unlike closed drainage systems, Penrose drains allow drainage to exit onto dressings rather than into a collection chamber 1.

Indications for Use

• Penrose drains are primarily used for superficial wound drainage to prevent fluid accumulation (blood, serum, pus) that could lead to hematoma formation or infection 1.
• They are commonly used in minor surgeries for soft tissue trauma or small subcutaneous tumor removals 1.
• They can be used in situations where active suction drainage is not required or where a simple, cost-effective drainage solution is preferred 1.

Insertion Technique

• Sterile technique is essential during insertion to prevent infection 2.
• The drain should be inserted through a separate incision (not through the primary surgical wound) to minimize the risk of wound contamination 2.
• The drain should be positioned at the most dependent part of the wound to maximize drainage by gravity 2.
• A safety pin or suture can be placed through the external portion of the drain to prevent it from migrating into the wound 1.

Securing Methods

• Traditional method: The drain is secured to the skin with a non-absorbable suture to prevent accidental removal or migration 2.
• Novel technique: In rural settings with limited follow-up care, the drain can be sewn onto the wound dressing rather than to the skin, allowing for automatic removal during dressing changes 1.
• Avoid using "purse string" sutures which can convert a linear wound into a circular one, potentially causing more pain and unsightly scarring 2.

Drain Management

• The wound and drain site should be covered with sterile absorbent dressings that require frequent changes as they become saturated 1.
• Dressings should be changed using sterile technique to prevent retrograde infection 1.
• The drain site should be monitored for signs of infection, including increased pain, redness, swelling, or purulent drainage 3.
• The drain should be shortened gradually (typically by 1-2 cm daily) as drainage decreases, rather than removed all at once 1.

Complications and Prevention

• Retrograde infection is a significant risk with Penrose drains due to their open nature; strict aseptic technique during dressing changes is essential 3.
• Drain retention can occur if the drain is accidentally sutured to fascia during closure; this may require endoscopic or fluoroscopic-guided removal 4, 5.
• Premature removal can lead to fluid reaccumulation, while leaving the drain in too long increases infection risk 3.
• The overall infection rate associated with Penrose drains is approximately 16.9%, with most complications being minor 3.

Removal Timing and Technique

• Drains should typically be removed when drainage output is minimal (less than 25-30 mL per 24 hours) 1.
• Most Penrose drains are removed within 3-5 days after placement, though timing varies based on the specific procedure and clinical situation 3.
• For removal, gently clean around the drain site, remove any securing sutures, and withdraw the drain with steady, gentle traction 1.
• After removal, the drain site should be covered with a sterile dressing until healed 1.

Special Considerations

• Patient education is crucial for those discharged with drains in place, including instructions on dressing changes, signs of infection, and when to seek medical attention 3.
• Research shows no significant difference in complication or infection rates between patients hospitalized for drain care versus those discharged home with drains in place within 24 hours of surgery 3.
• Alternative drain types (closed suction drains) should be considered for deeper wounds or when more controlled drainage is required 2.

Innovative Uses

• Penrose drains can be repurposed as guides for endostaplers during video-assisted thoracoscopic surgery (VATS) lobectomy procedures, making the division of fused pulmonary fissures easier and safer 6.

By understanding these principles of Penrose drain management, healthcare providers can effectively use this simple but valuable tool to promote wound healing while minimizing complications.