What is a Jackson-Pratt drain

Jackson-Pratt drain also called a JP drain, which is a closed-suction drain that is commonly used as a post-operative drain for collecting bodily fluids from surgical sites. The Jackson-Pratt drain pulls this fluid (by suction) into a bulb. The bulb can then be emptied and the fluid inside measured. Jackson-Pratt drain consists of an internal drain connected to a grenade-shaped bulb via plastic tubing. A Jackson-Pratt drain is a closed system drain that uses bulb suction to prevent wound drainage from collecting around the surgical site. A Jackson-Pratt closed suction drain is used to remove fluids that build up in areas of your body after surgery or when you have an infection. The benefits of a closed system drain are that it decreases the risk for infection and allows you to measure how much drainage the wound is draining. At first, this fluid is bloody. Then, as your wound heals, the fluid changes to light pink, light yellow, or clear. The drain will stay in place until less than 30 mL (about 2 tablespoons) of fluid can be collected in a 24-hour period.

The Jackson-Pratt drain is made up of two parts:

• A thin rubber tube
• A soft, round squeeze bulb that looks like a grenade

One end of the rubber tube is placed in the area of your body where fluid may build up. The other end comes out through a small incision (cut). A squeeze bulb is attached to this outer end.

Ask your health care provider when you may take a shower while you have Jackson-Pratt drain. You may be asked to take a sponge bath until the Jackson-Pratt drain is removed.

There are many ways to wear the Jackson-Pratt drain depending on where the drain comes out of your body.

• The squeeze bulb has a plastic loop that can be used to pin the bulb to your clothes.
• If the Jackson-Pratt drain is in your upper body, you can tie a cloth tape around your neck like a necklace and hang the bulb from the tape.
• There are special garments, such as camisoles, belts, or shorts that have pockets or Velcro loops for the bulbs and openings for the tubes. Ask your provider what might be best for you. Health insurance may cover the cost of these garments, if you get a prescription from your doctor.

Caring for the Jackson-Pratt drain is easy. Depending on how much fluid drains from your surgical site, you will need to empty the bulb every 8 to 12 hours. The bulb should be emptied when it is half full.

Before you are discharged from the hospital, your nurse will show you how to:

• empty the collection bulb
• record the amount of fluid collected
• squeeze the bulb flat and plug so that the suction works again
• keep the drain site clean and free of infection

Figure 1. Jackson-Ppratt drain

Is it okay to take a shower with incision and Jackson-Pratt drain intact?

48 hours after your surgery please remove your dressing and take a shower with lots of soapy suds. In fact, surgeons encourage showering to keep the area clean and dry. Allow soapy water to wash over wound like a water fall. Avoid directly scrubbing the incision and the Jackson-Pratt drain exit site. After taking a shower, pat your wound dry. You can place a clean dressing over the incision and Jackson-Pratt drain exit site if you desire, but leaving the wound open to air is OK at this point. Use a clean towel each time you shower and wear clean clothes every day. Take a shower once a day. The incision is held together with clips, sutures, steri-strips or dermabond. The Jackson-Pratt drain tube is held by a suture to your skin. While showering, secure the bulb to keep it from pulling on the skin or becoming dislodged.

Jackson-Pratt drain sizes

For Jackson-Pratt drain size please follow this manufacturer’s download link for a pdf document (https://www.cardinalhealth.com/content/dam/corp/web/documents/brochure/Cardinal-Health.Wound-Drains-Catalog.pdf)

Jackson-Pratt drain care

To care for a Jackson-Pratt drain you will want to do the following:

1. Empty it
2. Milk it
3. Keep it secured
4. Assess it regularly

Note: Most hospitals have specific protocols on how you are to care for a Jackson-Pratt drain. Therefore, follow these protocols and always refer to these protocols before providing any care to a Jackson-Pratt drain.

Emptying Jackson-Pratt drain

A general rule-of-thumb is to empty the Jackson-Pratt drain when it is halfway full. This usually amounts to 1-2 times per day.

