Stitches, Staples, and Drains…oh my.


Most of the time, when people have surgery, they wake up with a closed incision that has hidden absorbable sutures and requires no special care. But there are some operations and conditions that require placement of non-absorbable stitches or staples, or a surgical drain, and these can remain in place for days or even weeks.

It’s not uncommon to be sent home with stitches, staples, or drains in place. While at first many patients find it disconcerting to take care of these things at home, it’s actually quite simple and easy to learn.

This post will review what these things are used for, how they are maintained in the hospital, and what you need to do at home.

Stitches and Staples

Stitches and staples are used to hold skin together after an operation. Most of the time, there are absorbable sutures used to hold the deeper layers of your body’s tissues together, meaning that the stitches and staples that you see are there just to hold the skin together for faster healing and a smaller scar.

Stitch and staple removal is much less painful than most people expect, and takes no more than a few minutes: A stitch is removed by your surgical team, who grasp it with tweezers, pull it up to expose the loop of the stitch, and cut it with a pair of fine-tipped scissors. Most patients describe an odd sensation of pulling when the stitch is grasped, but generally this is a painless procedure. Staples are removed by your surgical team with a special staple remover that looks like a short, blunt-nosed pair of scissors and that opens the staple fully before it’s pulled out of the incision. Some patients describe the sensation as a light pinch, while others feel nothing at all. On occasion, a staple will get crooked in the skin and be more difficult to remove. That can be more painful, but it doesn’t last long.

Sometimes after removing stitches or staples, your healthcare provider may place thin adhesive strips known as Steri-strips on the wound, to keep the skin together while the healing process continues. These strips fall off on their own, usually after about a week, and other than not scrubbing them hard in the shower or soaking them in a pool or bath, they require no special care.

Surgical Drains

Surgical drains are usually used for one of two reasons: to keep fluid from building up in a space in the body, or to monitor for a leak from a new connection or repair. They are stitched in place to prevent their getting pulled out accidentally. Other than simple dressing changes, they require no special care. Most patients say that they don’t hurt, and many don’t even notice them most of the time.

Fluid buildup can be a big problem when surgery leads to a “potential space” — a place where tissues are not tightly stuck to each other. One example of this is in the repair of large hernias, where the space formerly occupied by the hernia is now empty and prone to collect fluid under the area of the incision, which is a setup for infection. Another example is a newly formed anastomosis (connection between two tubes), which are common in bowel surgery where a segment of intestine is removed and the two ends connected back to each other. In that case, your surgeon may place a drain at the site of the connection to monitor for, and drain, any leak that occurs before the two ends have had a chance to fully heal together.

Jackson-Pratt (JP) and Blake Drains

Two of the most common types of surgical drains  consist of a thin plastic tube with holes (called Jackson-Pratt, or abbreviated as JP) or slits (Blake) that are connected to a small, clear plastic grenade-shaped bulb outside of the skin that collects liquid from the drain. The plastic bulb that the drain connects to provides a gentle suction on the drain and collects any drainage fluid. When you are in the hospital, nurses empty the bulb often and measure and record the amount of fluid. The doctor determines when to remove the drain based on how much fluid is coming out of it.

If you go home with the drain in place, it may help to know that emptying the drain is easy, and before you leave the hospital your nurses will show you how it’s done. When the time comes to remove it, which happens either before you leave the hospital or when you return for your post-operative appointment in the clinic, the stitch holding it in place is cut and it pulls right out. Most patients describe the sensation as “weird,” and some have a pinching or burning sensation, but this usually goes away in under a minute.

Penrose Drain

These drains, which are thin, floppy rubber tubes, are used to keep a drained cavity open so that it can drain out through the skin. They are used most commonly in operations for infections, such as abscesses. The Penrose drain is usually stitched in place, and a gauze dressing is placed over it to collect any drainage. The gauze dressing is usually changed once or twice a day, but the drain itself requires no special care. This dressing care can be done at home, if necessary, and generally doesn’t restrict normal activities, including showering. Like all drains, your surgical team in the hospital or clinic will remove it.

Chest Tube

After lung or heart surgery, you’ll almost certainly have one or more chest tubes. These are rigid plastic tubes used to drain the chest cavity. Although it’s possible to go home with them, they are almost always removed in the hospital. Chest tubes are attached to a special device designed to prevent air from getting back into the chest, and this device may need to be connected to a suction connector on the wall of your hospital room for the first few days after surgery. Your surgical team should explain the chest tube setup to you – if they don’t, ask. Removal of a chest tube is much like the other drains discussed above, although you will be asked to do some special breathing exercises when the tube is pulled, to keep air from getting into your chest.

Pigtail Drain

Sometimes drains are placed after surgery. Most commonly, this is done to drain fluid collections or abscesses, which can occur several days after your operation. In that case, the drain is usually placed not by your surgeon, but by an interventional radiologist, who can place the drain very accurately using ultrasound or x-ray guidance, usually with a combination of local anesthetic and a mild sedative. These drains have a curl in the end, like the tail of a pig, and so are known as pigtails. They’re much like the JP and Blake drains discussed above, with a suction canister that needs to be emptied regularly. Some pigtail drains may also require regular flushing with saline. If so, your team will show you how to do this too.

Again, many patients worry about what it will feel like when the pigtail drain is removed. I’ve never had one, so I can’t speak from personal experience. But I’ve removed a few hundred, and the overwhelming majority of patients say that it feels “strange” and sometimes “stings,” but doesn’t hurt for any length of time after the drain comes out. If you experience ongoing or worsening pain that doesn’t fade quickly after the drain is removed, you should call your doctor.

Keep in mind that this blog provides general information and it shouldn’t take the place of a conversation with your surgeon and surgical team about your specific situation.

This story originally appeared in the  Health Dialog Care Compass Blog.

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