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PubMed2005

Comparison between flutter valve drainage bag and underwater seal device for pleural drainage after lung surgery.

AIM OF THE STUDY: The purpose of the present study was to compare the use of a conventional underwater seal device with suction and a flutter valve drainage bag for pleural drainage after lung surgery. PATIENTS AND METHODS: Altogether 59 patients undergoing elective lung surgery except pneumonectomy between February 2001 and April 2002 were prospectively randomized to receive postoperative pleural drainage by 28F chest tube(s) attached to underwater seal device placed on negative pressure of 15 cm of water or flutter valve drainage bag. Following withdrawal of four patients from the study, 55 patients were evaluated (31 patients in the underwater seal device group and 24 patients in the flutter valve drainage bag group). RESULTS: In the conventional underwater seal device group the mean drainage time was 2.6 (SD +/- 2.0) days and in the flutter valve drainage bag group the mean drainage time was 3.3 days (SD +/- 4.0); difference -0.8, 95% confidence interval (CI) -2.4 to 0.9. The mean length of hospitalization in the surgical ward was 3.6 (SD +/- 2.7) and 4.1 (SD +/- 4.4) days respectively (difference -0.5, 95% CI -2.5 to 1.4). CONCLUSIONS: The results of this study suggest that flutter valve drainage system is a safe and feasible alternative in managing postoperative air leaks and haemorrhage after lung surgery other than pneumonectomy if air leaks are not extremely massive.

Drainage↗
PubMed2001

Flutter valve drainage bag is a useful device for the pleural drainage.

BACKGROUND AND AIMS: The purpose of the present study was to compare the use of the flutter valve pleural drainage bag and the conventional underwater seal system for the pleural drainage in the treatment of pneumothorax and pleural effusion. PATIENTS AND METHODS: Altogether fifty patients who needed the pleural drainage at our hospital between February and October 1999 were randomized to this prospective study either into the flutter valve pleural drainage group or into the conventional underwater seal pleural drainage group, 25 patients in each. RESULTS: In the conventional underwater seal system group, the mean drainage time was 4.1 (SD +/- 4.0) days and in the flutter valve drainage bag group 4.8 (SD +/- 4.9) days (difference -0.7, 95% confidence interval (CI) -3.3 to 1.8). The mean length of hospitalization was 16.3 (SD +/- 20.9) days and 18.7 (SD +/- 27.0) respectively (difference -2.4, 95% CI -16.1 to 11.3). CONCLUSIONS: The results of this study suggest that flutter valve drainage bag is a safe and feasible system in the most cases when pleural drainage is needed in the treatment of pneumothorax and pleural effusion.

Aged↗
PubMed1989

[Gravity drainage versus suction drainage: an experimental and clinical study].

The importance of wound drainage in casualty and plastic surgery is unquestioned. The most common form is suction drainage. This involves the disadvantage that the drain can become attached to the tissue by suction, stopping the flow and blocking the drain. In addition, the secretion reservoir must be made of rigid material, which means large package sizes are inevitable. Encouraged by our knowledge of silicone drains, we carried out a study comparing silicone drains (without vacuum) and PVC drains (with vacuum suction). Electron-microscope studies of the PVC drains used for suction drainage revealed adhesion of wound secretion and cell detritus to the inner wall and the drainage perforations after less than 24 h. No occlusion and almost no adherence was observed with silicone gravity drains. When compared in clinical use for joint drainage, neither system had any severe complications. Removal of gravity drains was considerably less painful than withdrawal of suction drains. In soft tissue drainage the volume of secretion drained off was more constant and obviously larger with gravity drainage. From these results we conclude that gravity drainage can replace suction drainage to considerable advantage.

Clinical Trials as Topic↗
PubMed1991

[Slit drainage versus Redon drainage in a clinical comparison--initial experiences with a new kind of wound drainage system].

In a prospective, randomised study we compared the clinical properties of the established Redon drain with a new type of drain called "slit drain". Both types of drains were examined regarding the amount of drained fluid, the time elapsing until removal of the drain, the frequency of occlusion of the lumen as well as the patient's pain and the required force at extraction of the drain. The statistical analysis showed both drains to have equal abilities in draining of fluid if they were used under vacuum conditions. If used as nonsuction drains, the new device was able to drain more fluid than the established type of drain (p less than 0.05). Statistically relevant advantages of the slit drain were seen in a lower rate of obstruction of the lumen, a higher amount of drained fluid (as non-suction device) as well as an easier and less painful extraction.

