What is a Blake drain?

What is a Blake Drain?

A Blake drain is a soft, flexible silicone drain with four longitudinal fluted channels running along its entire length, designed to provide continuous drainage capability while minimizing patient discomfort and tissue trauma. 1, 2

Physical Characteristics and Design

• The Blake drain is constructed from soft silastic (silicone) material with a distinctive fluted structure comprising four channels that extend along the entire length of the drain 1, 3
• Common sizes include 19 French (F) diameter, which is significantly smaller than conventional rigid drains that typically range from 28F to 32F 4, 5
• The fluted channel design allows fluid to drain along multiple pathways even if one channel becomes occluded, though adequate length of the fluted portion is critical for optimal drainage performance 1

Clinical Applications

Thoracic Surgery

• Blake drains are widely used after chest surgery, including lobectomy, pneumothorax repair, and general thoracic procedures 1, 3
• Studies demonstrate that 19F Blake drains provide comparable fluid drainage to 28F conventional drains after lobectomy for lung cancer, with superior wound healing at drainage sites 4
• However, air evacuation capability is significantly limited compared to conventional drains - the 19F Blake drain performs equivalently to only a 12F conventional drain for air evacuation, requiring higher intrathoracic pressure 5

Subcutaneous Drainage

• The World Society of Emergency Surgery found that subcutaneous closed-suction Blake drains significantly reduced incisional surgical site infections (SSIs) after colorectal surgery from 12.8% to 4.5% (P = 0.025) 6
• Blake drains are particularly beneficial in patients with subcutaneous fat thickness >3.0 cm, where they serve as an independent predictor of reduced SSI risk 6

Other Surgical Applications

• Blake drains have been successfully used in breast surgery, where they demonstrate significantly less pain before (p = 0.05), during (p = 0.01), and after removal (p = 0.009) compared to conventional rigid drains 2
• In a patient preference study, 27 of 37 patients (73%) preferred Blake drains over conventional Portavac drains 2

Critical Performance Limitations

Air Evacuation Insufficiency

• When air leakage occurs after pulmonary resection, Blake drains demonstrate inadequate air evacuation in 73% of cases (16 of 22 patients) compared to only 24% with conventional drains (p = 0.004) 5
• This limitation persists regardless of whether suction or water seal management is used 5
• The drain requires higher intrathoracic pressure to evacuate air, making it unsuitable as the sole drainage method when significant air leaks are anticipated 5

Fluid Drainage Characteristics

• Drainage rates on the operative day are significantly lower with Blake drains compared to conventional drains, though rates equalize by postoperative day one 5
• Suction is required for Blake drains to achieve fluid drainage performance comparable to water-sealed conventional drains 5
• Greater variation in drainage output occurs with water-sealed Blake drains, making suction management preferable 5

Advantages Over Conventional Drains

• Patient comfort is markedly superior - Blake drains cause significantly less pain during placement, maintenance, and removal due to their soft, flexible construction 2
• Wound healing at drainage sites is significantly better, with excellent healing observed in all cases using Blake drains versus conventional drains 4
• The flexible silicone material reduces tissue trauma and patient complaints of discomfort 3
• No complications or adverse events have been reported specifically attributable to Blake drain use in large case series 3

Clinical Pitfalls to Avoid

• Do not rely on Blake drains as the primary drainage method when significant air leakage is expected - their air evacuation capacity is insufficient and may lead to subcutaneous emphysema or inadequate lung expansion 5
• Always use suction with Blake drains rather than water seal alone to optimize fluid drainage performance 5
• Ensure adequate length of the fluted portion is positioned within the drainage cavity, as drainage capability depends on sufficient fluted length 1
• Consider using conventional larger-bore drains (28-32F) instead of Blake drains for thoracic procedures where air leak management is the primary concern 6, 5