this video is to help you know how to
care for your Jp Drain.
It does not replace medical advice or
treatment.
I will say "you" in this video but "you" can
refer to yourself,
or whoever is helping to care for your
drain.
This video is made for people who have
drains after breast cancer surgery.
This video uses a female figure to
demonstrate how to take care of your
drain,
although breast cancer can affect people
of every gender. In this video
you will learn why you need the drain,
how the drain works, how to care for your
drain
after surgery, when the drain will be
removed,
how to shower with the drain, what to do
if you get an infection,
what to do if your drain is not working
or falls out.
The type of drain you will get is called
a JP or Jackson Pratt Drain.
You will have this drain for 7 to 14
days.
In this video I will refer to the
Jackson Pratt drain
as the JP drain or just drain.
Why you need the JP Drain
After surgery, fluid can collect around the area where
you had surgery
and near the incisions or surgical cuts.
The fluid is called seroma fluid.
If this fluid builds up it can cause
swelling around the incision.
Swelling puts pressure on the incision.
This causes pain
and delays healing.
The drain removes fluid buildup and
helps prevent swelling.
By draining the fluid there is less
pressure on the incision.
Less pressure allows the incision to
heal properly and reduces pain.
The drain has the following parts:
The drainage end which is placed inside
your body where the surgery occurred.
This part is thick and white, with lots
of little holes for the fluid to drain
through.
You will not see the drainage end.
A tube which is attached to the drainage
end and to the bulb.
A soft bulb with the stopper at the end
of the tube to collect
fluid. The bulb holds 100 milliliters of
fluid.
These measurements are on the side of
the bulb.
A clip to attach the bulb to your
clothing.
How the JP Drain works
the JP Drain works by draining
seroma fluid from the surgical site,
through the drainage end and tube, and into
the bulb.
The JP Drain is used for mastectomy
surgeries and axillary lymph node
dissection surgeries,
which remove lymph nodes near your
armpit.
Some patients will only have a
mastectomy, some will have just lymph
nodes removed,
and some will have both. If you had a
mastectomy the tube will be kept in
place with a stitch
on the surface of your skin near the
breast, where the drain enters your body.
You will be able to see the stitch.
If you had lymph nodes removed, the tube
will be stitched
under the arm where the surgery was done.
If you had a double or bilateral
mastectomy,
you will have two drains. If you had a
double mastectomy and lymph
nodes removed, you may have three or more
drains.
If you had a DIEP flap breast
reconstruction, you may also have drains
in your belly,
on the right and left side.
The drain removes fluid by suction and
gravity.
Squeezing the bulb and putting the
stopper in creates a constant and gentle
suction.
The suction pulls fluid away from the
incision, through the drainage end, and
into the bulb.
By keeping the drain below the cut or
incision, gravity works
to help drain fluids. This can be done by
clipping the bulb to your clothing at
the waist level,
or by placing it inside your
post-surgical camisole pouch.
The fluid in your drain is made up of
blood and seroma fluid.
The color of the fluid in your drain
will change over the course of a few
days.
Right after surgery it will be a bloody
red color.
Then over time it will change to a
pinkish yellow color,
then to a pale yellow color, which is the
seroma fluid. How to care for your JP
Drain after surgery
Taking care of your JP
Drain
helps ensure that you do not have the
drain for longer than you need.
The longer the drain is in, the greater
the risk of infection.
for some people, taking care of your JP
Drain may seem like a hard task,
But by following a few easy steps, you
can manage your drain
and help your body heal quickly. There
are two things you need to do to take
care of your JP Drain:
One: milk the drain, and two
empty the drain.
Milking the JP Drain. Milking the drain
may seem like an odd expression,
but milking the drain keeps the tube
from getting clogged.
If the tube gets clogged, then built-up
fluid cannot drain from the incision.
There are three steps for you to take to
milk the drain:
Step 1: Clean your hands. Cleaning your
hands will reduce the risk of infection.
Watch this video to learn how to clean
your hands well.
Step 2: With one hand hold the tube
where it enters your body.
KLeep this hand in place so you do not
tug on the drain.
Step 3: With your other hand, pinch
the tube just below the hand that is
holding the tube.
With your fingers pinched slide your
fingers down the tube.
Sliding your fingers down the tube
pushes any clots,
blood, tissue, or debris down into the
bulb.
Repeat this step a few times, sliding
your fingers down the tube
a little at a time.
Milk the drain every three hours during
the day while you are awake.
Each time you milk the drain repeat the
process of sliding your fingers down the
full tube
two to three times in a row. You do not
have to wake up and do this at night.
Emptying the JP Drain.
Empty the JP Drain when you wake up and
before you go to bed.
As the bulb fills up, you may empty it as
needed during the day,
but make sure you record how much fluid
was emptied each time.
Before you empty the JP Drain, make sure
you have
a clean area, the measuring cup your
nurse gave you,
a daily log or sheet to record the time
and amount of fluid emptied from the
drain,
a pen or a pencil. Your daily log will
include the date,
the time, and the amount of fluid emptied
from each drain.
Here is an example of a daily log for a
patient with a double or bilateral
mastectomy.
Wash your hands before you handle any
parts of the drain,
then remove the drain from your clothing,
surgical bra,
or camisole if it is attached.
There are eight steps for you to take to
empty the drain.
Step 1: Unplug the stopper on top of
the bulb.
The bulb expands as it fills with fluid.
you may notice that the bulb expands
further when the stopper
is removed. Do not touch the inside of
the stopper or the opening of the bulb
to reduce the risk of infection.
