IVC

INDICATIONS OF IVC FILTER

Failure of anticoagulation; e.g. development of deep vein thrombosis (DVT) or pulmonary emboli

(PE) despite adequate anticoagulation.

Contraindications to anticoagulation; e.g. a patient at risk of PE who has another condition that puts

them at risk of bleeding, such as a recent bleed into the brain, or a patient about to undergo major

surgery

Large clots in the vena cava or iliac veins

Patients at high risk of having a PE

failure of anticoagulation complication of anticoagulation: hemorrhage or thrombocytopenia large free-floating IVC/iliac vein thrombus

expanded indications:

cor pulmonale and DVT/PE patients with high risk of complications to anticoagulation

o metastatic diseaseo syncope in elderly

prophylactic placement in high-risk trauma patientso spinal cord injury

Inferior Vena Cava Filters: Review of Tyes, Indications and Insertion Techniques

Fri, 9/5/08 - 4:36pm

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Author(s): Chris Otero, MD, Hassan Tehrani, MB BCh, Kushagra Katariya, MD

Introduction The accepted standard of care for patients with venous thromboembolism (VTE) is anticoagulant therapy. Inferior vena caval (IVC) filters are reserved for those patients who fail anticoagulant therapy,

or have a complication or contraindication to anticoagulant therapy.1 Until the early 1970’s, the only method of IVC interruption was surgical, either by clipping, ligation or plication. The first clinical experience of an endoluminally-placed device to interrupt IVC flow was reported by Mobin-Uddin et al. in 1969.2 However, it was not until the introduction of a stainless steel umbrella-type filter by Greenfield et al. in 1973 that an effective method of endoluminally trapping emboli while simultaneously preserving IVC flow became possible.3 Indeed, for many years, the Greenfield filter set a benchmark by which newer filters were measured. Early generations of filter were inserted by surgical cut-down and venotomy. Eventually filters were able to be inserted percutaneously: initially through large 24 Fr sheaths, though newer generations of filters are able to be delivered through 6 Fr systems.4

IVC Filters Versus Anticoagulant Therapy in VTEDespite the safety and efficacy of modern day filters, the importance of systemic anticoagulation as the primary treatment of VTE cannot be understated (Table 1). The use of either unfractionated or low molecular weight heparin followed by three months of oral anticoagulation in patients with proximal deep venous thrombosis (DVT) is approximately 94% effective in preventing pulmonary embolism (PE) or recurrent DVT.5 The routine placement of IVC filters in addition to anticoagulation in patients with documented DVT was investigated by Decousus et al. in a randomized trial.6 This study revealed that the use of a permanent filter in addition to heparin therapy significantly decreased the occurrence of PE within the first 12 days compared to those without a filter. However, no effect was observed on either immediate or long-term mortality, and by 2 years, the initial benefit seen in the group of patients with filters was offset by a significant increase in the rate of recurrent DVT.6

Indications for Permanent FiltersDespite the efficacy of anticoagulant therapy in the management of VTE, there are certain situations and conditions in which the benefits of anticoagulation are outweighed by the risks of instituting such a therapy. These include contraindications and complications of anticoagulant therapy. In such circumstances, there may be absolute or relative indications for filter insertion (Table 2).7,8

Permanent Filter TypesCurrently, there are eight different types of permanent caval filters that are FDA approved. These include the Bird’s Nest filter (Cook Incorporated, Bloomington, IN), Vena Tech LGM filter (B. Braun, Bethlehem PA), Vena Tech LP (B. Braun), Simon Nitinol filter (Bard, Covington,GA), Titanium Greenfield filter (Boston Scientific, Natick MA), Over-the-Wire Greenfield filter (Boston Scientific), TrapEase filter (Cordis Corp.) and the Günther Tulip filter (Cook Inc.) (Table 3).

Temporary and Retrievable FiltersWell-founded concerns over the long-term complications of permanent IVC filters, particularly in younger patients in need of PE prophylaxis with a temporary contraindication to anticoagulation, has led to the development of temporary and retrievable filters. Temporary filters remain attached to an accessible transcutaneous catheter or wire. These have been used primarily in Europe for PE prophylaxis during thrombolytic therapy for DVT.10 Currently these devices are not approved for use in the United States. Retrievable filters are very similar in appearance to permanent filters, but with modifications to the caval attachment sites and/or hooks at one end that can facilitate their removal (Figure 1). Retrievable filters that are currently available in the United States include the Günther Tulip (Cook Inc.), Opt Ease (Cordis Corp.), and Recovery nitinol filters (Bard Peripheral Vascular, Tempe, AZ) (Table 4).11 The time limit of retrievability is in part dependant on the rate of endothelialization of the device, which typically occurs within 2 weeks. However, differences in design may extend the time period in which the filter may be safely retrieved, as has been documented with the Recovery Filter.12

Currently no consensus exists as to which patients have an indication for a retrievable filter. However, it is generally accepted that patients at high risk for pulmonary embolism or with documented PE and with a temporary contraindication to anticoagulation are candidates (Table 5).