Breast Neoplasms↗
PubMed2005

Wound drainage versus non-drainage for proximal femoral fractures. A prospective randomised study.

OBJECTIVES: The purpose of this prospective randomised study was to examine whether routine drainage in surgery for traumatic hip fractures is useful. BASIC PROCEDURES: At the end of surgery for hip fractures, 200 consecutive patients (51 men, 149 women) were randomised to receive suction drainage or not. The status of wound healing was evaluated, with specific reference to haematoma formation or wound infection. Indices of blood loss were the average blood loss during operation, a decrease in the haemoglobin level, fluid collected by the drain, and blood transfusion. MAIN FINDINGS: The severity of wound haematoma and the number of wound infections was not significantly different between the two groups. The average blood loss during operation was 172 ml in the drainage group and 179 ml in the non-drainage group. The volume of drainage fluid was 146 ml. The haemoglobin concentration decreased by 1.4 mg/dl in the drainage group and by 1.3 mg/dl in the non-drainage group (P = 0.83). During admission, 55 patients in the drainage group received 2.5 units of blood and 50 patients in the non-drainage group received 2.7 units. CONCLUSIONS: The severity of wound haematoma does not lead to statistically significant differences in wound infection rate. The routine use of suction drains may not prevent wound infections.

Aged↗
PubMed1984

Septic complications of percutaneous transhepatic biliary drainage. Evaluation of a new closed drainage system.

In a consecutive study of 49 patients with obstructive jaundice who underwent preoperative percutaneous transhepatic drainage, the incidence of bacteria in bile at the time of insertion of the drainage catheter was 29 percent. Patients drained with a conventional open drainage system showed an increase to 100 percent positive cultures after 20 days drainage. In this group, there was also a high incidence of episodes of bacteremia preoperatively and postoperatively and a high incidence of positive wound cultures. An antiseptic barrier incorporated into the drainage system reduced the incidence of positive bile cultures during the drainage period although this did not afford a significant reduction in bacteremic episodes and positive wound cultures. Using a new closed drainage system, the acquisition of environmental organisms to the bile was eliminated which allowed a significant reduction in septic complications both preoperatively and postoperatively. This new closed drainage system increased the value of preoperative decompression of the obstructed biliary tree by preventing exogenous bacterial contamination and reducing associated septic episodes.

Bacterial Infections↗
PubMed2001

External biliary drainage plus bile acid feeding is not equal to internal drainage in preserving the cellular immunity following prolonged obstructive jaundice.

This study investigates the importance of intestinal bile flow in cellular immunity. Sprague-Dawley rats undergoing bile duct ligation (BDL) and sham ceiliotomy (Sham) for 14 and 21 days were investigated. Experimental animals following BDL were further divided into an external drainage (ED) group, an ED group with rat chow mixed with 2:2:1 cholic acid, chenodeoxycholic acid, and deoxycholic acid (ED + BF), and an internal drainage (ID) group. Fourteen days later, they were killed and analyzed for spleen lymphocytic [3H] thymidine uptake (LHU) under mitogen stimulation with phytohemagglutinin, blood biochemistry, hemogram, and liver pathology. In the 14-day BDL experiment, LHU and serum albumin level were decreased in the BDL group (P < 0.05). After drainage, they were not significantly different among sham, ED, ED + BF, and ID groups. In the 21-day BDL experiment, the red cell volume was decreased (P < 0.05). After drainage, the ED, ED + BF, and ID groups still had a significantly lower LHU than the sham group (P < 0.05). However, the ID group had higher LHU than the ED and ED + BF groups (P < 0.05). The ED + BF group had a slightly higher LHU than the ED group but not statistically significant. Liver pathology returned to normal after drainage in the 14-day BDL model. In contrast, the 21-day BDL group had prominent periportal necrosis and developed periportal fibrosis after drainage. The present study reveals the duration of BDL determines the severity of hepatic damage. In the 14-day BDL groups, all kinds of drainage completely reverse the impaired liver function and cellular immunity. In the 21-day BDL group, 14-day drainage is inadequate for recovery because irreversible pathological changes are found. The reversal of cellular immunity in ID is better and faster, because it provides a better hepatic functional, nutritional, and hematological recovery besides the presence of primarily secreted bile acids.

