Pre‐procedure

ActionRationale

1. 1.Show
   Check the medical notes to identify which drain is to be removed. Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [152], C; Walker [217], C).
2. 2.Show
   Check patient comfort, for example position and pain level. Offer the patient analgesia as described on their chart or encourage self‐administration via a patient‐controlled analgesia pump (if applicable) and allow appropriate time for the medication to take effect.
   To promote patient comfort (NMC [152], C).
3. 3.Show
   Clean the trolley/tray per local trust guidelines and gather the equipment, checking the sterility and expiry date of equipment and solutions, and place everything on the bottom of the trolley.
   To minimize the risk of infection (Loveday et al. [110], R).
4. 4.Show
   Take the trolley/tray to the bed and adjust the bed to the correct height to avoid stooping.
   To promote good manual handling. E
5. 5.Show
   Wash and dry hands thoroughly and put on a fresh an apron.
   To minimize the risk of infection (NHS England and NHSI [137], C).

Procedure

1. 6.Show
   Remove the dressing pack from the outer pack and place it on top of the clean dressing trolley/tray. Using aseptic technique, open the packaging of the other equipment required during the procedure (sterile gloves, dressing, etc.) and place the contents onto the sterile field of the opened dressing pack.
   To minimize the risk of infection (Loveday et al. [110], R).
2. 7.Show
   Expose the drain site, adjusting the patient's clothes to expose the wound, taking care to maintain their dignity.
   To minimize the amount of skin exposed; to maintain dignity. E
3. 8.Show
   Wearing disposable gloves, remove the dressing covering the drain site and place it in a soiled dressing bag away from the sterile field.

   1. Closed drains may have a small sterile gauze dressing surrounding the exit site.
   2. Open drains will be covered with either a wound drainage bag (if copious exudate) or a small, absorbent, non‐adhesive sterile gauze dressing (if only minimal exudate). Once the drainage bag/dressing has been removed from an open drain, the volume and character of exudate should be measured and recorded. If requested by the surgical team, gauze dressings can be weighed once saturated to ascertain the volume of drainage.
   To minimize the risk of infection (Loveday et al. [110], R).
4. 9.Show
   Observe the drain to ensure the skin suture holding the drain in position is intact.
   To ensure the drain is well secured and not withdrawn or retracted. Dislodgement can increase the risk of infection, erosion into adjacent structures (e.g. blood vessels or organs) and irritation to surrounding skin. E
5. 10.Show
   Observe the skin surrounding the drain site for signs of excoriation, fluid collection or infection (inflammation of wound margins, pain, oedema, purulent exudate or pyrexia). Note: swabs of wound and drain sites should only be taken if infection is suspected.
   To recognize and treat suspected complications (Fraise and Bradley [64], E; Walker [217], E).
6. 11.Show
   Using aseptic technique, clean the surrounding skin with an appropriate sterile solution, such as 0.9% sodium chloride.
   To minimize the risk of infection (Loveday et al. [110], R; Wilkins and Unverdorben [230], E).
7. 12.Show
   If appropriate, cover the drain site as follows.

   1. Closed drains should only be covered with a non‐adherent, absorbent dressing if there is exudate or to promote patient comfort.
   2. Open drains should be covered with a wound drainage bag (if exudate copious) or a small, absorbent, non‐adhesive sterile gauze dressing (if only minimal exudate).
   To allow effluent to drain, prevent excoriation of the skin, promote patient comfort and contain any odour. E

Post‐procedure

1. 13.Show
   If applicable, tape the dressing securely. If the drain is attached to a drainage bag or bottle, it should also be secured at one other point (e.g. with adhesive tape).
   To prevent the drain coming loose. E
2. 14.Show
   If the drain is attached to a drainage bag or bottle, this should not be placed on the floor but placed below the level of the wound to allow drainage. If the drain is attached to a suction drain, ensure this is working correctly.
   To ensure continuity of drainage. Ineffective drainage can result in oedema or haematoma. To minimize the risk of cross‐infection (Hess [78], E).
3. 15.Show
   Check dressing/bag is secure and comfortable for the patient.
   For patient comfort. E
4. 16.Show
   Dispose of all clinical equipment in the clinical waste bag or sharps bin according to local trust guidelines.
   To ensure safe disposal. E
5. 17.Show
   Document in the patient's notes that the dressing has been changed, and report any unusual signs or complications to surgical colleagues (NMC [152]). If the volume of exudate on the dressing has been measured, this should be documented on the fluid balance chart.
   To ensure effective communication and instructions for ongoing care. For accurate documentation of drainage (NMC [152], C).