Surgical drains: why they are used and how to manage one at home

A surgical drain is a thin plastic tube. The Christie leaflet explains that it is inserted during surgery, secured with a stitch, and sits partly outside the body where it is connected to, or covered by, a bag. The Cambridge leaflet describes a wound drain as a thin plastic tube with one end placed under the skin at the surgical site and the other attached to a container that provides gentle suction to draw excess fluid away.

After an operation the body naturally produces a liquid called serous fluid at the surgical site. If it builds up under the skin it can form a seroma, which can cause swelling and discomfort and may become infected. The drain removes the fluid and prevents this. The Christie leaflet says a drain removes any fluid that collects within the wound, which helps reduce swelling, discomfort and bruising.

Drains are used after many kinds of operation. The leaflets read for this page concern breast surgery and a general surgical oncology ward, and specific instructions differ by operation and type of drain, so the leaflet from your own hospital takes priority over general information.

The Christie leaflet states that if you are clinically well and have a surgical drain, you can still go home, and that you will be taught how to look after it on the ward before you are discharged. The Cambridge leaflet says that if your surgeon is satisfied with your recovery and your situation at home allows, you can be discharged with your drain in place, and that a plan for removal will have been put in place before you leave.

You should be supported after discharge. In the Cambridge leaflet, a member of the breast nursing team contacts you on the next working day to discuss your drain output, and the leaflet lists the unit contact for problems. The Christie leaflet says a specialist nurse will contact you regularly to monitor the drain output and gives 24-hour hotline numbers. Before you go home, the Christie leaflet says to make sure you have gauze, dressings and three to four spare drain bags.

Measuring is the main daily task. The Christie leaflet says to measure at the same time every day for an accurate reading: open the plug at the bottom of the bag, empty the contents into a measuring jug, write the amount on the chart, and dispose of the fluid down the toilet. The Cambridge leaflet describes a fluid output log for recording the level on the bottle each morning, or marking the container.

Bags or bottles sometimes need changing. The Christie leaflet says a drain bag will need changing every 2 to 3 days, normally by the practice nurse or a district nurse. The Cambridge leaflet says the bottle may need changing if it is full or too heavy to carry, or if the blue indicator is fully expanded, which shows that there is no suction left. If you do not have a spare bottle or do not feel comfortable changing it, you contact the breast unit, and this can wait until the next working day.

The Cambridge leaflet adds that changes in the colour of the fluid are normal: it changes from red to pink and then yellow, and usually has very little odour.

As the wound heals, the amount of fluid reduces, and the drain can be removed once the output is low enough. The Cambridge leaflet says the drain usually comes out once the fluid collected is within an agreed daily amount, normally in the breast unit. The Christie leaflet says the team will either arrange for a community nurse to remove the drain or ask you to attend clinic.

The Christie leaflet explains that the drain is removed by cutting the stitch and gently pulling it out, and a simple dressing is applied. It is generally not painful, being often described as an odd sensation. It also points out that output may rise before it falls, usually because of movement.

The Christie leaflet lists symptoms of infection as a temperature, redness, swelling, heat, pus or pain, and says to seek medical attention from your GP or the hospital if you think you have an infection. It also says to call if you notice increased swelling or a significant increase in drain output.

The Cambridge leaflet says that if you are concerned about any redness, heat, swelling, bruising or pain, you should contact the breast unit and, if they are not available, NHS 111, or as a last resort the emergency department. The breast care nurses are available Monday to Friday during office hours, with NHS 111 as the out-of-hours route.

• Temperature, redness, heat, swelling, pus or increasing pain around the wound or drain site.

• Swelling that is increasing or a significant rise in drain output.

• A drain that has fallen out, become disconnected or lost suction and you cannot fix it.

• Anything else that worries you: use the contact numbers you were given, or NHS 111 out of hours.

Whether you are treated in an NHS or a private hospital, drain care should be explained before discharge and a named team should monitor you. Questions worth asking before you leave include who will check the drain output and how often, how and where the drain will be removed, who changes bags or bottles, which supplies you will be given, and whom to ring day and night if there is a problem.