Wednesday, April 23, 2008

Jackson-Pratt


I must admit I have a Jackson-Pratt fetish. No, it isn't as sordid as it sounds. I just love leaving these babies inside the human body (in the appropriate clinical scenario, of course). Nothing helps a frazzled general surgeon sleep better at night after a tough, dicey case than knowing you've left a drain behind.

What's a Jackson-Pratt (JP)?
A closed suction, silastic tube with multiple perforations on the flat part that resides in the body. You can attach it to a bulb which applies a constant negative pressure to the intracorporeal portion of the tubing.

What purpose do they serve?
Helps evacuate fluid/blood/pus from spaces in the body.

When do you decide to leave one?
-Lap appy for perforated/gangrenous appendicitis
-Nasty gallbladders with spillage of foul bile during a lap chole
-If there are common duct stones seen on a cholangiogram and I can't clear the duct laparoscopically; higher risk of the clips coming off from elevated ductal pressure.
-Emergency lap chole on a patient on plavix/aspirin, or even if the liver bed looks a little "oozy". Gives you an idea of any "bright red" blood loss.
-Next to low colorectal anastomoses
-Most pancreatic surgery
-Patients who present with peritonitis and massive fecal contamination
-After mastectomies/axillary dissections
-After excision of large lipomas (dead space can fill with serous fluid)
-Under the flaps after a large open ventral hernia repair
-Groin dissections
-Those cases where I just sorta feel like it.....

Now you don't want to stick a JP in the belly after every case. They provide a route for skin bacteria to enter the abdomen and cause abscesses. The closed suction design makes this less likely compared to say, the Penrose drain, but you have to be careful nonetheless. There is good literature to suggest that leaving a drain in after splenectomy will lead to higher rates of infectious complications. Also, you have to be careful leaving drains in too long around a fresh anastomosis. Sometimes the JP can erode into healing bowel and cause a fistula. I've even had a patient yank at the JP and snap it off flush at the skin surface, and have to go back in to retrieve the tip laparoscopically.

When do you take out a JP?
Depends. Breast drains I leave in until daily outputs are consistently less than 30cc a day. Most JP's left in after gallbladder surgery come out the next day unless I'm waiting for an ERCP to be done. Drains left after complicated cases of perforated appendicitis usually come out in a day or two. It's a judgment call for the most part.

Does it hurt?
A bit. Usually not much at all, and it comes out fast.

Going home with a JP happens occasionally, especially in breast and pancreatic surgery. They're not too difficult to care for; patients receive teaching from nursing staff and me prior to discharge, and are instructed to measure daily outputs. I usually send them home with a JP instruction packet, something like this.

63 comments:

Sid Schwab said...

I love 'em, too. Used to use another reservoir, because it sucked better, but the nurses could never figure them out, even when I demonstrated many times...

I never heard the common duct stone/forcing clips off concept. Not entirely sure it makes physiological sense. And for diffuse peritonitis, I don't think random drains have much advantage; but I certainly used them with a localized process such as a gangrenous retrocecal appendix, or a pelvic infection. Some of my mentors felt -- and they might have been right -- that drains to prevent abscess don't work because they become walled off so quickly. I certainly used them whereever I was worried about leakage of one thing or another. I sent lots of women home with them after mastectomy and never had reason to regret it.

Devorrah said...

Love your blog--I always learn something. Thanks.

by: PM, SN said...

I love those little grenades. I've even seen one placed at the distal end of a T-tube after a choly. There's something satisfying about emptying them out into measuring containers and recompressing them.

JP is a trademark, and I can't seem to find the "generic" name for this device besides "drain to self-suction".

rlbates said...

My tummy tuck patients usually ask "When can we get rid of "my balls"? A little crude humor between women.

Love the post and the drains!

Buckeye Surgeon said...

Sid-
I agree philosophically with you regards fecal peritonitis. But it seems no matter how much irrigation you use, the ascites that collects afterwards just begs to form an abscess. I leave one in the pelvis and another along the right paracolic gutter, up over the liver. As long as the fluid doesn;t look murky after a day or two, I take them out.

