M. D.
Anderson Cancer Center
Date: January 2010
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Narrator:
Depending on the type of surgery you have had, you may have one or more incisions. After some surgeries, blood and normal body fluids may collect in the surgical site, which is also called the wound. These fluids can build up at the site and slow the healing process. They may also interfere with your daily activities and cause you discomfort. For these reasons, the surgeon may insert a flexible tube called a wound catheter in the surgical site during the surgery. The wound catheter allows fluid from the surgical site to drain into a reservoir that can be emptied on a daily basis for as long as the catheter is in place.
Your wound drainage system consists of the drain tubing, also called the catheter, and a bulb, also called a reservoir. The catheter is placed inside the wound by the surgeon and is secured to the skin outside the wound with a suture or stitch. The other end of the catheter is connected to a reservoir which also serves as a suction device that helps draw the fluid from the wound into the reservoir where it can be emptied.
Depending on the type of surgery you have had, you may have one or more wound catheters in place. There is risk for infection at the main incision site or at the wound catheter site as it enters the skin. To avoid infection and help the healing process, it is important that you and your care partner know the proper method for cleaning and caring for your incision and wound catheter site. You will need to be aware of potential problems with the wound catheter and warning signs of infection. It is important that you know whom to call if problems arise. As you watch this video, you may want to write down important information for future reference.
Your incision may be closed with sutures that dissolve on their own or sutures that need to be removed at a later time. In addition, there may be Steri-Strips over the incision. Right after surgery, it is usual to have a slight amount of puffiness around each suture or staple and the area around the wound catheter insertion site. You may feel some tenderness in the area. It's also normal right after surgery to have some oozing of clear yellowish fluid with a small amount of blood from the incision and around the wound catheter insertion site.
You will notice that the fluid in the reservoir coming from your surgical site right after surgery will be red. This is normal because the fluid contains some blood and blood cells. The fluid that is draining will become less red over time and usually becomes clear yellow with occasional small blood clots or fibrous tissue that is a normal part of the healing process. Call your care center and let your nurse know right away if the fluid becomes more red or bloody or if it is whitish or milky in color over time or if you measure more than 250 cc of fluid within a 24-hour period.
You will be given everything you need to care for the incision and wound catheter insertion site before you are discharged. The supplies include tape and 4 x 4 gauze pads. If you run out of supplies you can buy more supplies such as gauze pads at any drugstore. It is helpful for you to have a friend or family member as a care partner to help you care for the incision.
The following instructions are directed to you or your care partner, whoever is responsible for wound care. You can begin showering 48 hours after surgery even with the wound catheter in place but should remove the dressing over the catheter insertion site and reapply it each time you shower. If you're unable to shower, the site should be cleaned with soap and water at least once a day. Always be sure that you and your care partner wash your hands first and then remove the dressing that is over the wound catheter. Wash the drain site with a clean wash cloth and soap and water. You will need to change the dressing and clean your wound catheter insertion site once a day.
If the dressing becomes soiled or saturated with body fluids, you may need to change it more often. You or your care partner must inspect the incision and wound catheter insertion site once a day and make note of any changes in color of the incision or drainage, or swelling at the incision site or around the wound catheter insertion site. Lay out and open the supplies in a clean dry area. Look for signs of infection around the incision or wound catheter insertion site. Typical signs of infection may include redness, swelling, drainage with pus, opening of the incision, bad odor, pain and/or fever with a temperature above 101.5 degrees Fahrenheit. If you have any of these signs of infection, call the care center and let your nurse know.
There are two 4 x 4 gauze pads in each gauze package. Start by folding one gauze pad in half. With the folded edge up, place the gauze pad under the wound catheter. If you have two catheters place the pad under both. Fold another pad in half. With the folded edge down place it over the catheter and tape in place. The dressing should be replaced every time you clean the insertion site or if the dressing falls off or becomes soiled.
