What do you do if a Jackson-Pratt (JP) drain stops draining?

Management of a Non-Draining Jackson-Pratt (JP) Drain

When a JP drain stops draining, the first step should be to check for obstruction (blockage or kinking) by flushing the drain with normal saline. 1

Initial Assessment and Troubleshooting

• When there is a sudden cessation of fluid draining, it is most likely due to obstruction rather than resolution of the fluid collection 1
• First check for kinking of the drain, especially at the skin exit site, as small soft drains are prone to kinking in mobile patients 1
• If no kinking is found, flush the drain carefully with normal saline (10 ml is adequate for a small bore drain) to clear potential blockage 1
• Some clinicians advocate leaving urokinase in the drain for a while (similar to its use in blocked central venous catheters), though evidence doesn't show this is superior to saline 1
• Ensure the drainage bottle/collection chamber remains below the level of the insertion site at all times to prevent backflow 2

Evaluation After Attempted Unblocking

• If the drain remains blocked despite flushing attempts, imaging (ultrasound or other) should be used to confirm whether significant fluid remains in the cavity 1, 3
• A permanently blocked drain should be removed and replaced if necessary, especially if imaging shows significant fluid remaining in the pleural cavity 1
• If imaging confirms absence of significant fluid collection, the drain can be safely removed 1, 3

Criteria for Drain Removal

• The drain should be removed once there is clinical resolution 1
• Clinical resolution indicators include:
  • Decreased fever and improved general well-being 3
  • Normalization of acute phase reactants in blood tests 3
  • Radiographic evidence showing resolution of the collection 3
  • Drainage output less than 300 mL/24h of non-purulent fluid 3

Drain Removal Technique

• Provide adequate analgesia before removal 3
• For chest tubes specifically, removal should be done either during Valsalva maneuver or during expiration, with a brisk firm movement 3
• For other surgical drains, follow site-specific protocols for safe removal 3

Common Pitfalls and Caveats

• Blocked drains can indicate obstruction rather than resolution - always check for kinking and consider flushing before deciding to remove 1, 3
• Premature removal of drains may lead to fluid reaccumulation requiring repeat procedures 3
• Delayed removal of drains increases risk of infection, patient discomfort, and prolongs hospital stay 3
• JP drains play an important role in reducing complications - studies show their use can reduce sternal wound complications in cardiac surgery patients 4 and pelvic abscess formation in complicated appendicitis 5

Documentation and Monitoring

• Record the amount, color, consistency, and odor of drainage for clinical monitoring 2, 6
• Daily reassessment of drainage amount should be documented on a dedicated chart 2
• Changes in the character of drainage may indicate complications requiring intervention 2