Pre‐procedure

ActionRationale

1. 1.Show
   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. Another member of staff may be needed to reassure the patient during the procedure.
   To promote patient comfort (NMC [152], C).
3. 3.Show
   If applicable, release the vacuum on the drainage bottle by clamping the tubing coming from the patient; keep the clamp on the bottle open. Loosen the Luer‐Lok to allow air into the bottle. Reattach the Luer‐Lok and release the clamp coming from the patient. Leave for 2–3 minutes. Note the amount of drainage in the bottle.
   This releases the vacuum and prevents suction during the removal of the drain, which may cause tissue damage or pain (Walker [217], C).
4. 4.Show
   Clean the trolley/tray and gather the equipment, checking the sterility and expiry date of the equipment and solutions, and place everything on the bottom of the trolley.
   To minimize the risk of infection (Loveday et al. [110], E).
5. 5.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
6. 6.Show
   Wash and dry hands thoroughly and put on an apron.
   To minimize the risk of infection (NHS England and NHSI [137], C).

Procedure

1. 7.Show
   Remove the dressing pack from the outer pack and place it on the top of the clean dressing trolley/tray. Using aseptic technique, open the packaging of the other equipment required during the procedure (sterile gloves, vacuum bottle, 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. 8.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. 9.Show
   Wearing disposable gloves, remove the dressing covering the drain site and place it in a soiled dressing bag away from the sterile field.
   To minimize the risk of cross‐infection (Loveday et al. [110], R).
4. 10.Show
   Wash and dry hands thoroughly and put on apron and sterile gloves using aseptic technique.
   To minimize the risk of infection. Use of aseptic technique is essential when caring for and removing drains because micro‐organisms may pass through the drain to tissue and body cavities, which may result in infection and surgical complications (Fraise and Bradley [64], E; NHS England and NHSI [137], C; Walker [217], C).
5. 11.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). If the drain site appears inflamed or purulent, a swab should be obtained and sent for microbiology and sensitivity analysis.
   To assess the site for any signs and symptoms of infection and report findings to surgeons as needed (Knowlton [91], E).

   To recognize and treat suspected complications (Fraise and Bradley [64], E; Walker [217], C).
6. 12.Show
   The skin surrounding the drain site should only be cleansed (with 0.9% sodium chloride) if necessary – that is, if the drain site is purulent or to ensure the suture is visible and accessible.
   To reduce the risk of infection (Fraise and Bradley [64], E; Walker [217], C).
7. 13.Show
   Using a non‐touch technique, place the sterile field under the drain tubing and gently lift up the knot of the suture with sterile forceps. Use the stitch cutter to cut the shortest end of the suture as close to the skin as possible and remove the suture with the forceps.
   To allow space for the scissors or stitch cutter to be placed underneath. To minimize cross‐infection by allowing the suture to be liberated from the drain without drawing the exposed part through tissue (Pudner [168], E).
8. 14.Show
   Warn the patient of the pulling sensation they will experience and reassure them throughout.
   To promote comfort and co‐operation (Walker [217], C).
9. 15.Show
   Fold up a sterile gauze swab several times to create an absorbent pad (Hess [78]). Loosening up of the drain should be done if possible, especially for a drain that has been in for some time. For round drains, this can be done by gently rotating the drain to ‘break’ it free. For flat ones, gentle movement from side to side can achieve this.
   To minimize pain and reduce trauma. E

   Drains that have been left in for an extended period will sometimes be more difficult to remove due to tissue growing around the tubing (Walker [217], C).
10. 16.Show
    With gloved hand, place one finger on each side of the drain exit site, first stabilizing the skin around the drain with firm pressure. With the other hand, firmly grasp the drain as close to the skin as possible and gently remove it. Steady, gentle traction should be used to remove the drain rather than sudden, jerky movements. If there is resistance, place free gloved hand against the tissue to oppose the removal from the wound.
    A firm grasp of the shortest length minimizes patient discomfort. This is especially important for supple drains such as those made from silicone or rubber, which can stretch for some distance and then suddenly break free (Walker [217], C).
11. 17.Show
    Maintain gentle pressure over the site for a few seconds until the drainage and/or bleeding has stopped or is minimal.
    To prevent bleeding or leakage from the drain site. E
12. 18.Show
    The edge of the drain should be clean cut and not jagged. The drain should be inspected to ensure that it is intact. If there is any doubt that the drain is intact, the surgeon should be contacted to inspect the drain before disposal.
    This clean appearance ensures that the whole drain has been removed. E
13. 19.Show
    Cover the drain site securely with a sterile dressing and tape. A wound management bag may be placed over a mature exit site if fluid discharge remains high after drain removal.
    To prevent infection entering the drain site. E

    To prevent fluid collection or haematoma. A dressing may be necessary for 3–5 days to manage residual wound drainage (Knowlton [91], E).
14. 20.Show
    If the site is inflamed or there is a request for the tip of the drain to be sent to microbiology, cut the drain cleanly with sterile scissors and place the tip a sterile specimen container, maintaining asepsis.
    To recognize and treat suspected infection (Fraise and Bradley [64], E; Walker [217], C).
15. 21.Show
    Check the dressing/bag is secure and comfortable for the patient.
    To promote patient comfort. E

Post‐procedure

1. 22.Show
   Measure and record the contents of the drainage bottle in the appropriate documents.
   To maintain an accurate record of drainage from the wound and enable evaluation of the state of the wound (NMC [152], C).
2. 23.Show
   Dispose of all clinical equipment in clinical waste bag or sharps bin according to local trust guidelines.
   To safely dispose of used equipment. E
3. 24.Show
   Document in patient's notes that the drain has been removed, reporting complications to surgical colleagues.
   To ensure effective communication and instructions for ongoing care. To ensure accurate documentation (NMC [152], C).
4. 25.Show
   Observe the drain site dressing for signs of excess fluid discharge (soaked dressing). On routine dressing change, observe the site for signs of infection (inflammation, oedema, purulent exudate or pyrexia) and obtain a wound swab if appropriate. Report any unusual signs or complications and record them in the appropriate documentation.
   To recognize and treat potential complications (Fraise and Bradley [64], E; Walker [217], C). To ensure accurate documentation of any unusual signs or complications (NMC [152], C).