Items you will need are:

• A measuring cup
• A pen or pencil and a piece of paper

Empty the Jackson-Pratt drain before it gets full. You may need to empty your drain every few hours at first. As the amount of drainage decreases, you may be able to empty it once or twice a day:

1. Get your measuring cup ready.
2. Wash your hands well with soap and water or with an alcohol-based cleanser. Dry your hands.
3. Open the bulb cap. DO NOT touch the inside of the cap. If you do touch it, clean it with alcohol (decrease chances of infection).
4. Turn bulb upside down and squeeze contents into a measuring cup.
5. Squeeze the Jackson-Pratt drain bulb, and hold it flat.
6. While the bulb is squeezed flat, close the cap (make sure the bulb stays compressed).
7. Document how much drainage you emptied very important. This is so important because surgeons will order for a Jackson-Pratt drain to be removed when the site is draining less than 30 mL (2 tablespoons) per 24 hours.
8. Flush the fluid down the toilet.
9. Wash your hands well.

Write down the amount of fluid you drained out and the date and time each time you empty your Jackson-Pratt drain.

Depending on the reason for having a Jackson-Pratt drain, at first, a new Jackson-Pratt drain will drain bloody drainage. This drainage is called serosanguineous fluid (which is blood and serous fluid mixed together). Then as the wound heals, the drainage will go from light pink to light yellow to clear and the amount of drainage will taper off. It is important to note for signs of infection, which would be drainage that is cloudy yellow or tan or green with a foul smelling odor.

How to milk a Jackson-Pratt drain

Milking it. The purpose of milking a Jackson-Pratt drain is to prevent clot formation in the tubing. If a clot forms in the tubing you may notice dark, stringy debris in the tubing, and the bulb suction will not work. Again, always refer to your hospital protocol for how frequent you should milk a Jackson-Pratt drain. Generally, this is performed and documented every four hours.

Steps on how to milk a Jackson-Pratt drain:

• Use thumb and index finger of one hand to secure the tubing close to the insertion site.
• Use the other thumb and index finger to strip down the tubing 3 to 4 times to move any drainage or debris into the bulb.
• Do this as many times as you need to. The clot should move down the tube and into the bulb.

Secure it. Keep the drain secure and lowered at the insertion site so it will drain proper. Many facilities have secure devices (like how you would secure a Foley catheter and some drains have a tab where you can safety pin it to a patient’s garment).

Assess it regularly! Always get in a habit of regularly assessing the skin at the drain insertion site and keep the dressing around insertion site dry and clean (change daily…clean with warm soap and water).

Sign of infection include:

• Redness/warmth
• Pain
• Swelling
• Hardness

Changing your dressing

You might have a dressing around the drain where it comes out of your body. If you do not have a dressing, keep the skin around the drain clean and dry. If you are allowed to shower, clean the area with soapy water and pat it dry with a towel. If you are not allowed to shower, clean the area with a washcloth, cotton swabs, or gauze.

If you do have a dressing around the drain, you will need the following items:

• Two pairs of clean, unused, sterile medical gloves
• Five or six cotton swabs
• Gauze pads
• Clean soapy water
• Plastic trash bag
• Surgical tape
• Waterproof pad or bath towel

To change your dressing:

1. Wash your hands well with soap and water. Dry your hands.
2. Put on clean gloves.
3. Loosen the tape carefully and take off the old bandage. Throw the old bandage into the trash bag.
4. Look for any new redness, swelling, bad odor, or pus on the skin around the drain.
5. Use a cotton swab dipped in the soapy water to clean the skin around the drain. Do this 3 or 4 times, using a new swab each time.
6. Take off the first pair of gloves and throw them in the trash bag. Put on the second pair of gloves.
7. Put a new bandage around the drain tube site. Use surgical tape to hold it down against your skin.
8. Throw all used supplies in the trash bag.
9. Wash your hands again.

Sometimes, a large amount of fluid may leak from around the drain site, making the gauze dressing completely wet. If this happens, use soap and water to clean the area. Verify that the bulb drain is secured and “flat” to provide the needed suction. Another potential side effect is the development of a clot within the drain. This appears as a dark, stringy lining. It could prevent the drainage from flowing through the tube. Be sure to notify your doctor if either of these complications occurs.