Re: common duct stones. If it seems likely that the patient will need a post op ERCP, I like having one in there as a safety valve. The common duct gets insufflated with all that air from the scope and I worry about clips getting dislodged.

Anonymous said...

I have had jp drains and then I have had GD JP drains. One was after my gall bladder surgery and it came out 24 hrs later and with only a bit of pain. The others (2) were after a major abd. open surgery and they were left in until day 4 or 5. Let me tell you there was no comparrison between that GB drain being pulled out and these being pulled out. First they were so long that I swear when he pulled them out they must have been wrapped around everything. Hurt like h***. He knew it was going to also and told me far ahead of time they would. I couldn't even take a deep breathe that allowed him time to pull one completely out. The first one I took deep breathe, he pulled, I stopped, he stopped...Repeat 3 times.

enrico said...

What's the fundamental difference between JP and Blake drains? I've seen both written in op reports but every suction drain I've seen looks this way. Is is some technicality about how the tubing is on the inside?

rlbates said...

Enrico, yes--the Blake drains have four channels (http://ecatalog.ethicon.com/EC_ECATALOG/ethicon/content/CAT_173.htm) and the JP is flat with holes.

Anonymous said...

I personally prefer Blake drains for two good reasons: first, they seem to function longer because they don't have holes to get plugged up by omentum or fibrotic debris, and two, they come out much more smoothly and with less pain than a JP with all its holes catching on everything including the fascia.

Kacey said...

I had a JP left in for 24hours after a carotid endareterectomy. When the resident pulled it the next morning, he nicked something and they rushed me back to surgery at 8:00 in the evening for repair. Afterwards, I had a hard knot on that side, but it didn't seem to concern the vascular surgeon. But, it sure bothered me! This winter, after 3 1/2 years, something started bulging out of the middle of the incision. Lucky me---I was in Florida and the doctors won't see snow-birds with peculiar problems. After it broke open and small amounts of purulent drainage ensued, I wiped it off for a month with Betadine and hoped for the best. I finally saw a vascular surgeon (she came over to the Urgent Care and checked me out as a favor to the attending ) and she sent me for a CAT Scan of the neck --- then called the next day and told me to get home to Ohio as fast as possible. My surgeon opened the incision and the infection was all the way down to the carotid graft, but the samples for pathology would not grow any organisms. After a visit to an infectious disease doc, I was put on Keflex 500mg. tid for a year. I'm thinking it was there for the whole three and a half years ---- and the hard bump is still there! Dang! (P.S. ---Jackson-Pratts really hurt when pulled)

Buckeye Surgeon said...

Kacey-
The idea of a JP left in for a carotid is puzzling. Foreign bodies next to a vascular graft is a frightening prospect indeed. Sorry to hear about your experience.

Kate said...

I like JP drains as well even though I'm a nephrologist; our renal transplant surgeon uses them regularly when he places a new kidney and simultaneously starts low dose heparin to prevent clotting of the allograft. They are "way cool" and usually come out in 3 days (easily).

I enjoy your blog; just found it!

wendy said...

I have had a JP in for 10 days now following a hernia surgery. The PA mentioned to me that I had an empty "pocket" in my abdomen that apparently had been there as a result of previous RNY surgery 5 years ago and that they put the drain in to drain off this pocket which was filling with blood and fluid. I went back to the doctor a few days ago and they left it in because it is still draining 80-90 cc/day. There's some nasty stuff coming out of that thing including globs of fat and tissue. Now, the drainage has changed to bright red and thick and continues to come out 80-90cc/day. Should I be worried? My doc didn't seem concerned.

Anonymous said...

For Wendy: I had a large hernia repair on april 10 and still have one jp drain . It is ebbing away but turning darker and not lighter.. I guess we have a similar problem...

Buckeye Surgeon said...

wendy-
When to remove drains is a judgment call by the individual surgeon. There's no correct answer. Leave it in too long and you risk seeding the tract with an infection. Take it out too early and you can get troublesome seroma collections..... I tend to not leave them in longer than four or five days.... and I'm certainly wary to leave them in for any length of time if I've repaired the hernia with mesh.

