A Text-book of Diseases of Women

by Charles B. Penrose

The tube may be cleaned by any careful nurse. The bedclothes should be drawn down to the pubis and the clothing should be drawn up, so that the abdomen is exposed. Sterile towels should be placed about the rubber dam. The hands of the nurse should be sterilized. The dam should be opened, the cotton should be removed, and the orifice of the tube exposed. The tube should be emptied with the long-nozzled syringe ([Fig. 203]), or with some other easily sterilized apparatus by which the fluid may be withdrawn.

Fig. 203.—Syringe for cleaning drainage-tube.

All fluid should be withdrawn from the drainage-tube. The dam should be carefully cleansed by wiping with cotton wet with the solution of bichlorid of mercury. A fresh cotton plug should be inserted in the tube, and the dam should be folded and pinned over a handful of cotton. The whole should then be covered with a sterile towel.

The tube should be emptied or cleaned as often as it becomes filled. It is often necessary at first to clean it every fifteen, thirty, or sixty minutes. If free bleeding is taking place, it is most quickly arrested by frequent cleaning of the tube. Unless the nurse is experienced, the operator or assistant should watch the drainage-tube for the first hour after operation, in order to direct the nurse in regard to the required frequency of cleansing. A record should be kept of the amount of fluid withdrawn.

The intervals between cleansings are gradually increased until once every six or twelve hours becomes sufficient. It is not often necessary to keep the tube in the abdomen longer than two or three days.

The tube should be removed when the fluid discharged becomes serous in character and small in amount—about one dram every four or five hours. Before removing the tube the flannel binder should be opened and the wound should be exposed. When the glass tube is withdrawn, it is best to replace it by a small rubber tube. This may be done by inserting the rubber tube to the bottom of the glass tube, which is then withdrawn. If we were certain that the tube-tract were aseptic, the introduction of the rubber tube would be unnecessary, and we might close the lower angle of the incision immediately by suture. This procedure, however, may be followed by fluid-accumulation and the formation of abscess in the tube-tract. It is therefore safest always to use the rubber tube. The rubber tube should be withdrawn gradually, an inch or two every day, so that the tract will close from the bottom. In order to prevent the rubber tube slipping altogether into the drainage-tract, it is advisable to insert a small safety-pin through the extra-abdominal end. The end of the rubber tube should be surrounded and covered by several layers of gauze and the abdominal pad.

Gauze-drainage.—Capillary drainage with gauze is sometimes more convenient than drainage with the tube. A strip, about 2 inches in width, of several layers of gauze should be carried, from the part of the pelvis to be drained, out through the lower angle of the abdominal incision. When the sutures are introduced the lower angle of the incision should not be too tightly closed, or drainage will be impeded. The extra-abdominal end of the gauze drain should be surrounded and covered by several layers of loosely-packed gauze and by the abdominal pad and binder. Sterile cotton should be tucked under the binder immediately above the pubis, and, if necessary, around the upper and lateral margins of the pad. The dressing need not be disturbed for one, two, or three days, unless the discharge has soaked through the abdominal binder.

A convenient capillary drain is made of a gauze bag containing several strips of gauze.

One objection to the gauze drain is the difficulty of removal. Lymph-processes and granulations penetrate the interstices of the gauze, and often render its removal very difficult. The surgeon fears to use too much force in attempts at withdrawal, because an adherent loop of intestine or the omentum may be pulled out of place or damaged, or the lymph-wall of the drainage-tract may become opened and expose the general peritoneum to infection. To avoid this difficulty the writer has for some time employed a drain made by surrounding the gauze bag with an ordinary rubber condom the end of which has been cut open ([Fig. 204]). With this arrangement the surgeon may feel certain that there are no adhesions except at the end of the drain. Such drains may be removed as easily as the glass tube. The condom may be sterilized by boiling. Gauze drains should be removed at the end of two or three days. After withdrawing the gauze it is advisable to insert a small rubber tube, for reasons that have been mentioned in considering the use of the glass drainage-tube.