Step 2: Turn the bulb upside down over
the measuring cup
and gently squeeze it. The fluid from the
bulb will drain into the measuring cup.
Step 3: Once the bulb is drained of fluid
turn the bulb right side up. There may be
blood clots or bits of body tissue at
the bottom of the bulb.
This is normal and will not harm you.
Do not wash the bulb or try to rinse it
with water.
Washing the bulb or rinsing the bulb can
lead to infection.
Step 4: Squeeze the sides of the bulb
together
until your fingers feel the palm of your
hand. Squeezing the bulb will restart the
suction.
Step 5: Continue to squeeze the bulb
while you put the stopper back in the
plug.
Check to see that the bulb stays fully
compressed to ensure that there is
suction.
Step 6: Place the bulb back in the
pouch of your surgical bra or camisole
or clip it to your clothing.
Step 7: Check the amount of fluid in the
measuring cup. It is normal to have blood
clots,
bits of tissue, or red and yellow fluid
called the seroma fluid
in the cup. Write down the amount and
time you emptied the drain
in a journal or in your daily log. To get
drainage log pages you can print out,
click the link below. If you have more
than one drain,
record the amount of fluid emptied from
each drain.
Do not add the amounts from different
drains together.
Step 8: Flush the fluid from the
measuring cup down the toilet
and rinse the measuring cup with water.
When your JP drain will be removed.
Keeping a log of the amount of fluid you
drain lets your healthcare team know
when to remove the JP Drain.
The amount of fluid you have in your
drain will become less and less as your
incision heals.
When the total amount of fluid that
comes out of one drain
is less than 30 milliliters in 24 hours
for two days in a row, the drain is ready
to come out.
When your surgery is finished your,
surgeon will place an electronic order
to the Toronto Central LHIN
the Toronto Central LHIN will then
arrange for community care nursing.
You will get a call from the community
care nursing team once you have left the
hospital
and gone home. The nursing team will let
you know
if you need to go to a community health
clinic near your home, or if the nurse
will come to your home.
You will have a total of two to four
visits with the nurse.
You may need more visits with the nurse
if the JP Drain must stay in for a
longer amount of time.
The nurse will check the drain and the
drain's insertion site.
The drain's insertion site is where the
drain enters your skin.
The nurse will also check your level of
pain and review your daily log of JP
Drain output.
When the drain is ready to come out, the
nurse will first remove the stitch
holding the drain in place. The nurse
will then remove the drain,
including the drainage end. Having the
drain removed is not painful.
The nurse will put a dressing of gauze
and tape on your JP Drain insertion site
while it continues to heal. Change your
dressing once per day
or if the dressing is soaked through.
The dressing only needs to be on
until there is no more fluid seeping out
of the insertion site
of the drain. To change the dressing,
First wash your hands. Remove the old
dressing
then apply a fresh gauze pad to the
insertion site with tape.
Showering with the JP Drain.
You may shower with the drain in place
48 hours after surgery.
Do not shower before then.
Showering before 48 hours can increase
the risk of infection.
You may have a sponge bath during this
time but do not get the insertion site
wet.
Before you shower, tape the bulb to your
skin at the hip,
or use a velcro belt to attach the bulb
so that it does not dangle and risk
falling out.
Use medical tape which you can buy at
your local drugstore.
You do not need to cover the JP Drain
insertion site when you shower
because the stitches close off the area.
If you feel more comfortable having a
dressing over the JP Drain insertion
site while you shower,
you may apply a plastic dressing with
tape. Remove the dressing after you have
showered.
Use mild soap with no scents. Soaps with
scents
can cause irritation allergic reactions
and
increase the risk of infection. Examples
of mild soaps are:
Aveeno, Dove, Cetaphil,
or Ivory soap. Do not soak the insertion
side of the drain.
Rinse and pat the area dry after you are
done showering.
What to do if you get an infection.
Signs of infection include: redness,
heat, pus or discharge, new pain,
hard swelling or rapid new swelling,
or a fever of 38 degrees or higher for
more than 24 hours.
If you think you have an infection get
medical help.
On a weekday, Monday to Friday, call your
nurse coordinator at Princess Margaret.
On weekends or after hours, go to your
family doctor,
walk-in clinic, or emergency room.
What to do if your drain is not working
or falls out.
If you notice that the drain is not
flowing, try the following:
Check the bulb and make sure that it is
compressed.
The bulb must be compressed in order to
create suction.
Refer to Steps 4 and 5 of how to empty
the drain.
Check the stopper. The stopper must be
fully in the plug and securely closed.
if it is not securely closed, air can get
into the bulb
and the bulb will not create suction.
Check the drainage tube. Sometimes the
tube can get clogged due to blood clots,
old tissue, and built up debris from
seroma fluid.
Try milking the tube to release any
blockages.
Refer to the steps under Milking the
JP Drain
to milk the tube if the drain is still
not working.
Then, contact the community care access
nurse, your nurse surgical coordinator
or surgeon's office. There may be another
cause such as an air leak at the
insertion site.
If it is an air leak at the insertion
site, it may need to be completely sealed
with the dressing.
Rarely is a new drain required.
The drain, along with the drainage end,
can slip out of place
or fall out at the insertion site if it
is pulled or gets caught.
This rarely happens. If your drain slips
or falls out
contact your surgeon's office. A new
drain may or may not be required
depending on when the drain came out of
place.
You have come to the end of the JP Drain
video
Refer back to it as often as you need.
If you have any questions,
Please contact your surgeon's office.