“Drains? We ain’t got no drains. We don’t need no drains! I don’t have to show you any stinking drains.”

Gold Hat probably didn’t say it quite like that, but it fits. (don't ask me who Gold Hat is, please)

No more Drains, hooray!

It was a good day in many respects – Tracy had her drains pulled (literally) today.  Many tears (Tracy’s) however as - holy smokes – they were a lot longer than I remembered.  For a minute or two I thought Susan was going to pull Tracy’s toes out through the sides of her chest wall.  Did you ever see Braveheart?  If you have, you sort of get the idea. Freedom! 

I know we talked about these medieval things last year, and again a week or so ago, but here’s the drill:

Jackson-Pratt Drain Care 101.

Perform the following b.i.d. (Morning / Evening)  (that's "twice a day" for you non-med types)

1.       Place biohazard disposal bag next to drainer's chair (i.e. a Shaw’s plastic bag from the recycling bin), opposite from the drainee.

2.   Wash hands

3.   Ask patient to stop fidgeting.

4.       Lay out a (sterile?) field (two layers unused paper towels)

5.       Place out on the field:

a. Measuring cup (really)

b. Sterile extra-long cotton tipped swabs (two sets)

c. Sterile gauze 4x4’s (two sets)

d. Sterile gauze 2x2’s (two sets

e. Sterile bulk poofy gauze batts (2 sets)

f. Dixie cup w/hydrogen peroxide

g. Bacitracin

6.       Sneeze (then start over at step 1, however, may skip step 2).      

7.       Ask patient to stop fidgeting. Again.

8.       Release the corset / binder, retaining full control at all times so as to avoid getting an eye poked out on the backlash if you inadvertently let go of one side

9.       Unzip the front-loader, paying special attention to the zipper and any gauze attached to the drain koozie Velcro.

a. DO NOT EVER: (even if unintentional)

                                              i.   Snap bra straps (not even to be funny – because – it isn’t. Oops)

                                             ii.   Tug at stuck gauze (it's stuck to something FOR A REASON)

                                            iii.   Forget to support drain koozies after unzipping (they are heavy and are attached to plastic lines which are attached to the patient with thread needled through her skin)

                                           iv.   Pluck at *anything* which looks like a loose thread, because it isn’t loose)

10.     Perform fully for each side in order:

a. Inspect the drain through-hulls for any redness, swelling, oozing, or anything else which does not look “normal”

b. Remove Jackson-Pratt grenade from its respective koozie

c. While maintaining *light* pressure on the bulb, remove the drain plug

d. Empty the exudate (see lesson plan for Thursday, August 26, 2010) into the measuring cup and note the amount in CCs.

e. Swab the area with hydrogen peroxide soaked swab paying particular attention to the drain line retaining sutures. (see step #9.a.iv)

f. Discard swab#1

g. Daub off any remaining hydrogen peroxide with a sterile 2x2 (again, with 9.a.iv in mind)

h. Load up second swab w/Bacitracin

i. Swab area around through-hull thoroughly, paying really special attention now to 9.a.iv.

j. Discard swab#2

k. Take two 4x4s, double them over on each other, placing one under the drain line adjacent to the through-hull, and the other doubled-over 4x4 on top forming a 4x4 sandwich (yes, it takes two hands)

l. While holding them in place, position one poofy gauze batt up against the doubled over 4x4s

m. Carefully, bring around one half of the front-loader to hold gauze in place, watching for any kinked / trapped drain lines

11.     Zip up front loader

12.     Stretch (a lot – to the point of wincing) the corset around the patient and wrap everything back up the way you found it (see #8)

13.     Wrap up biohazard bag and dispose of properly (toss in trash)

14.     Return unused supplies to the cabinet

15.     Empty exudate into the sanitary receptacle (toilet) as it stains man-made solid surface sink material.  Oops.

16.     Rinse (Empty) measuring cup w/Hydrogen Peroxide, dry, and return with other supplies

Special Note:

DO NOT mix the exudate directly with the left over hydrogen peroxide from the Dixie Cup. If you do, you end up with what can only be best described as a hand-held Exudate Volcano.  It is red, foamy, and unstoppable. Trust me on this one. Oh – and it stings.

17.     Hand patient a tissue

18.     Log exudate numbers into Excel, and plot a new progress chart (actual chart below)

This is a drain koozie.  There are two of them, one on each side.