When should a Jackson-Pratt (JP) drain be placed during surgical procedures?

When to Place a Jackson-Pratt (JP) Drain

Avoid routine JP drain placement in most surgical procedures, as drains do not reduce mortality, morbidity, infections, anastomotic leaks, or re-interventions, and may actually increase complications. 1, 2

General Principle: Selective Use Only

The World Society of Emergency Surgery and WHO explicitly discourage routine, prophylactic use of intra-abdominal and surgical drains in clean and clean-contaminated cases due to lack of evidence supporting benefit. 2, 3 The available data across surgical disciplines suggest that prophylactic drainage can be avoided in most cases and may lead to increased morbidity and higher treatment costs. 4

Specific Scenarios Where JP Drains Should NOT Be Used

Abdominal/Pelvic Surgery

• Avoid routine drain placement after appendectomy for perforated appendicitis, as drains provide no benefit in preventing intra-abdominal abscess formation and lead to longer hospitalization. 2
• Do not use drains routinely in emergency colorectal surgery, as recent data shows no benefit. 2
• Avoid drains after closure with omental patch technique in perforated peptic ulcer cases. 2
• Do not place drains routinely in elective abdominal and pelvic surgery, as they do not decrease anastomotic leak rates, reoperation, or mortality. 1

Trauma Surgery

• Avoid closed suction drains in trauma patients undergoing emergency laparotomy for hollow visceral injuries, as they are associated with increased surgical site infections. 2

Breast Surgery

• Do not use drains routinely in standard wide margin lumpectomies without axillary dissection. 5
• Prophylactic subcutaneous drainage offers no advantage in most breast procedures except specific scenarios. 1

Limited Scenarios Where JP Drains MAY Be Considered

High-Risk Subcutaneous Drainage (Controversial Evidence)

Consider subcutaneous JP drain placement only in these specific high-risk situations:

• Colorectal surgery with thick subcutaneous fat (>3.0 cm) in high-risk patients, where passive or active drainage reduced superficial SSI from 38.6% to 14.3% in one study. 1
• Axillary lymph node dissection for seroma prevention (one of only two procedures showing benefit in meta-analysis of 52 RCTs). 1, 5
• Breast biopsy procedures for hematoma prevention (the other procedure showing benefit). 1

Specific Surgical Contexts

• Thoracic surgery: JP drains placed as thoracostomy drains during thoracotomy showed significantly fewer complications (15.3% minor, 6.2% major) compared to traditional trocar drains. 6

Critical Pitfalls to Avoid

• Drains do not reduce collection rates and paradoxically may increase infection risk by providing a conduit for bacterial entry. 2
• Drains delay hospital discharge and provide no benefit in earlier detection of fluid collections. 2
• Drain-related morbidity is substantial, including fever, wound infections, peritoneal fluid accumulation, and wound dehiscence. 2
• If drains are placed, remove them as soon as possible (ideally within 24 hours) to reduce infection risk, as prolonged drainage increases SSI risk. 3, 5

Drain Management If Placed

When JP drains are used in the limited scenarios above:

• Remove when drainage is serous and output <300-500 mL/24 hours. 3
• Ensure proper evacuation technique: side-in method generates 87.4 cm H₂O pressure versus only 17.7 cm H₂O with bottom-up method. 7
• Monitor for decreased suction as fluid accumulates (pressure drops significantly with 25-100 mL fluid in bulb). 7
• Remove drains if infection is suspected. 1