Animals↗
PubMed2000

Simultaneous pancreas-kidney transplantation in the mycophenolate mofetil/tacrolimus era: evolution from induction therapy with bladder drainage to noninduction therapy with enteric drainage.

BACKGROUND: In the past, enteric drainage or the omission of induction immunotherapy has been shown to be predictive of suboptimal outcomes of simultaneous pancreas-kidney (SPK) transplantation. We have reassessed the need for bladder drainage and induction immunotherapy to optimize the outcome of SPK transplantation. METHODS: One hundred consecutive recipients of SPK transplants who received mycophenolate mofetil and tacrolimus immunosuppression were studied. The first 50 recipients had bladder-drained pancreas allografts and received induction immunotherapy. The results were compared with the next 50 recipients who had enteric-drained pancreas allografts, which included a subgroup (n = 17 patients) who were randomized to receive no induction immunotherapy. RESULTS: The 1-year actuarial patient, kidney, and pancreas survival rates in the bladder-drainage group were 98.0%, 94.0%, and 94.0%, respectively. The 1-year actuarial patient, kidney, and pancreas survival rates in the enteric-drainage group were 96.8%, 96.8%, and 89.4%, respectively. In the enteric-drainage group, the incidence of rejection at 1 year was 6.1% in recipients who received induction therapy versus 23.5% in recipients who did not receive induction therapy. The average number of readmissions per recipient was 1.8 in the bladder-drainage group versus 0.9 in the enteric-drainage group. CONCLUSIONS: Primary enteric drainage of the pancreas allograft in recipients of SPK transplantation is the preferred surgical technique in the tacrolimus/mycophenolate mofetil era.

Adult↗
PubMed1992

Percutaneous catheter drainage compared with internal drainage in the management of pancreatic pseudocyst.

The records of 92 patients with symptomatic pancreatic pseudocysts referred for surgical management over a 27-year period were retrospectively reviewed to compare outcome in 42 patients managed with operative internal drainage procedures (group I) with that in 52 patients managed with computed tomography-directed percutaneous catheter drainage (PCD) (group II). The two groups were similar for patient age, sex, pseudocyst location, and cause. The frequency of antecedent pseudocyst-associated complications was less in group I (16.7 versus 38.5%, p less than 0.05). Seven group I patients and four group II patients had major complications (16.7 versus 7.7%, not significant). Group II mean duration of catheter drainage was 42.1 days, and the drain track infection rate was 48.1%. The frequency of antecedent operative cyst drainage was similar (14.2 versus 13.5%), as was the frequency of subsequent operations for complications related to chronic pancreatitis (9.5 versus 19.2%, not significant). Mortality rate was greater in group I (7.1% versus 0%, p less than 0.05). Pseudocysts can be effectively managed either by open operation with internal drainage or by PCD. Drawbacks of PCD include the controlled external pancreatic fistula and the risk of drain track infection. Percutaneous catheter drainage has the following advantages: (1) low mortality rate, (2) does not require a major operation, (3) does not violate the operative field in cases when subsequent retrograde duct drainage procedures are required. Neither PCD nor internal drainage is definitive, and with either technique subsequent correction of underlying pancreatic pathology may be necessary.

Adult↗
PubMed1997

Estimation of the minimum pump speed to prevent regurgitation in the continuous flow left ventricular assist device: left ventricular drainage versus left atrial drainage.

Due to the fact that centrifugal and axial pumps do not require valves, there is a possibility of back flow when the pump speed is low. To estimate the minimum required pump speed to prevent this regurgitation, an in vitro simulation test was conducted. A pulsatile pump simulated the natural heart while a centrifugal pump simulated the continuous flow left ventricular assist device (LVAD). The LVAD flow was attained from the left atrial (LA) drainage or left ventricular (LV) drainage. The minimum or regurgitate flow was observed in the systolic phase with LA drainage and in the diastolic phase with LV drainage. LV drainage always provided higher flow than LA drainage at the same pump speed. These differences are due to the various total pressure heads of the LVAD. To prevent the regurgitation, the LVAD should maintain a certain pump speed which can create positive flow against the aortic systolic pressure with LA drainage and against the aortic diastolic pressure with LV drainage. These required pump speeds can be identified by the LVAD flow-pressure curve.