Placement of Suprarenal IVC FiltersCertain circumstances preclude the placement of a filter in the infrarenal IVC. This includes thrombus extending into the infrarenal IVC, renal vein thrombosis or pregnancy. The safety of suprarenal placement of IVC filters is well documented, with no reported instances of renal dysfunction and no differences in the rates of filter migration, recurrent PE or caval thrombosis.4

oo complex pelvic fractureso multiple long bone fractures

prophylactic placement before hip/knee replacement in patients with prior DVT

Inferior Vena Cava Filter Placement

What is inferior vena cava filter placement?

Inferior Vena Cava Filter Placement Care Guide

Inferior Vena Cava Filter Placement

Inferior Vena Cava Filter Placement Aftercare Instructions

Inferior Vena Cava Filter Placement Discharge Care

Inferior Vena Cava Filter Placement Inpatient Care

Inferior Vena Cava Filter Placement Precare

En Espanol

Inferior vena cava filter placement is surgery to place a filter into your inferior vena cava. The inferior vena cava, or IVC, is a large blood vessel found in your abdomen (stomach). It begins at your abdomen, and continues up to your heart, inside your chest. The IVC brings blood from the lower parts of your body back to your heart. During the procedure, a catheter (thin plastic tube) is inserted into the blood vessels in your neck or groin. A doppler ultrasound or fluoroscope (x-ray) is used to guide the catheter into your IVC. The IVC filter is inserted through the catheter and into the IVC where it attaches to the walls of the vein. The catheter is pulled out after the procedure and the filter is left in.

What is an inferior vena cava filter?

An IVC filter is a specially shaped mesh made of very thin wires. It is placed in the center of the IVC to trap blood clots going to your heart. This helps prevent the blood clots from blocking blood vessels in your lungs and causing serious problems. The following are the types of IVC filters:

Permanent filters: These filters are left firmly in the IVC and are not taken out. Examples include the Greenfield filter, Bird's Nest filter, and TrapEase filter.

Temporary or retrievable filters: These filters can be removed from the IVC after a period of time. They may also be left permanently in the IVC depending on the person's condition. Examples include the OptEase filter, Gunther Tulip filter, and Recovery filter. They have small hooks or knobs on one end so that they could be removed by caregivers. A special catheter with a hook is used to remove temporary IVC filters. Your caregiver will tell you when the IVC filter may be removed.

What is pulmonary embolism?

Pulmonary embolism is a condition where blood vessels in your lungs get blocked by a floating blood clot. When this happens, the area it supplies with blood may die and rot. You may have trouble breathing, chest pain, fainting, bluish skin color, and you may even die. The blood clot that causes this condition usually comes from the blood vessels in your legs or hips. Blood clots are made of fat and fibers. Clots that stick on blood vessel walls make the vessels narrow. They may completely clog the blood vessel, or they may break off from the walls and float in your blood.

Why might I need an inferior vena cava filter placed?

You may need surgery to place an IVC filter when you have blood clotting problems. You may also need it if you are at risk of having blood clots, such as during pregnancy or surgery. You may also need it after trauma, such as a head injury or fractured pelvis. A filter may also prevent patients who have a history of deep venous thrombosis, from getting clots in their lungs. When medicine to thin the blood cannot be used, an IVC filter may be placed.

What are the risks of having an inferior vena cava filter?

There are risks with IVC placement surgery, including infection and bleeding. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.

Your IVC and the tissue around it may get damaged. Your IVC filter may break, loosen, change position, or get blocked. If there are problems with your filter, you may need to have more surgery. Ask your caregiver if you have any questions or concerns about your condition, treatment, or care.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Copyright © 2011. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

DUPLEX VENOUS SCAN

WHAT IS A VENOUS DUPLEX STUDY?

Venous Duplex studies are simple, painless evaluations of the veins in the �

legs or arms.