How to check for infection

Watch the skin around the drain for these signs of infection:

• increased redness
• increased pain
• increased swelling

Other signs of infection:

• fever greater than 100.4 ºF (38 °C)
• cloudy yellow, tan, or foul-smelling drainage

Report any of these symptoms to your doctor as soon as possible.

Jackson-Pratt drain clogged

If there is no fluid draining into the bulb, there may be a clot or other material blocking the fluid. If you notice this:

1. Wash your hands with soap and water. Dry your hands.
2. Gently squeeze the tubing where the clot is, to loosen it.
3. Grip the drain with the fingers of one hand, close to where it comes out of your body.
4. With the fingers of your other hand, squeeze down the length of the tube. Start where it comes out of your body and move toward the drainage bulb. This is called “stripping” the drain.
5. Release your fingers from the end of the drain where it comes out of your body and then release the end near the bulb.
6. You might find it easier to strip the drain if you put lotion or hand cleanser on your hands.
7. Do this several times until fluid is draining into the bulb.
8. Wash your hands again.

10 Things to avoid doing while recovering

1. Do not soak in a bathtub, Jacuzzi, or pool.
2. Avoid applying hydrogen peroxide to wound/Jackson-Pratt drain exit site. Soap and water are the best agents to keep the wound clean.
3. Avoid smoking. It delays wound healing.
4. Avoid separating the Jackson-Pratt drain bulb from tubing in attempt to pull out fluid strands or to flush out tubing. The Jackson-Pratt drain system must remain together to keep the germs from entering the wound.
5. Avoid applying powders, lotions or creams to wound/Jackson-Pratt drain exit site. Drinking the recommended fluids is the best way to keep skin hydrated.
6. Avoid wrapping the tubing in loops. It must remain patent for continuous suction.
7. Avoid overexertion. Overexertion can cause pain and seroma formation.
8. Avoid lying or sleeping on your incision or Jackson-Pratt drain.
9. Avoid drinking alcohol. It delays wound healing
10. Be careful while taking a shower. Have someone help you take a shower. Do not bend over to reach your knees or feet. Use a shower mat and use a shower chair to prevent from falling.

Water, juice, milk, herbal teas and fruit are recommended for hydration after surgery, about 9 cups per day. Good sources of protein are extremely important for wound healing. Beans, nuts, eggs, chicken, peanut butter, yogurt and whole grains are all good sources of protein. Moderate exercise, like a 10 minute walk and leisure activities around the house, is a good way to regain your strength and help speed your recovery. Avoid household chores and lifting heavy items until you have fully recovered, about a 2 to 8 week period. Please check with your physician for more details about your recovery time. Take the prescribed pain medications as directed. Pain can hinder you from moving about.

Jackson-Pratt drain complications

The Jackson-Pratt drain site may be painful. You may have trouble lying on the side with your Jackson-Pratt drain. Your Jackson-Pratt drain site may leak. The Jackson-Pratt drain may be pulled out by accident. The tubing may get blocked, crack, or break. The tubing may damage your tissue. You may have a scar. The Jackson-Pratt drain site may get infected. This infection could spread inside your body.

Call your doctor if:

• Stitches that hold the drain to your skin are coming loose or are missing.
• The tube falls out.
• Your temperature is 100.4°F (38.0°C) or higher.
• Your skin is very red where the tube comes out (a small amount of redness is normal).
• There is drainage from the skin around the tube site.
• There is more tenderness and swelling at the drain site.
• The drainage is cloudy or has a bad odor.
• Drainage from the bulb increases for more than 2 days in a row.
• The squeeze bulb will not stay collapsed.
• The drainage stops suddenly when the drain has been steadily putting out fluid.

What to do if the tube comes out or disconnects at home

• If the Jackson-Pratt drain tube accidentally comes out, put Vaseline on the wound and cover it with a Band-Aid.
• If the Jackson-Pratt drain bulb falls off, clamp the tube using a plastic clamp. Tape gauze to the end of the tube to keep it clean. Then call your health-care provider.
• If you have problems breathing, call your local emergency services number for an ambulance or go to the nearest Emergency Department.