She originally presented as a transfer from an emergency hospital for a life-saving pyometra (internal uterine infection) surgery on Thursday. Shelby had a ruptured pyometra in which her belly was flushed and she was placed on strong antibiotics. Unfortunately, she came back in yesterday as she developed septic peritonitis (infection in the abdominal cavity) due to the amount of infection that was open in her abdominal cavity. She went back to surgery and the infection was cleaned out with several flushes. Post-op we placed a drain – this one is called a Jackson Pratt drain but we commonly place Penrose drains in dogs and cats for bite wounds. Below is some education on why drains are needed.
Drains are commonly used in small animals.
Drain placement is indicated for:
1. Dead space elimination
2. Evacuation of fluid or gas
3. Prevention of anticipated accumulation of fluid or gas
4. Severe contamination
Drains may be passive or active. Passive drains (ie penrose drain) rely on gravity, capillary action, natural pressure gradients, or overflow. Active drains (ie Jackson-Pratt drain) create and rely on negative pressure (suction) to promote outflow, they are also attached to a closed system. These also allow for quantification of fluid and provide a minimally invasive opportunity to the clinician to perform a cytological examination of the fluid.
The volume of drainage such as via a Jackson-Pratt drain should be emptied every 2-6 hours depending on volume, recorded, and totaled daily. This helps gauge if fluid accumulation is decreasing or increasing. In excessive fluid draining, patients may even become hypovolemic, in these cases, the production may also be considered to calculate Ins and Outs and increase your fluid therapy rate or consider fluid blouses if hypovolemic. Cytology may also be performed on the fluid, it is important to note that the JP bulb may be contaminated and not be representative of the abdominal fluid, hence if there are bacteria present, a direct sample from the cavity should be obtained to perform a spun down an in-house cytologic evaluation.
The best indicator for removal of a drain is an abrupt decrease in the volume of fluid being removed and a change in its characteristics to serous, non-odorous but slightly turbid fluid. It is important to remember that a drain is a foreign material to the patient’s body, so the body will produce a certain amount of fluid just due to the presence of the drain. In general, 1-2 ml/kg of fluid will be produced by the body in reaction to the presence of a drain. It is rare for drains to completely stop being productive. Be careful not to remove a drain too soon as seroma formation can occur in wounds if drains are pulled too early.