Diane said...

I too have a JP drain in. I'm also wondering when it will be too long. The last one, after abdominoplasty I removed myself. I'm not a nurse but it was very easy to do instead of waiting for my surgeon over the weekend. This time, tomorrow will be two weeks but I'm still draining around 45cc/day. Any thoughts would be appreciated. Thanks.

nanette said...

I had an open cholecystectomy 4/25 and the drain is still in. I made arrangements to get an ERCP, but just in the last couple days the drainage of bile has stopped. Now I have a minimal amount of what looks like blood draining. I don't want the ERCP now for fear it will disrupt the healing. From what I am reading, 6 weeks is too long for a drain to be in, and my surgeon should have ordered an ERCP weeks ago when the drainage didn't lessen as expected. I also have an infection around where the tube comes out, to make matters worse, but that seems to be getting better on Levaquin.

nanette said...

Oh and Diane, I feel for you, but I think you are doing OK. It's less than mine was two weeks out, and mine seems to be stopping finally.

I don't know about you, but I hate having that thing coming out of me! It's not just the inconvenience. It creeps me out. I feel like something out of a horror movie. I think having this foreign object in my body is slowing down the healing, because of my mental reaction to it.

Buckeye Surgeon said...

Dianne-
It's a judgment call. I use 30cc/day as a guide for breast cases. As I've said before, leaving them in too long risks infection. But premature removal leads to fluid collections. Be in close contact with your surgeon about the outputs and the nature of the fluid.

Nannette-
Not all bile leaks after cholecystectomy need ERCP. Sometimes the leak will seal just with adequate drainage. One thing to consider would be a HIDA scan or an MRCP to assess whether there is a continued leak...

Kristin said...

I had surgery on my bladder, right kidney and ureter because I had a duplicated collecting system on that side and reflux. I had a JP drain in for about 6 days. They took it out the day I came home from the hospital. Surprisingly, it didn't hurt coming out. At least the nurse had warned me ahead of time that it might.

nanette said...

Buckeye surgeon- I just went to the GI and they are going to do a HIDA scan. I'm glad because that seems a lot less intrusive than the ERCP. Also I am down to about 5 ml per day. so I'm pretty sure that drain will come out on my next visit! Yay!

I hope it doesn't hurt coming out...

And last but not least, thanks for this blog. A lot of these medical forums contain mostly dubious advice from people who have no medical training. I believe what you say because you are a doctor. :)

Anonymous said...

I have 2 JP drains in for lymphoceles, following a hysterectomy and lymph node dissection. They've been in for 15 days, and the past few days, following a tube change and schlerotherapy, they're both leaking at the insertion site. Any thoughts?

Anonymous said...

I had a elective lap chole 16 days ago for pylops. I was diagnoised with a low grade bile leak five days after surgery. I have had a JP drain in for 10 days now. I only drain bile @ night when I sleep. During the day the drainage is the color of urine. I was told this is good and is part of the normal healing process. When should the drain come out? I am draing about 40-55ml per day now. Thedrain is red and very uncomforable where it is inserted. Thanks for any input:)

Buckeye Surgeon said...

anon-
Most bile leaks will close in 1-4 weeks. Need more information for further assistance: where is the leak? has ercp been done? recent hida scan?

one happy nurse said...

Thanks for the response, I never had an ERCP. Was told I only needed one if they were going to place a stent. I have been told that since it's a low grade leak I don't need a stent. I only had the HIDE scan to diagnose the leak. Not since. The doc told me that she "thinks" its a leak on the periphery of my liver and not in the main biliary tree. She belives I was clipped during surgery. Being a nurse myself I am not a good patient and feel that someone should be held accountable. Is this a common complication of a lap chole. The drain is the worst part of all of this. If I have been draining 40-50ml a day and only half is bile can the drain come out and do I need the hide scan prior to removing the drain to make sure the leak has healed? Thanks a million for any help or suggestions:)

Anonymous said...