WHY IS IT DONE?

This test is done to evaluate veins and to determine if clots are present. �

WHERE IS THE PROCEDURE DONE?

Vascular Lab, 2nd Floor, Tisch Hospital. �

HOW LONG DOES IT TAKE?

The test takes 20 minutes but you will be away from your room for about �

one hour.

WHAT PREPARATION IS NEEDED?

There is no preparation for this painless test. �

You may eat before the test. The nurse will give you your prescribed �

medications.

Escort staff will take you to the Vascular Lab in a wheelchair. �

WHAT HAPPENS DURING THE PROCEDURE? PATIENT & FAMILY EDUCATION / NYU Medical Center

Venous Duplex

The test is performed while you lie on a stretcher or hospital bed. �

The nurse or technician will place a small amount of gel on your legs or �

your arms and scan the veins with a duplex imaging machine.

Images are recorded while the technician performs the study. �

WHAT HAPPENS AFTER THE PROCEDURE?

You will be returned to your room where you can resume all previous �

activities if the results are negative and there is no blood clot present.

Your doctor will receive final results of the study within 48 hours. �

However, a preliminary report will be made available the same day.

What is Venous Ultrasound Imaging?

Ultrasound imaging, also called ultrasound scanning or sonography, involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. Ultrasound exams do not use ionizing radiation (as used in x-rays). Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels.Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions.Venous ultrasound provides pictures of the veins throughout the body.A Doppler ultrasound study may be part of a venous ultrasound examination.Doppler ultrasound is a special ultrasound technique that evaluates blood flow through a blood vessel, including the body's major arteries and veins in the abdomen, arms, legs and neck.

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What are some common uses of the procedure?

The most common reason for a venous ultrasound exam is to search for blood clots, especially in the veins of the leg. This condition is often referred to as deep vein thrombosis or DVT. These clots may break off and pass into the lungs, where they can cause a dangerous condition called pulmonary embolism. If the blood clot in the leg is found early enough, treatment can be started to prevent it from passing to the lung.A venous ultrasound study is also performed to: determine the cause of long-standing leg swelling. In people with a common

condition called varicose veins, the valves that keep blood flowing back to the heart in the right direction may be damaged, and venous ultrasound can help the radiologist decide how best to deal with this condition.

aid in the placement of a needle or catheter into a vein. Sonography can help locate the exact site of the vein and avoid complications, such as bleeding.

map out the veins in the leg or arm so that pieces of vein may be removed and used to bypass a narrowed or blocked blood vessel. An example is using pieces of vein from the leg to surgically bypass narrowed heart (coronary) arteries.

examine a blood vessel graft used for dialysis if it is not working as expected; for example, the graft may be narrowed or blocked.

Doppler ultrasound images can help the physician to see and evaluate: blockages to blood flow (such as clots). narrowing of vessels (which may be caused by plaque). tumors and congenital malformation.

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How should I prepare?

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.You may be asked to wear a gown during the procedure.A period of fasting is necessary only if you are to have an examination of veins in your abdomen. In this case, you will probably be asked not to ingest any food or fluids except water for six to eight hours ahead of time. Otherwise, there is no other special preparation for a venous ultrasound.

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What does the equipment look like?

Click to view larger

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.

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How does the procedure work?

Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.Doppler ultrasound, a special application of ultrasound, measures the direction and speed of blood cells as they move through vessels. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and creates graphs or color pictures that represent the flow of blood through the blood vessels.

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How is the procedure performed?

For most ultrasound exams, the patient is positioned lying face-up on an examination table that can be tilted or moved.A clear water-based gel is applied to the area of the body being studied to help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin. The sonographer (ultrasound technologist) or radiologist then presses the transducer firmly against the skin in various locations, sweeping over the area of interest or angling the sound beam from a farther location to better see an area of concern.Doppler sonography is performed using the same transducer.When the examination is complete, the patient may be asked to dress and wait while the ultrasound images are reviewed. However, the sonographer or radiologist is often able to review the ultrasound images in real-time as they are acquired and the patient can be released immediately.This ultrasound examination is usually completed within 30 to 45 minutes.

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What will I experience during and after the procedure?

Most ultrasound examinations are painless, fast and easy.

After you are positioned on the examination table, the radiologist or sonographer will apply some warm water-based gel on your skin and then place the transducer firmly against your body, moving it back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined.If scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer.Ultrasound exams in which the transducer is inserted into an opening of the body may produce minimal discomfort.If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured.Once the imaging is complete, the gel will be wiped off your skin.After an ultrasound exam, you should be able to resume your normal activities immediately.