Aortic Valve Insufficiency↗
PubMedDate not supplied

Conversion from external nasobiliary drainage to internal drainage using endoscopically available scissor forceps.

Endoscopic nasobiliary drainage may cause undue stress, such as pharyngeal discomfort. We converted external drainage to internal drainage by cutting the external drainage tube with endoscopically available scissor forceps. Endoscopic nasobiliary drainage tubes were cut in the vicinity of the papilla using scissor forceps in 4 patients. The drainage tube was successfully cut in all patients. The tube was left for short-term internal drainage in 3 patients until the operation or endoscopic treatment was performed. The remaining patient with pancreatic head cancer was followed as an outpatient and the tube stent was occluded 62 days after cutting. Although further studies using a larger number of patients are needed, our procedure is thought to be beneficial to patients undergoing endoscopic nasobiliary drainage.

Aged↗
PubMed1979

[Clinical use and comparative study of Ulmer drainage and of the usual Redon tissue drainage].

After discussing the shortcomings of the usual Redon drainages and the description of our own technique of vacuum-tissue suction drainage, there follows a report about a comparative examination between Redon drainages and the new 'Ulmer drainage'. Up to now the superiority of the Ulmer drainage was proven only by calculation and experiment, now this fact can be fully confirmed by a succession of clinical examinations. By inserting both types of drainages in one surgical wound, the Ulmer drainage delivered on the first day 1.5 times; on the second and third day, almost 2.5 times the amount of secretion compared with the usual Redon drainage.

Clinical Trials as Topic↗
PubMed2006

Jejunal loop drainage versus direct pancreatic duct drainage after pancreatic head resection.

PURPOSE: Perioperative mortality after pancreatic head resection has fallen to below 5% in high-volume centers, but dehiscence of the pancreatojejunostomy remains a major concern. Despite various methods of protection, insufficiency rates still range from 6% to 19%. External drainage of pancreatic juice from the anastomotic site has shown promising results in the last decade. We compared the morbidity and mortality of two widely used drainage systems. METHODS: The subjects were 143 patients who underwent pancreatic head resection, followed by jejunal loop drainage with the top of the drain being placed between the pancreatojejunostomy and hepaticojejunostomy in 89, and by direct drainage of the pancreatic duct in 54. RESULTS: The median age was similar in both groups. Pancreatic fistula developed in 3 (5%) patients with a pancreatic drain and 6 (7%) with a loop drain. Breakdown of the pancreatojejunostomy occurred in 1 (2%) patient with a pancreatic drain and 2 (2%) with a loop drain. The overall perioperative mortality was 0.7%. The surgical and medical complications and postoperative course were similar in the two groups. CONCLUSION: The choice of drainage system did not impact on the number or severity of postoperative complications or survival, indicating that loop drainage is as safe and effective as direct pancreatic duct drainage.

Adult↗
PubMed1995

Chest physiotherapy in cystic fibrosis: a comparative study of autogenic drainage and the active cycle of breathing techniques with postural drainage.

BACKGROUND--Autogenic drainage has been suggested as an alternative method of chest physiotherapy in patients with cystic fibrosis. In this study autogenic drainage was compared with the active cycle of breathing techniques (ACBT) together with postural drainage. METHODS--Eighteen patients with cystic fibrosis took part in a randomised two-day crossover trial. There were two sessions of one method of physiotherapy on each day, either autogenic drainage or ACBT. The study days were one week apart. On each day the patients were monitored for six hours. Mucus movement was quantified by a radioaerosol technique. Airway clearance was studied qualitatively using xenon-133 scintigraphic studies at the start and end of each day. Expectorated sputum was collected during and for one hour after each session of physiotherapy. Pulmonary functions tests were performed before and after each session. Oxygen saturation (SaO2) and heart rate were measured before, during, and after each session. RESULTS--Autogenic drainage cleared mucus from the lungs faster than ACBT over the whole day. Both methods improved ventilation, as assessed by the xenon-133 ventilation studies. No overall differences were found in the pulmonary function test results, but more patients had an improved forced expiratory flow from 25% to 75% with autogenic drainage, while more showed an improved forced vital capacity with ACBT. No differences were found in sputum weight and heart rate, nor in mean SaO2 over the series, but four patients desaturated during ACBT. CONCLUSIONS--Autogenic drainage was found to be as good as ACBT at clearing mucus in patients with cystic fibrosis and is therefore an effective method of home physiotherapy. Patients with cystic fibrosis should be assessed as to which method suits them best.

