Help with p/p on removal of JP drains.

[bogworks]

Our doc's in our small rural hospital are asking our nurses to DC Jackson Pratt and Hemovac drains. We need to create a policy and procedure for this. Do any of you already do this and would you be willing to share your p/p so we don't have to recreate the wheel?

[LouisianaNurse2006]

New nurse here, so I'm not much help, but I have d/c's the JP drain already. I would think the manufacturer would have good info for a protocol regarding removal. If you come up with something, it would be nice of you to post it here, so we all know if we are doing it correctly.

THANKS.

[meownsmile, BSN, RN]

I dont know what p/p you would need. The doctor writes the order. I would think its a matter of staff being familiar with the equipment and that can be done in the form of inservice. There is really no major p/p changes that need to be done. Only 2 things that are of importance,, 1- make sure suction is removed prior to pulling and 2- make sure any sutures holding the JP drain is removed prior to pulling. The hemovac's usually arent even stitched in.

OH and making sure the drain is intact when it is out. But then i would think they wouldnt be forcing a removal and would call the doctor if there were difficulty removing a drain.

[fetch33]

When I was a new nurse, 20 years ago, I watched another nurse removed a hemovac... and had blood slung clear across my uniform as she yanked it out! Since then, I've always held 4X4's over the drain site while I pulled, AND use a chux or towel thrown over the area as I pull, because sometimes there is some leakage. Weird story, we had patient that the nurse was unable to removed the hemovac. The patient ended up having to go back to surgery to get the hemovac removed.... seems the doc unknowingly stitched right through one of the drain holes, thus suturing the drain into the incision!

[jmgrn65, RN]

To write policy and procedure you need or should have evidence based practice to back it up, you will need to do research. There are many nursing research search engine, even just google it. Look it up nursing med-surg text. etc. Any p/p that is written has to have references. Good Luck

[P_RN, ADN, RN]

I GOOGLED "how to remove a drain from a wound" and came up with 959,000 sites.

Unfortunately most were from malpractice attorneys and legal crud. A P/P is very necessary.

[Lola and Me]

A JP drain is usually held secure with a suture or two. once these are removed just a tug and then pressure. If you can find the post operative charting in the chart and read the details on the drain ( length, how it was placed, secured etc?) then you can chart against that.

[truern]

Pull that danged thing FAST!! I had two in place after abdominal surgery and it stung like heck getting them pulled. Don't think you're doing your patients a favor pulling them out nice and slow

[KK92RN]

any nursing procedure book should have how to do it step by step and you really don't need a policy on a procedure unless its required by some certifying agency and i don[t believe that is.

[P_RN, ADN, RN]

I came back across this thread just now.

Look at this site from the UK. It's a free e-book

http://esechealth.com/drains/online.asp

and one of the sections deals with Wounds/drains/removing. It's called Drowning in Drainage. Down at the bottom of the list is "removing them."

[amandarez]

We have pre-printed order sheets for the post op joints and spinal surgeries that also list drain orders. The MD just checks them off.

If drains put out more than 240 cc (this is off hand and might be a bit higher) in one 8 hour period, uncharge them for 8 hours.

If drains put out less than 30cc, then pull on POD 1; otherwise all drains are to be removed on POD 2.

JP drains are usually stitched in. Hemovacs usually aren't (some of our md's do stitch in hemovacs for hips). UNCHARGE before you pull it.

[BBFRN, BSN, PhD]

A word about sutures: Some of our docs place purse-string sutures to their JP sites. If there are purse-string sutures, you don't remove them, because you're going to pull them together and tie them for site closure after the tube is pulled.

I would also suggest that if the docs want you guys to pull their drains, that they initially inservice you on it. Then you can inservice and check off any new people after you.