Pre‐procedure

ActionRationale

1. 1.Show
   Check the medical notes to identify which drain is to be shortened. 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).
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
   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], 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 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 the 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.
   To minimize the risk of cross‐infection (Loveday et al. [110], R).
4. 9.Show
   Wash and dry hands thoroughly and put on a fresh apron and sterile gloves using aseptic technique.
   To minimize the risk of infection (NHS England and NHSI [137], C). Use of an 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 (Walker [217], 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). If the drain site appears inflamed or purulent, a swab should be obtained and sent for microbiology and sensitivity analysis.
   To recognize and treat suspected complications (NICE [150], E).
6. 11.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 (Loveday et al. [110], R).
7. 12.Show
   Using a non‐touch technique, place the sterile field under the drain tubing. If the drain is sutured in place, gently lift up the knot of the suture with sterile forceps (Action figure 12). 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. 13.Show
   Warn the patient of the pulling sensation they will experience and reassure them throughout.
   To promote comfort and co‐operation (Walker [217], E).
9. 14.Show
   With a 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, grasp the drain firmly as close to the skin as possible and gently ease the drain out of the wound to the length requested by the surgeon. Steady, gentle traction should be used to ease the drain out 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], E).

   To allow healing to take place from the base of the wound. E
10. 15.Show
    Using gloved hand, place a sterile safety pin through the drain as close to the skin as possible, taking great care not to stab either yourself or the patient (Action figure 15). Sterile tape should be used to secure the drain to the skin.
    To prevent retraction of the drain into the wound and minimize the risk of cross‐infection and sharps injury. E

    The tape is used as an additional measure to prevent the drain from falling out. E
11. 16.Show
    Cover the drain site with a suitably sized sterile gauze dressing (taped securely) or a wound drainage bag (depending upon volume of exudate).
    To prevent infection entering the drain site. E

    To prevent fluid collection or haematoma. E
12. 17.Show
    Check dressing/bag is secure and comfortable for the patient.
    To promote patient comfort. E

Post‐procedure

1. 18.Show
   Dispose of all clinical equipment in the clinical waste bag or sharps bin according to local trust guidelines.
   To safely dispose of used equipment. E
2. 19.Show
   Document in the patient's notes that the drain has been withdrawn, clearly stating:

   • length of drain withdrawn (in centimetres)
   • length of drain left visible from wound exit site to end of drain (in centimetres)
   • any complications during the procedure.

   Report complications to surgical colleagues.
   To ensure effective communication and instructions for ongoing care (NMC [152], C).
3. 20.Show
   Observe the drain site dressing for signs of excess fluid discharge (soaked dressing). On routine dressing change, observe the site for signs of drain retraction, withdrawal or infection (inflammation, oedema, purulent exudate or pyrexia) and obtain a wound swab if appropriate. Report any unusual signs or complications and record in appropriate documentation.
   To recognize and treat potential complications (Fraise and Bradley [64]; Walker [217], E). To ensure accurate documentation of any unusual signs or complications (NMC [152], C).