Adolescent↗
PubMed2005

The utility of a drainage needle for percutaneous abscess drainage.

OBJECTIVE: In this article, I describe a percutaneous drainage needle that consists of six side holes in its cannula. The needle is specially designed for effective evacuation of complex abscess collections consisting of internal solid components, including floating debris, that tend to block the needle aperture during aspiration. The characteristic features of the needle and its performance in both in vitro and in vivo environments are described. MATERIALS AND METHODS: An in vitro experiment was performed with the use of a model of a fluid collection containing floating sheets of gelatin sponge to mimic a complex body collection consisting of floating fibrinous strands. Five radiologists were asked to perform aspiration from two collections of normal saline and 5% methylcellulose of two different volumes using an ordinary aspiration needle and the drainage needle. The needle was evaluated in a prospective in vivo study of 30 postoperative abdominal collections in 29 consecutive patients that were drained by a single radiologist. Complete evacuation was attempted initially with a conventional aspiration needle. When there was sonographic evidence of residual fluid collection, a repeat aspiration using a drainage needle was performed during the same session. RESULTS: In the in vitro experiment, the median percentage of fluid aspirated with the conventional needle from the 10- and 15-mL collections of saline was 10% and 15% and from the 10 mL and 15 mL of methylcellulose solution was 20% and 26.67%, respectively, whereas the drainage needle was able to remove 100% of fluid in all attempts. In the in vivo study, the conventional needle was able to remove all drainable fluid from the 12 simple collections. For the 18 complex collections, the drainage needle was always able to remove some residual fluid from the collection after aspiration with the conventional needle. The median percentage of fluid volume aspirated with the conventional needle was 55.6%, whereas that aspirated with both the conventional and drainage needles was 95.5%, with a significant difference by Wilcoxon's signed rank test (p < 0.001). CONCLUSION: This drainage needle was effective in evacuating fluid from complex abdominal collections that could not be drained with conventional end-hole needles.

Abdominal Abscess↗
PubMed2000

Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage.

OBJECT: This study was conducted to determine the best position for the subdural drainage catheter to achieve a low recurrence rate after burr-hole irrigation and closed-system drainage of chronic subdural hematoma (CSDH). METHODS: The authors studied 63 patients with CSDH in whom the drainage catheter tip was randomly placed and precisely determined on postoperative computerized tomography (CT) scans and 104 patients with CSDH in whom CT scans were obtained 7 days postsurgery. The location of the subdural drainage catheter, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were determined and compared with the postoperative recurrence and reoperation rates. Patients with parietal or occipital drainage had a higher rate of CSDH recurrence and much more subdural air than those with frontal drainage. In addition, patients with residual subdural air demonstrated on CT scans obtained 7 days postsurgery also had a higher recurrence rate than those without subdural air collections. Furthermore, patients with a subdural space wider than 10 mm on CT scans obtained 7 days postsurgery had a higher recurrence rate than those with a space measuring 10 mm or less. CONCLUSIONS: The incidence of postoperative fluid reaccumulation seems to be reduced by placing the tip of the drainage catheter in the frontal convexity and by removing subdural air during or after surgery.

Adult↗
PubMed1981

Short-term thoracic duct drainage in drug resistant immunologically mediated glomerulonephritis. Evaluation of lymph and blood lymphocyte characteristics during drainage.

Thoracic duct drainage has so far been employed in clinical nephrology mainly in renal transplantation and in immunologically mediated glomerulonephritis. The effectiveness of duct drainage in producing immunosuppression has been widely demonstrated, and several authors have used long-term, and others short-term drainage. 12 patients suffering from drug resistant immunologically mediated glomerulonephritis were treated with short-term (mean 10 days) thoracic duct drainage. In order to define the time, type and evolution of changes in immunological status, humoral and cellular immunity were studied daily in all patients. Marked changes (mainly in the number of lymphocytes drained and in their nucleic acid content and E-rosette forming capacity) take place in the first (4-5) days of drainage. These findings, together with positive clinical and laboratory results obtained in our patients, suggest that satisfactory immunosuppression may be achieved by short-term drainage, which is simpler and safer than long-term drainage. The procedure might thus be extended to a wider number of immunological diseases where drug therapy fails to take effect.

Adolescent↗