What Happens if the JP Drain is Left Open
If a Jackson-Pratt (JP) drain is left open to continuous free drainage, it will reduce pressure within the collection cavity and prevent effective internal drainage, potentially worsening clinical outcomes by maintaining the fluid collection rather than allowing it to resolve. 1
Mechanism of Harm from Continuous Open Drainage
The fundamental problem with leaving a JP drain open is pressure gradient disruption:
- When a percutaneous drain remains open to continuous free drainage, it reduces pressure within the perigastric or intra-abdominal collection 1
- This pressure reduction prevents internal drainage of material into the gastric lumen or natural body cavities 1
- The collection cavity cannot contract and obliterate as intended, prolonging the pathologic state 1
Proper JP Drain Management Protocol
The correct approach is intermittent clamping with periodic lavage:
- The drain should be clamped and only opened when performing aggressive lavage of the collection 1
- Lavage should be performed every 4-6 hours if the patient is not responding clinically and radiologically in a timely manner 1
- This maintains adequate pressure gradients to allow internal drainage while still providing therapeutic benefit 1
Additional Complications of Improper Drain Management
Beyond pressure-related issues, open drains create multiple problems:
- Increased infection risk: Drains provide a conduit for retrograde bacterial migration and are associated with higher surgical site infection rates 2, 3, 4
- Delayed hospital discharge: Drains prolong hospitalization without providing benefit in earlier detection of fluid collections 2, 3
- Direct drain-related morbidity: Including fever, wound infections, peritoneal fluid accumulation, wound dehiscence, and tissue inflammation 2, 3, 4, 5
- Mechanical complications: Bowel obstruction from intestinal loops wrapping around the drain, drain breakage with retained fragments, and drain occlusion from blood clotting 6, 7, 8
Clinical Indicators of Failure
Signs that continuous open drainage is failing:
- Patient's clinical state worsens 1
- Collection cavity increases in size rather than contracting 1
- This indicates insufficient pressure reduction in the gastric lumen relative to the perigastric collection, likely from persistent downstream stenosis 1
Critical Pitfall to Avoid
Never leave a JP drain to passive continuous drainage when managing post-surgical collections or leaks. The drain must be actively managed with intermittent clamping and lavage protocols to maintain therapeutic pressure gradients while preventing the complications of both continuous drainage and complete drain absence 1.