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Who interprets the results and how do I get them?

A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician or the physician who referred you for the exam, who will share the results with you. In some cases the radiologist may discuss results with you at the conclusion of your examination.

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What are the benefits vs. risks?

Benefits

Most ultrasound scanning is noninvasive (no needles or injections) and is usually painless.

Ultrasound is widely available, easy-to-use and less expensive than other imaging methods.

Ultrasound imaging does not use any ionizing radiation. Ultrasound scanning gives a clear picture of soft tissues that do not show up

well on x-ray images. Venous ultrasound helps to detect blood clots in the veins of the legs before

they become dislodged and pass to the lungs. It can also show the movement of blood within blood vessels.

Compared to venography, which requires injecting contrast material into a vein, venous ultrasound is accurate for detecting blood clots in the veins of the thigh up to the knee. In the calf, because the veins become very small, ultrasound is less accurate. However, potentially dangerous venous clots are lodged in the larger veins.

Total abdominal hysterectomy bilateral salpingo oophorectomy (TAHBSO) is the removal of entire uterus, the ovaries, fallopian tubes and the cervix. TAHBSO is usually performed in the case of uterine and cervical cancer. This is the most common kind of hysterectomy. Removal of the ovaries eliminates the main source of the hormone estrogen, so menopause occurs immediately.

Lifestyle modifications

    A. Avoid obesity and inactivity

        i. Nutrition without excess calories

        ii. Exercise

            1. Daily aerobic such as walking

            2. Anaerobic activity useful for muscle toning

                a. Heavy weightlifting may traumatize muscles

                b. Anaerobic does not substitute for aerobic

    B. Avoid dehydration

        i. Drink water

        ii. Minimize alcohol consumption

    C. Avoid cigarette smoking

        i. Quit smoking

            1. Willpower is best

            2. Nicotine patch, gum, nasal spray

            3. Bupropion (Wellbutrin [GlaxoSmithKline])

    D. Maintain normal blood pressure

        i. Note some guidelines define normal as <120/80 mm Hg rather than <140/90 mm Hg

        ii. If lifestyle changes do not reduce blood pressure, use medication

II. Mechanical measures

    A. Vascular compression stockings

        i. 10 to 18 mm Hg if immobilized or in bed; otherwise, use higher compression levels

        ii. 20 to 30 mm Hg below-knee stockings if no varicose veins, swelling, or skin pigmentation changes

        iii. 30 to 40 mm Hg below-knee stockings if leg exam has evidence of prior venous disease

    B. Intermittent pneumatic compression boots

        i. Ideal for immobilized patients, either in hospital, skilled nursing facility, or at home

        ii. Device is better tolerated when combined with 10- to 18-mm Hg vascular compression stockings

        iii. Some devices have “cooling buttons” to enhance comfort

III. Pharmacological measures

    A. Injectable medications

        i. Low-molecular-weight heparin

            1. Enoxaparin 40 mg daily

            2. Dalteparin 5000 Units daily

        ii. Unfractionated heparin 5000 Units every 8 hours

        iii. Fondaparinux 2.5 mg daily

    B. Oral medication

        i. Warfarin

    C. Baby aspirin 81 mg daily

        i. Provides more protection against heart attack and stroke than against DVT

        ii. DVT prevention effect is weak

Deep venous thrombosis

Deep venous thrombosis is the formation of a blood clot in a vein that is deep inside a part of the body, usually the legs.

Causes

Deep venous thrombosis (DVT) mainly affects the large veins in the lower leg and thigh. The clot can block blood flow and cause swelling and pain. When a clot breaks off and moves through the bloodstream, this is called an embolism. An embolism can get stuck in the brain, lungs, heart, or other area, leading to severe damage.

Blood clots may form when something slows or changes the flow of blood in the veins. Risk factors include:

After a pacemaker catheter has been passed through the vein in the groin Bedrest Cigarette smoking Family history of blood clots Fractures  in the pelvis or legs Giving birth within the last 6 months Heart failure Obesity

Recent surgery (especially hip, knee, or female pelvic surgery) Too many blood cells being made by the bone marrow (polycythemia vera), causing

the blood to be thicker and slower than normal

You're also more likely to develop DVT if you have any of the following conditions:

Blood that is more likely to clot (hypercoagulability) Cancer Taking estrogens or birth control pills. This risk is even higher if you smoke.