Depending on the type of surgery you've had, you may be taught how to perform a procedure called “stripping” of your wound catheter. This is done twice a day before emptying the reservoir to prevent the wound catheter from becoming clogged with blood clots or fibrous material that develop as part of the healing process. Check with your doctor or nurse to find out if you should strip your wound catheter. To strip the catheter, take an alcohol prep pad and hold it between your thumb and forefinger as you pinch the catheter. The alcohol pad helps your finger slide more easily against the tube. With your other hand, hold the catheter near the insertion site to avoid dislodging it. Starting closest to the area where the catheter enters the skin begin to gently move the alcohol pad down the entire length of the catheter. The fluid should move down the catheter as you move the alcohol pad. Repeat this procedure for each catheter that you have. It is not necessary to clear all the fluid from the catheter, but try to move as many clots down the catheter into the collection reservoir as you can.
If the flow of drainage is blocked and stripping does not restore the flow, call the clinic and let your nurse know this. Empty the reservoir into the measuring container twice a day unless your doctor or nurse asks you to do so more often. Your nurse will give you a measuring container to collect and measure the drainage. Do not let the reservoir completely fill because this will stop the drainage from flowing into the reservoir. If the drainage stops, contact your nurse. Do not disconnect the tubing from the reservoir at any time.
To empty the reservoir, unplug the drainage plug from the emptying port, hold the reservoir upside down over the measuring container and squeeze reservoir to empty the collected fluid. On the volume of drainage chart that your nurse or doctor gave you, record the date, time and amount of fluid collected. Also each evening take your body temperature and record it on the chart. Your nurse will ask to see this record sheet when you come in for your follow up visit.
You will need to reactivate the reservoir after you empty it. Squeeze the reservoir to compress it as completely as possible. With the reservoir compressed, insert the drainage plug into the emptying port as far as possible and release the reservoir. Reservoir should expand gradually over time as it fills with fluid. If the reservoir does not expand gradually and collect fluid contact your nurse. Flush the collected fluid down the toilet and clean the measuring container with soap and water so it is ready for the next collection. Wash your hands before and after handling the reservoir. Using the plastic strap attach the reservoir to your clothing as directed. You must place the reservoir below the skin insertion site to maintain adequate drainage. Do not disconnect, kink, or puncture the catheter tubing that is connected to the reservoir. If the catheter tubing is disconnected or damaged, contact your nurse.
The length of time that your wound catheter remains in place depends on the amount of fluid coming from the surgical site. Once you measure less than 30 cc of drainage over a 24-hour period for two days in a row, your wound catheter is ready to be removed. Call the clinic so your nurse can schedule your appointment for your catheter to be removed. The drains will usually be removed within three weeks of the surgery regardless of drainage output, however, your doctor may recommend removal at a different time.
After the wound catheter is removed, keep the area clean with soap and water and continue to place a dressing over the insertion site until there is no drainage or discharge coming from the site. You are responsible for your incision and wound catheter site care once you go home after surgery. It is important that you be able to recognize any unusual changes with your incision, the wound catheter, and the catheter insertion site.
To help your home care go as smoothly as possible, take and record your temperature once a day and call the care center and let your nurse know if any of the following things occur: The reservoir cannot be activated, the drain falls out or is accidentally cut, the drainage fluid in the reservoir becomes foul smelling, you have fever of 101.5 degrees or greater, there is any increased redness, swelling, or abnormal drainage from the wound catheter insertion site, there is an air leak, fluid leak or any other malfunction in the system, clots form in the tubing and blocked drainage, the reservoir is not collecting fluid, if you measure more than 250 cc of drainage in 24 hours, if the amount of drainage is less than 30 cc in a 24-hour period for two days in a row, if the wound catheter is no longer secured to your skin with a suture.
You will be given all of the supplies and information to properly care for your incision, wound catheter, and wound catheter insertion site. It is very important that you carefully follow these instructions for your incision and wound catheter site care. You may find it helpful to write down your questions and concerns. Do not hesitate to call the clinic to speak with your nurse for help and answers or if you experience any of the problems mentioned in this program.
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© 2010
The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd,
Houston, TX 77030
1-800-392-1611 (USA) / 1-713-792-6161