Perioperative Jackson-Pratt Drain Management
Routine prophylactic use of intra-abdominal surgical drains, including JP drains, is discouraged in clean and clean-contaminated cases, as they provide no mortality or morbidity benefit and may increase complications including surgical site infections and delayed hospital discharge. 1
Evidence Against Routine Drain Use
The most recent high-quality evidence demonstrates significant concerns with routine surgical drain placement:
In elective colorectal surgery, a 2023 prospective international matched cohort study of 1,805 patients found drains were not associated with reduced collection rates or earlier detection of complications, but were associated with delayed hospital discharge and increased surgical site infection risk 1
In emergency laparotomy patients, drains showed no benefits regarding mortality, morbidity, infections, anastomotic leaks, or re-interventions compared to no drains 1
In trauma cases, closed suction drains after acute laparotomies for hollow visceral injuries were associated with increased surgical site infection rates 1
Meta-analyses of elective colon resection replicated these findings, showing no effects on clinical or radiological anastomotic dehiscence, wound infection, re-operation, extra-abdominal complications, or mortality 1
When JP Drains May Be Considered
Despite the evidence against routine use, JP drains may have selective indications:
Contaminated abdominal cases may represent a different situation where drains could be beneficial, though evidence remains weak 1
Pancreaticoduodenectomy and major hepatobiliary surgery where specific leak concerns exist, though this should be surgeon-specific rather than routine 1
Pelvic surgery after rectal resection has traditionally used pelvic drains, though a 2004 Cochrane review questioned their routine safety and effectiveness 1
Critical Management Principles When Drains Are Used
Documentation Requirements
When a JP drain is placed, document the following at regular intervals:
Volume of output measured in milliliters over specific time periods (typically every 8-12 hours) 2
Character of drainage: serous, serosanguineous, sanguineous, purulent, or bilious 2
Color: normal (clear to light pink) versus abnormal (dark red, green, brown, or turbid) 2
Presence of abnormal components: blood clots, tissue debris, or enteric content 2
Maintenance and Monitoring
Maintain negative pressure by ensuring the JP bulb remains compressed; vacuum pressure must be reinstated when necessary 3
Strip the drain tubing periodically to prevent clogging from blood clots or debris, which can compromise drainage efficiency 4
Monitor for complications: infection at insertion site, drain migration, or inadvertent organ injury 3
Removal Timing
Remove drains as early as safely possible, ideally within 24-48 hours in most cases to minimize infection risk and facilitate early mobilization 1
Output-based criteria: Consider removal when output is <30 mL per 8-hour period and character is serous rather than sanguineous 3
Prolonged drainage (10-17 days) may be indicated only in specific circumstances such as documented CSF leaks after spinal surgery, but this is not applicable to abdominal surgery 5
Common Pitfalls to Avoid
Do not use drains routinely based on tradition alone; require specific clinical indication 1
Do not assume drains prevent or detect anastomotic leaks—pooled data show enteric content or pus is observed in only 1 in 20 drains in patients with clinical leaks 1
Do not leave drains in place longer than necessary—each additional day increases infection risk and delays mobilization 1
Do not rely on drain output alone to guide clinical decision-making; clinical examination and laboratory parameters remain paramount 1
Integration with Enhanced Recovery Protocols
Within ERAS (Enhanced Recovery After Surgery) pathways:
Avoid routine drainage to facilitate early mobilization and reduce catheter-related complications 1
Optimize fluid management using goal-directed therapy rather than compensating for potential third-space losses with drains 6, 7
Remove all tubes and drains early (including urinary catheters by postoperative day 1) to reduce infection risk and enable patient autonomy 1