Should the skin around a postoperative gallbladder drain tube be cleaned with povidone‑iodine or sterile normal saline?

Drain Tube Site Care: Use Sterile Normal Saline, Not Iodine

For routine cleaning around a postoperative gallbladder drain tube, use sterile normal saline rather than povidone-iodine solution. 1

Rationale for Saline Over Iodine

The evidence strongly supports sterile normal saline for wound and drain site cleaning in the postoperative setting:

• Wounds should be cleansed with sterile normal saline with no need for iodine- or antibiotic-containing solutions for routine care 1
• Saline irrigation is sufficient for removing superficial debris and maintaining cleanliness around drain sites without the potential tissue irritation associated with repeated antiseptic exposure 1

When Iodine-Based Solutions Are Appropriate

Povidone-iodine has a specific role in preoperative skin preparation only, not for ongoing drain site maintenance:

• Chlorhexidine-alcohol 2% is superior to povidone-iodine for preoperative skin antisepsis before surgical incisions, demonstrating lower surgical site infection rates 1
• If chlorhexidine is contraindicated or unavailable, povidone-iodine can serve as an alternative for preoperative preparation 1, 2
• Povidone-iodine solutions have demonstrated effectiveness when used for bladder irrigation in specific surgical contexts, but this does not translate to routine drain site care 1

Practical Drain Site Care Protocol

For daily maintenance of gallbladder drain sites:

• Clean the skin around the drain tube with sterile normal saline using sterile gauze 1
• Change dressings when they become damp, loosened, or visibly soiled 1
• Use sterile gauze dressings if the site is bleeding or oozing; otherwise sterile transparent semi-permeable dressings are acceptable 1
• Do not apply topical antibiotic ointments or creams to the drain insertion site, as these may promote fungal infections and antimicrobial resistance 1

Common Pitfalls to Avoid

• Avoid using detergent-containing antiseptic preparations (such as povidone-iodine surgical scrubs) for wound care, as the detergent component can cause tissue damage and delay healing 1
• Do not confuse preoperative skin preparation protocols with postoperative drain maintenance—these require different approaches 1
• Repeated application of antiseptics like povidone-iodine to healing tissue is unnecessary and potentially harmful to wound healing 1, 3

Special Circumstances

If signs of infection develop around the drain site (increased redness, purulent drainage, warmth):

• Continue cleaning with sterile saline 1
• Notify the surgical team for evaluation and potential culture 1
• Antimicrobial therapy decisions should be based on clinical assessment and culture results, not routine prophylaxis 1