Had a hida scan today. The leak is coming from where the gallbladder was. It's a mild leak. Today I have only had 10cc out. The doctor on call would not take the drain out. He said I have to wait until Monday. It there any risks to leaving a drain in that is no longer draining? Will I need a stitch or two from where the drain was? I am considering taking the drain out myself. If the drainage stops are there any real risks in do so? Thanks.

Buckeye Surgeon said...

Anon-
Sounds like your surgeon has the right idea. Duct of Luschka leaks (the sort you seemed to have) are generally benign and will close spontaneously. I strongly discourage you from taking the drain out yourself.

Anonymous said...

I had a JP drain placed in my left calf on 07-16. I had a bad laceration that did not close in Nov 2006, and my orthopedic surgeon did a skin graft to close it about 3 months after the injury. Well, I ended up with a void in my calf, and the surgery last week was the second done by my new plastic surgeon. She did not put a drain in the first time, but because of collecting fluid, she decided to put one in this time. I have 2 questions. I noticed the actual bulb can disconnect, what would be the ramifications of disconnecting this thing for a few hours ? Also, could i remove the bulb, and put a few cc's of saline in a syringe and flush the line ? I am afraid to milk it because the tubing looks awfully thin, the actual tubing being only an 1/8th of an inch or so.

Buckeye Surgeon said...

Anon 7/19-
No reason for you to disconnect the bulb or to be doing any sort of flushing without explicit instructions from the surgeon who placed it. You risk seeding the wound cavity with bacteria by opening up the tubing to air.

Milking it is fine. Those tubes shouldn't break.

Anonymous said...

I am having surgery to remove a 15cm lipoma. I will have a JP for an estimated 10 days. I will have to empty it about twice a day. I am so nervous about removing it myself. Are they difficult to use? Thanks for this blog.

Buckeye Surgeon said...

Anon-
All patients get explicit instructions prior to discharge. I've even admitted patients overnight if they seem uncomfortable with management of the JP after outpatient surgery. Unlikely the tube will stay in the full 10 days. Most can come out in 5-7 days after lipoma surgery.

Anonymous said...

Thanks for the info, Buckeye (I'm a Buckeye too, by the way). Is lipoma surgery typically pretty quick?

Anonymous said...

AniNonymous in California

I had abdominoplasty on September 16, 2008. (I regret it!) I still have one (of originally two drains) on the left side. It is still producing about 10 cc every two hours.

What could be causing the continues flow of fluid? I do think I remember bumping that drain slightly about 6 days ago.
Could that have caused something?

I do have diabetes, though I have monitored and controlled the sugar numbers very carefully, so they have been very normal.

Completed Surprised said...

Long story shortened as much as possible: 10 years ago in December had my 3rd son by 3rd c-section. Ends of scar would intermittently open and ooze and smell profane. Went to see doctors and they all said no to antibiotics and no to removing scar ("not medically necessary"), scan opens and closes at will. just all around nasty. Fast forward to spring 2008, moving furniture to paint den, later on scar popped open again, this time oozing much. went to new doctors in new region where I moved to in US and he immediately referred me to reconstructive plastic surgeon. PS ran culture: staph and strep in fluid. Scheduled surgery. Thought scar coming out only and would be back home by lunch. Nope, not so much. When PS put in blue smurf dye to see if infection contained, it snaked into my abdominal cavity toward my colon. He immediately opened my cavity and called in general surgeon. Oh, can you imagine what he found. OB/GYN has stitched my colon to my abdominal wall 10 years ago w/ very last stitch of the surgery. And, evidently, I acquired a staph infection in hospital. (Must point out first doctor told me to get off my feet and rest was my OB/GYN). But, I digress. So, abdominal wall adhered to colon and staph had eaten hole in colon. And I had 3 hernias. So, awesome PS repaired colon, 3 hernias, cut out infected scar by removing about 6 inches of my gut (which is nice) and sewed me up beautifully. Can definitely tell the difference in his techniques than the nasty staples OB/GYN used all those years ago. So, surgery on 9.22.08 and I still have the JP drain in. Averaging now about 40 ml per day give or take. PS wants to be 25 or under. Have eliminated sodium as much as possible. Did have a few nibbles of family's chinese food last night, but ate high fiber cereal as my meal. Can anyone recommend how to lower the output of this fluid. What can I do to get this little sucker (no pun intended) out of me. I actually say I went in to have something removed, but acquired a testicle. I'm ready to get neutered! This site has great, thorough discussions and after researching dozens of sites, I'm blogging here in hopes of getting some answers. I'm not looking for blame of my OB/GYN. He is a dear man and respected physician and I'm sad to say he is unfortunately dying of colon cancer. Just sad. But, I wanted to put that out there because that is not where I'm headed with this. I'm in the here and now and want to be free of the pain and go on with my life. Thanks in advance and have a great day.