DVTs are most common in adults over age 60, but can occur at any age.

Sitting for long periods when traveling can increase the risk of DVTs. This is most likely when one or more of the risk factors listed above are also present.

Symptoms

Changes in skin color (redness) in one leg Increased warmth in one leg Leg pain  in one leg Leg tenderness in one leg Skin that feels warm to the touch Swelling  (edema) of one leg

Exams and Tests

Your health care provider will perform a physical exam. The exam may show a red, swollen, or tender leg.

The following tests may be done:

D-dimer blood test Doppler ultrasound exam of the legs Plethysmography  (measurement of blood flow) of the legs X-rays to show veins in the affected area(venography)

Blood tests may be done to check if there is increased chance of blood clotting (hypercoagulability). Such tests include:

Activated protein C resistance (checks for the Factor V Leiden mutation) Antithrombin III  levels Antiphospholipid antibodies Genetic testing to look for mutations that make you more likely to develop blood

clots, such as the prothrombin G20210A mutation Lupus anticoagulant  or Protein C and protein S levels Screening for disseminated intravascular coagulation (DIC)

This list is not all-inclusive.

Treatment

Your doctor will give you medicine to thin your blood (called an anticoagulant). This will keep more clots from forming or old ones from getting bigger. These drugs cannot dissolve existing clots.

Heparin is usually the first drug given.

If heparin is given through a vein (IV), you must stay in the hospital. Newer forms of heparin can be given by injection once or twice a day. You may not

need to stay in the hospital as long, or at all, if you are prescribed this newer form of heparin.

A drug called warfarin (Coumadin) is usually started along with heparin.

Warfarin is taken by mouth. It takes several days to fully work. Heparin is not stopped until the warfarin has been at the right dose for at least 2

days. You will most likely take warfarin at least 3 months. Some people must take it for the

rest of their lives, depending on their risk for another clot.

When you are taking warfarin, you are more likely to bleed, even from activities you have always done.

Changing how you take your warfarin, taking certain medicines, and eating certain foods can change the way the warfarin works in your body. If this happens, you may be more likely to form a clot or have bleeding problems. Never stop taking your medicine or change the dose without talking to your doctor.

If you are taking warfarin:

Take the medicine just the way your doctor prescribed it Ask the doctor what to do if you miss a dose You will need to get blood tests often to make sure you are taking the right dose

You will be given a pressure stocking to wear on your leg or legs. A pressure stocking improves blood flow in your legs, and reduce your risk for blood clots. It is important to wear these every day.

In rare cases, surgery may be needed if medicines do not work. Surgery may involve:

Placement of a filter in the body's largest vein to prevent blood clots from traveling to the lungs

Removal of a large blood clot from the vein or injection of clot-busting medicines

Outlook (Prognosis)

Many DVTs disappear without a problem, but they can return. Some people may have long-term pain and swelling in the leg known as post-phlebitic syndrome. Wearing tight (compression) stockings during and after the DVT may help prevent this problem.

Blood clots in the thigh are more likely to break off and cause pulmonary embolism (PE) than blood clots in the lower leg or other parts of the body.

Possible Complications

A blood clot can break free in the leg and travel to the lungs (pulmonary embolus) or anywhere else in the body, and can be life threatening. Rapid treatment of DVT helps prevent this problem.

Post-phlebitic syndrome refers to long-term swelling (edema) in the leg that had the deep vein thrombosis. Changes in skin color and pain can also be present. These symptoms may be noticed right away, or may not develop for one or more years afterward. This problem is called post-thrombotic syndrome.

When to Contact a Medical Professional

Call your health care provider if you have symptoms of DVT.

Go to the emergency room or call the local emergency number (such as 911) if you have DVT and you developchest pain, difficulty breathing, coughing blood, fainting, loss of consciousness, or other severe symptoms.

Prevention

Wear the pressure stockings your doctor prescribed. They will improve blood flow in your legs and reduce your risk for blood clots.

Doctors may prescribe blood thinners to help prevent DVT in people at high risk, or those who are undergoing high-risk surgery.

Moving your legs often during long plane trips, car trips, and other situations in which you are sitting or lying down for long periods of time can also help prevent DVT. People at very high risk for blood clots may need heparin shots when they are on a flight that lasts longer than 4 hours.

Do not smoke. If you smoke, quit. Women who are taking birth control pills or estrogen must stop smoking. 

w does a Jackson Pratt drain work?

