What are the differences between a Romovac drain and an Active Drainage Kit (ADK) drain?

Romovac vs ADK Drain: Key Differences

The terms "Romovac" and "ADK" (Active Drainage Kit) are not standard nomenclature in surgical literature, but based on drainage system principles, the fundamental distinction lies in whether the system uses passive gravity drainage versus active suction drainage.

Understanding Drain Classification

Surgical drains are categorized by two primary characteristics that determine their function and clinical performance 1:

• Closed vs Open Systems: Closed drains collect fluid in a sealed reservoir (preventing environmental contamination), while open drains allow fluid to drain directly into dressings 2, 1
• Active vs Passive Drainage: Active drains apply negative suction pressure, while passive drains rely on gravity and capillary action 1, 3

Active Suction Drains (Likely "Romovac" Reference)

Active suction drains include systems like Hemovac and Jackson-Pratt (JP) drains, which are the most commonly used closed suction systems in North American surgery 4:

• Mechanism: These systems generate negative pressure by compressing a collapsible reservoir, creating suction that ranges from low-vacuum to high-vacuum (up to 900 mbar) 2
• Suction degradation: As the reservoir fills, suction pressure decreases sharply—dropping to only 13-20% of initial values when the reservoir reaches 50% capacity 4
• Material: Typically made of PVC (polyvinylchloride), which electron microscopy studies show develops adhesion of wound secretion and cellular debris to the inner wall within 24 hours 3
• Pain on removal: Suction drains cause significantly more pain during removal compared to gravity drains 3
• Tissue complications: High-vacuum suction can cause tissue and blood to be sucked into the drain, potentially producing elevated quantities of secretion 2

Passive Gravity Drains (Likely "ADK" Reference)

Gravity drainage systems, often made of silicone or polyurethane, provide drainage without active suction 2, 3:

• Mechanism: Fluid drains by gravity alone, requiring the collection reservoir to be positioned below the surgical site 3
• Material advantages: Silicone drains show almost no occlusion or adherence of secretion on electron microscopy, even after 24+ hours 3
• Drainage volume: Clinical studies demonstrate more constant and apparently larger volumes of secretion drained with gravity systems compared to suction drains in soft tissue surgery 3
• Pain profile: Removal of gravity drains is considerably less painful than withdrawal of suction drains 3
• Equivalence to suction: Gravity drainage systems guarantee equally effective secretion drainage compared to high-vacuum Redon drainage 2

Clinical Performance Comparison

Infection Risk

• Both systems show no significant difference in wound infection rates when used for up to 72 hours 2
• Open drainage systems (secretion going directly into bandages) are obsolete for primarily uninfected wounds 2

Practical Management

• Suction drains require frequent monitoring: Reservoirs must be checked regularly (especially in the first 24 hours) to ensure adequate compression, as filling rapidly degrades suction 4
• Reservoir size matters: Anticipated drainage volume should dictate reservoir choice, with larger reservoirs preferable in most cases 4
• Gravity drains need positioning: The collection system must remain below the patient's chest level at all times 5, 6

Common Pitfalls to Avoid

• Do not use high-vacuum suction routinely: In soft tissue wounds, high-vacuum leads to tissue ingestion and may paradoxically increase secretion production 2
• Empty suction drains frequently: Failure to maintain reservoir compression results in loss of 80-87% of suction capacity at half-full 4
• Avoid PVC for prolonged drainage: PVC materials occlude faster than silicone or polyurethane alternatives 3
• Never use open drainage systems: For uninfected surgical wounds, open drains are contraindicated due to infection risk 2

Evidence-Based Recommendations

For most soft tissue surgery, gravity drainage systems made of silicone or polyurethane offer equivalent drainage efficacy to active suction systems, with the advantages of less pain on removal, reduced tissue trauma, and lower occlusion rates 2, 3. Active suction drains remain appropriate when specific clinical indications exist (such as dead space obliteration in large cavities), but routine prophylactic use is not supported by evidence 7, 2.