Buckeye Surgeon said...

Surprised-
Interesting history! Sounds like you've had the correct defintive procedure. Unfortunately, there's no evidence that changing your diet will do anything to help reduce seroma outputs. My stance is to remove a drain no matter what after a week or so because of infectious risks but everyone does it a little differently. Good luck.

Completely Surprised said...

Thanks Buckeye,
I guess I have a few more questions about this if you don't mind. Is seroma fluid the usual abdominal fluid that is caused by the injury of the tissue (surgery). In my research, I see seromas most related to breast surgery, typically a mastectomy. Would all the infection that lived in my body for so long cause this? One more thing I forgot to point out. My PS said my colon was not "flapping about as normal colons do" and that it was seemingly crammed in post delivery/preclosing during my csection. He said the General Surgeon and he put it back how it was supposed to be. Ironically, my bm's have always been very regular, never any blood or mucus. All I had was typical premenstrual pain and tugging from what I thought was scar adhesions. When I think of how sick I really was, I literally shudder. The hernias scared me as well. I had dealt w/ pain and swelling for so long in my left leg. But, I thought needing to lose some lbs caused that. Can you explain that pain? I've seen that multiple c-sections can cause some lower limb pain. I have far less pain today. In fact, for the first 2 weeks, I was pain free in my leg. Feels like it's a little swollen again. I just want to start walking again and want the drain out and the leg swelling to decrease.

Buckeye Surgeon said...

Surprised-
Seromas can occur anywhere. Not exclusive to breast surgery. Anytime to remove tissue, the body fills in the deadspace with serum.

As for the leg pain, Im at a lost. Could be anything. Have a doc take a look.

Anonymous said...

I have had Jackson Pratt drains 5 times in 2 years. I am a breast cancer survivor. Please look at my new drain garment at my website. I launched last week with my new company. www.surgishorts.com.

Thanks,
Jackie

Frank McGonigal said...

I had an appendectomy and had a Jackson-Pratt drain put in.
4 nurses tried to remove it after a few days,but it wouldn't budge.
The Surgeon came in and I told him about the 4 nurses who tried to remove it.
He said "Oh it'll come out and gave it a yank.
It broke off at skin level and he said it wouldn't be a problem as lots of people are walking around with things like staples in them.
4 months later the 7" broken end came through attached to a stool.
How in hell did that drain end up in my bowel ? would it cause any damage inside ?.
If it had been left in permanently would it have caused any other problems ?.
I go back to see him tomorrow and I have a few pointed questions to put to him.
I'm very angry at the moment at his cavalier attitude to this situation.

Surgishorts.com said...

Please visit my website and view the new garment for use with Jackson Pratt Drains.

www.surgishorts.com

Thank You,
Jackie Green

Anonymous said...

How much suction power to they produce in mmg??? Cannot find info on it. Thanks to anyone that has an answer for me!

Anonymous said...

Enjoyed the info on the blog very much. I am a nurse of 33 years and a Doc's look at practices is a very different perspective. I came here seeking input about JP drains. I currently work in long term care although my experience is diverse. Our current Director of Nurses is just a great nurse, business woman and manager. We have been accepting admissions with higher acuity. I need some updating.
We have several problems in long term care. One is widely differing skill levels in the nursing staff. Another is that the surgeon does not follow the pt back to the nursing home. The third is the MD on call rotates through. Often I am asking for orders for my pt from a doc who knows nothing about the pt or the history. I read all H&P's, the surgical reports, review labs etc before I call the MD. I then call give a background picture and the current clinical findings I am concerned with. Also as a long term care nurse I have much more involvement with pt, and family than do most other aspects of nursing.
Given this background here is my question. I have young 30's pt who has a pineal tumor and is in a vegatative state. He has a peg tube in place and Mom is a nurse. He recently developed a gangranous gallbladder that burst during removal. He subsquently flooded his Jp with 150 cc of drainage. He was transported to a larger hospital had an ECRP done and removed a blood clot. He developed
pneumonia and has a PICC line and is receiving 3 abx's gentamycin, lyvox. He back to our facility with a JP in place that is probably 3 weeks old. Yesterday there was 15cc in the JP of rusty clear serosangious dranage. He bowel sounds are hypoactive and his lung sounds are diminshed and have ronchi. He has restarted his tube feeding also. Yesterday there was no residual for his tube feeding. Today there was no drainage in the JP drain for 24 hours. Same poor bowel sounds and lung sounds. I did get 15 cc cloudy foul smelling yellow green drainage residual before I started to give my pt his tube feeding. I called the on call doc gave him the same hx as above. I recieved orders to hold the tube feeding and restart when there was no residual. I checked again in 1 1/2 hours and there was clear yellow residual. In another 2 hours the residual had cleared. The evening nurse resumed the tube feedings etc. I felt like the pt needed to be evaluated in the ER basically due to the poor bowel sounds and no drainage in the JP, esp in light of this young mans hx. My fear was that the JP was again blocked and there was infectious material backing into the gut from the billary system. Is my understanding of the pathology and the purpose of the JP drain goofed? IF so please fill me in. I hate feeling clueless.
Thank You
Jill
yamanurse@hotmail.com

Anonymous said...

Hi, I am a 35 yr old paraplegic and have some important questions regarding these jp drains.

I have had several decubitus ulcers surgeries, including two muscle flaps and one excision & closure. recently I discovered 11cm of a drain had been left inside my body and it has caused me a world of complications. determining which surgery caused this is proving to be difficult to investigate. first of all, how long could these drains survive inside the body? my first surgery was in 1996 and a jp was used. my second surgery was in 2005 but I cannot recall if a jp was used or not. however, from xray and CT images, it appears that it showed up after the 2005 surgery. would a surgeon use the drain/strip part of the drain (the end of the jp with the plastic strip and holes) as a surgical tool during surgery? I have also had a girdle stone procedure done on my right hip due to a bone infection in my hip joint and developed a fistula to my thigh and I wonder if this was caused by the drain that was left behind. I also contracted MRSA after the 2005 surgery. any information you could provide would really help me with my investigation of this mystery. your quick response would be very greatly appreciated. thanks in advance!

Joe

Anonymous said...

Should JP's be replaced/swaped if they are in longer than 3 weeks? Not sure if this is something done to prevent infection or if the JP just stays in until the drainage amount is low enough for removal...

Jonathan said...

i have a JP for about 3 week now (it supposed to be removed today) but something weird appear in it this morning , its look like a 20 cm worm or tissue i really dont know what is that ... thing? I ask my nurse this morning and she said in 36 years of my carreer i never saw that before.

Anyone have any idéa ? and i look on the site that tell after like 1 week with a JP we may have an infection or i have it for 3 week now and the last 4 days drain only like 20cc witch is like blood color do we need to take care about that or no?

Other thing i already get an other JP that will be removed like 7 day after it was put in it and the nurse tell me to get off the presure of the JP like 30 min before the extraction to release the tissue from the JP. Don't know if it work but that not really hurt when it was extract , hope this will help.

(P.S: sorry for my bad enflish)

jonathan said...

I just got my JP removed yesterday and the doctor said it was the fibrinous tissue that comme out the J.P. , and as i said i release the pressure like 2 HOURS before the extraction and the doctor pull it out in one shot and that just surprise me more than it hurt.

nicoledabrowski said...