The JP drain removes fluids by creating suction (pulling) in the tube. To produce suction, the bulb is pressed flat and is connected to the tube sticking out of your body. Suction is created as the bulb sucks in air from the tube going into your body. This pulls fluid out from the area where the drain was placed and into the rubber tubing. The fluid then travels through the tubing and into the bulb of the JP drain. As the JP drain bulb fills with fluid, it goes back to its round shape.

Why do I need a Jackson Pratt drain?

When fluid builds up in a body area, the area may not heal as fast as it should, or an infection may start. Too much fluid in a body area may also cause pain and swelling. Using a JP drain after surgery may help you heal faster and decrease your risk of getting an infection. The JP drain also helps clear away pus and may help infections heal faster. A JP drain may be used after surgery on your spine to check if spinal fluid is leaking, and collect it. JP drains may also be used after skin flap surgery and skin grafting.

When is a Jackson Pratt drain removed?

The amount of fluid that comes out of the surgery or wound area and into the JP drain will decrease as the area heals. In most cases, the drain will need to stay in place until less than 30 milliliters (about two tablespoons) of fluid are draining from it in a day. Your caregiver will keep track of how much fluid is draining into the JP drain, and he will tell you when the drain will be taken out. If you are caring for your JP drain at home, you will need to keep track of the amount of fluid that you are emptying from the drain.

What are the risks of having a Jackson Pratt drain?

If a JP drain is not taken care of correctly, it may allow germs to enter your body and cause an infection. If the drain is placed after certain types of surgery, you may get an infection if it stays in your body longer than it is needed. If you get an infection, you may have more pain and swelling, and your wound will heal more slowly, or it may not heal at all. The end of the tubing inside your body may get blocked with blood or other materials. If this happens, the bulb cannot correctly suction fluids. You may develop a fistula (unwanted tunnel), or the drain may make a hole in your intestine. If you have a drain after skin flap or skin graft surgery, the tissue may not heal.

How do I take care of the skin around my Jackson Pratt drain entry site?

Change bandages at the JP drain entry site every day to keep it clean and dry. Your caregiver will tell you if you need to do this more often. Collect the following items and place them where they can be reached easily:

Two pairs of clean medical gloves.

A clean container.

5 to 6 new cotton swabs.

New gauze pads.

Saline solution or soap and water.

Plastic trash bag.

Surgical tape.

Waterproof pad or bath towel.

Follow these steps to care for your skin around the JP drain entry site:

Wash your hands with soap and water. Dry your hands and put on clean gloves.

Loosen the tape and gently remove the old bandage. Throw the old bandage into a plastic trash bag.

Look for any new redness, swelling, or pus at the place where the drain enters your skin. Check for a foul (bad) smell coming from the area. Tell caregivers if you see any of these changes. Make sure the stitches that attach the JP drain to your skin are tight. Tell caregivers if they are loose or missing.

Place a waterproof pad or towel under the JP drain to soak up any spills.

Pour a small amount of saline solution or clean water into a container. Dip a cotton swab in the solution once. Gently clean the skin around the drain, moving in circles. Start from the place where the drain enters your skin and clean outward in circles, moving away from the insertion site. Clean your skin 3 to 4 times, using a new swab each time.

Let the skin dry. Take your gloves off and put on a clean pair. When the area is dry, put a new bandage around the JP tube entry site. Use surgical tape to hold it down against your skin. Tape the tubing down to the bandages. Attach the bulb to your clothing using a safety pin.

Throw all used supplies in the trash bag along with your gloves. Wash your hands after you are finished.

When do I empty the Jackson Pratt drain?

For the first 24 hours (one day) after most types of surgery, there will often be drainage coming out of the wound. Check the drain at least every four hours. Empty it if it is half full of fluid. Do not let the drain fill up any more than half full. After one day, empty your JP drain when it fills up half way, or every 8 to 12 hours even if it is not half full. After the drain is emptied, the empty bulb needs to be squeezed. This is done to keep the suction of the JP drain strong enough to pull out more fluid.

How do I empty the Jackson Pratt drain?

The following are general directions for emptying the JP drain bulb, and squeezing the bulb. Gather the following supplies, and place them where they can be easily reached:

One pair of clean medical gloves.

Clean measuring container.

Cotton balls.

Medical alcohol or alcohol swab.

Notebook.

Plastic trash bag.

Follow these steps to empty the JP drain:

Wash your hands with soap and water. