I was asked about surgical drains: how they’re installed, what they’re for, and why I’m still sitting on one. I will warn you now, not only does this essay describe inserting tubing into torsos, it also describes what was easily the most painful and traumatic part of my surgery and hospital stay. I’ll indicate when I’m about to start that story so you can bail if you’d like.
Basic surgical drains are easy. They are put in during the surgery, and serve to drain leaking fluids out of body cavities while everything heals up. I started out with two of them, both JP drains. It’s a piece of tubing with a squeeze bulb at the end. A single suture holds the tubing in position. Every day it’s emptied through a little plug like the stopper on an inflatable ball. The bulb is squeezed before the stopper is closed again, which provides a bit of suction to help fluids drain. When they drain less than 25mL a day, generally, they are removed. One of mine was taken out while I was in the hospital, and one came home with me.
Because I developed an infection, I needed more drains to get rid of the nasty stuff building up in my body cavity. Those drains were a different type, called IR drains because they’re installed by Interventional Radiology. These drains are gravity-fed (although the internet tells me it’s possible to hook them to suction, that was never done for mine), and comprise a length of tubing with a bag on the end. The bag is emptied daily. The tubing has a stopcock on it so it can be flushed twice a day with sterile saline.
So. The IR drains. It is absolutely wonderful that abdominal surgery is no longer required to put in these abscess-draining tools. That would have been much more invasive than what they do now, which is use CT scans to safely place the drain without puncturing anything.
But still, it was a whole lot of not-fun, and if you are feeling squeamish you might want to stop here.
The first IR drain installed was to drain a spot near my liver, on the right side of my body. IR fits in-patients in around scheduled outpatient work and emergency room patients, so it was rather late by the time they hauled me downstairs to the CT room. This is not so long post-surgery, and at the height of my infection, so I was pretty sick and already in a lot of pain.
For some reason the CT room was extremely warm – the staff were all complaining. The nurses and radiology tech boosted me from my wheelie hospital bed to the CT platform, which hurt. The tech started an IV. I asked for happy juice (fentanyl) and was assured I would get some, along with pain meds.
Then everyone disappeared.
I am now alone in an overheated room with no idea where everyone went or how long I’d be there by myself, in pain, on the table. (The radiology folks were certainly in the shielded room with the window and could see me fine, but I had no idea and wasn’t in good enough shape to really make that connection.)
Eventually they ran me into the CT scanner for preliminary images. You’ll notice I said nothing about actually receiving any drugs. When the techs came back into the room to set up for the actual procedure, I asked again, and was again assured that I’d be getting drugs.
They set up the procedure, which involves sterile drapes, disinfectant, and lidocaine. That’s the only part that didn’t hurt, but I could feel everything below surface level (just not as pain).
My understanding of the way the drain installation works is that they put a wire in first because that can be easily tracked on the CT scans. That part involves several passes through the machine. Having a chest/abdomen CT requires putting your arms over your head. I’d just had my entire abdomen sliced open: this was both difficult and extremely painful. (For the curious, there’s a distinct pop when the wire goes thru the membrane around the liver, but physical rather than auditory.)
My recollection (which could be wrong) was that I didn’t receive either fentanyl or additional pain meds until at least this point in the process, which was far too late. (They’re really only effective if given BEFORE the painful and stressful procedure.) Regardless, by this point I was in the most pain that I’d experienced at any point so far, including right after surgery, and was hyperventilating in the CT machine. I even came away with a bit of CT scan PTSD: my last scan was kind of rough.
Once the wire is in place, they’re done with the CT part except for one final check. The next part is to insert progressively larger tubing over the wire, then pull out the small bits. How do you do that? Jam it in. I could feel every stage. I don’t think any of this hurt; if it hurt at all it was subsumed in the rest of the pain.
Then they cleaned up, hoisted me back on to my wheelie bed, and hauled me upstairs. My recollection is that I spent the rest of the night lying in bed shaking, and that it took pretty much until morning to get the pain under control. Shock? Maybe. I don’t remember that part especially clearly.
Then there’s the second drain. Scans showed another abscess near the colon resection, and it needed to be drained. The best way to do that safely is to go in through the right butt cheek and follow the curve of the pelvis into position. As complicated as it sounds, that appears to be the standard method.
I said I didn’t want to remember it, and the nursing and IR staff agreed that they could arrange that. This time, they gave me a nice dose of something before sending me down to IR. Unfortunately IR turned out to be unexpectedly busy, and I had to wait for a very long time and it all wore off. And the only nurse on duty at that time of night was rather mean about me needing to use the bathroom while I waited, since I couldn’t walk very well and she had to help me. (Ability to take myself to the bathroom: major milestone in my recuperation, but one I hadn’t quite achieved yet.)
Eventually I got into the procedure room, which wasn’t roasting hot, and they managed to give me fentanyl before starting anything else, so while my plan to not remember any of it failed, it wasn’t anything like the first experience, even with the rolling on my side for butt cheek access. (Not at all comfortable; even this far out I can’t lie on my side for very long.)
Stupidest part about the butt drain installation: they put the hard plastic stopcock right next to my butt, so I’d be sitting on it all the time. I got them to change that, but then the only way to flush it would be for someone to disconnect the joint where the stopcock was, and I couldn’t do it myself. I managed to get someone from IR to come put in a new accessible stopcock before I left. He was extremely nice, and amused by the challenge. I have had an equal mix of extremely good and fairly horrible experiences with IR (they did my liver biopsy, which was as awesome as a liver biopsy can get).
The liver drain hurt nearly the whole time it was in: it went through the muscles between my ribs, so flexed around it a lot. It still hurts for the same reason, even though it’s been out for a week. (Compounded by foolishly wearing a bra for a long time without noticing that it was chafing on the dressing until too late.) Nothing but trouble, that one. Except for the whole “contributing to keeping me alive” thing, I suppose.
The butt drain hurts when sat upon, which is most of the time. I can eventually find a comfortable sleeping position with lots of padding, but it takes some wiggling. Somehow trying to remember what works doesn’t result in anything that actually works.
More grossness, and probably TMI, but might be useful to someone someday. I’m trying to be honest and true here, even when icky.
I don’t know when the butt drain going to come out. The nasty lower abscess ate a hole in my vagina wall, and that fistula means that all the drainage stuff is weird and unpleasant. The butt drain may stay until everything heals up. It’s not a very large hole, so we are still hoping it heals on its own, but if it doesn’t I’ll need minor surgery to patch it.
I have another CT scan in two weeks to check on the size of the fluid collections (the remains of the abscesses, which after a month of antibiotics are sterile but still need to go away). They are all shrinking: there are several, but only two were large enough to require external drains; the body can reabsorb quite a bit. If the one with the drain it in shrinks away from the pigtail drain end, I may have to go back to IR and have them move it. You can imagine how I feel about that possibility. I’m hoping it either shrinks enough that it no longer needs a drain and I can get rid of this damned thing, or that it shrinks around the drain end instead of away. My mother wondered if I could get it to slosh in the right direction. I’m certainly willing to try, I’m just not quite sure what direction that is.
I can report that it doesn’t hurt to get them out, no matter what it felt like getting them installed. I could feel the tubing sliding internally, but there was no pain even at the skin surface. I’d been a bit worried because they’d been in so long.
Now I just need to heal enough that the last one can come out. C’mon body, you can do it!