I hate my JPs- I just had a tummy tuck & they are SO uncomfortable- more uncomfortable than the actual surgery!!!! I am going into my doctor today hopefully to get these bad boys removed...I ABSOLUTELY HATE THEM! You doctors are HORRIBLE for making us go home with these things! UGH!

LINDA said...

My husband had the Whipple Procedure done for pancreatic cancer. He has had a JP drain for 3 weeks. The stuff that comes out is vile and smells horrible and changes color day by day. Now, the drain tube is plugged up and nothing is coming out into the bulb. Fluid is leaking out of the abdomen through the stoma opening. Doctor is on vacation but PA says we may have to have a bigger tube inserted tomorrow. As of yesterday he was still draining over 200cc per day. The site is infected and pussy and is this what is pluggin up the tubing? Any suggestions? Yes, he is on antibiotics for this infection.

Lindsay said...

My Dad just had a radical prostatectomy 5 days ago and was switched from a JP to a passive gravity drainage bag. I love a good Jackson Pratt, so I was a bit disappointed when we went home with this crappy drainage bag. It keeps getting clogged with stringy clots and his 24hr output is still around 250cc's. I'll be so glad to see the drain go!

CC said...

I had a coccygectomy and the JP drain was removed less than 24 hrs later by the surgeon. 8 days later I returned for an emergency surgery due to infection. They found a 3 in piece of fractured JP drain inside. Have you heard of this happening?

Anonymous said...

I had bilateral free flap reconstruction on 1/26/10. The right breast was delayed after a mastectomy in Feb. of 07, the left was a prophylactic mastectomy with immediate reconstruction.

I have had the abdominal JP drain for 5 weeks and am still draining 40cc's average per day. The drain is now starting to get an unpleasant odor. My Plastic surgeon wants to leave it in until I am at 30cc's per day for two consecutive days. I am ok with that because I don't want to develop a seroma, but I am also concerned about the odor.

What is your opinion?

BRANDI said...

Wow am I glad I found this blog! I have 2 stints and a jp bag in, that has been draining about 300cc's a day. I was rushed into surgery 2 nights ago, following a gallbladder removal from 8 days prior. I have had the hida scan,ERCP, stints and jp drain, however,my fluid is still coming out red. My doctor says this is normal, although, I donot feel this is normal.I am 28 years old and very young for this kind on problem. My blood presure since all of this has been running in the 170's over 100's. My surgen has already lost my trust in him over the whole situation, that I will not mention here. Can someone please tell me to set my mind at ease that all of these things are ok? I am very scared and just want to stop hurting.

Thank you for any input!

Anonymous said...

Had a sarcoma chemo radiation and finally extraction. Went home with 3 Jackon Pratts. 2 were removed after 4 weeks one left in for 6. Had the 3rd one pulled out and an infection developed MRSA. HAd a muscle flap operation to plug the hole and another 2 JPs inserted. Intense pain followed. Had the JPs removed and infectin was gone yet intense pain followed for the next 5 years. I always thought there was a foreign body (ie.e JP broke off inside my back) Had a thrid operation to cut 4 intercostal nerves and 7 general nerves to kill pain. It did not work. I asked the Dr. to look for a foreign body inside me. Jokingly he said no cell phones found inside. After 6 months of more pain (i.e. the pain killing operation did not work). I still suspect there is something left behind in me. After reviewing photos of the last operation I noticed the Dr. did not go back into the site of where the pain radiates but went in to cut the nerves so -- he really could not have reviewed if there was a a piece of JP left behind or not. Intense pain persists every day all day. I take a ton of pain med but to no avail. It sucks. Anyone have any advice insight or suggestions. Is it possible that a piece of JP still be inside me after all these years causing the pain???????

Jennie said...

I had a ruptured appendectomy and cecum removal. When I woke up from my surgery, I had one JP drain coming out of my left groin (don't ask my why the drain was coming out of my left side when your appendix is on my right). I had 140-150ml a day for 2 weeks and then it slowly dwindled down to 50-60ml after 2 months. The doctor wouldn't remove it unless I produced less than 40ml. Two months later, I had severe pain from where the tube was coming out. The doctor finally did a CT scan and just found a swollen colon. He removed it that same night and put me on flagyl. After 2.5 months, I am finally better. I am writing this because I googled this issue for hours and didn't find anything close to what happened to me other than this site. I just wanted to let people know that this can happen after a routine surgery. I just wish they had put me on antibiotics the day after my surgery.

Brooke said...

IF there are ny radiologists out there tht read thsi please advise wht tytpe of CT would you do if you were looking for a broken off piece of Jackson Pratt inside soemone. IS there a specific test you would want done to see plaastic inside someone. WIth or without contrast.

Brooke said...

Radiologist what type of CT would you order to see if there ws a broken JACKSOn Pratt inside someone?

Novia Schlough said...
This comment has been removed by the author.
Shandell said...

I'm not sure if you still check this, hoping you do! I had a radical hysterectomy and lymphandectomy 6 1/2 weeks ago and I STILL have a JP Drain in, I am still getting any where between 300-500cc every day. I don't think this is normal and my dr doesn't seem concerned... Do you have ANY advice for me?

Katie S said...

Shandell
I hope this still gets checked too! April 11 I had a 10cmx10cm benign lipoma removed from the deep subfascial area of my lower back. I still have my JP drain. I suspected the beginnings of infection about 3 days ago and was put on druacef but it does not seem to be responding. Now I am getting small amounts of green viscous pus from the jp site and the drainage looks like orange pond water: very murky with bits of flotsam. Additionally, the site is EXTREMELY painful, with the lightest tug causing a great deal of distress. I intend to call my surgeon back on Monday, but are there any alternatives to a JP drain. Because of the infection, I'd like to have the drain pulled ASAP, but I am still draining about 100ccs a day and do not want to risk any fluid related complications. Here's hoping this forum still gets checked.

Anonymous said...

My dad had a mass removed frm tail of pancreas and the spleen removed. He has wore the drain now for 10 days and the stuff hasn't slowed down at all. He went to doc and they are gonna check it again Tuesday. I am concerned something else may be leaking. How would u know if that was the case?

Anonymous said...

First and foremost, I am not a physician. I speak only from experience. I've spoke with other patients regarding their drains and recovery and have come to the conclusion that everyone will have a different draining experience. I think draining is a good sign but if you are alarmed please call the surgeons to get some
Peace of mind!

Anonymous said...

I had surgery on 7/26/13 for a very bad gallbladder. They left a jp drain in, and have sent me home with it. They said I had damage to one of my bile ducts, and since I had a gastric bypass several years back they were unable to do a ercp. I am draining around 300cc of bile in a 24 hour period. They didnt tell me how long my jp would be in, or how long it may take the bile duct to heal. And I cant find very many answers anywhere. As far as I can tell the drain is doing what it's supposed to do, not to much pain, and I'm keeping the site clean. Just would like to know how long it may take a bile duct to heal? Thank you, Deborah in Wise, VA

Dr. G Sinha said...

Hello Doctor, Came across your blog today while searching for drainage after open gb surgery. My 73 yr old mum underwent open gb surgery, after her cbd got nicked while being operated laparoscopically on 11/03/14.The operating surgeon did a hepaticojejunostomy & a jejunojenuostomy ( he is a liver transplant surgeon) and he has left a closed suction drain in situ to drain the peritoneum. Mum is afebrile on tab Ceftum 500 mg BD (Cefuroxime axetil) orally and at home since 19/03/14. The bile had been draining steadily 70 ml on 19/03/14, 90 ml on 20/03/14. In your experience how many days does it take to go below 30 cc? She is ambulant. Also do I need to give her antibiotics with the drain in situ? I thought it was advisable although its taking away her apetite. She's non diabetic, but hypertensive(on Atenolol 25 mg OD).She weighs about 45 kg. Could you care to suggest another antibiotic? and how many days? Would really appreciate your opinion.Her SGOT, PT are between 45-50 IU/L yesterday, but ALP & GGTP are raised still(218IU/L & 245 IU/L). Could not find any literature on this subject on the net.Today her USG abdomen revealed no collection of fluid. I am a practising GP based in New Delhi India, right now on leave to nurse her.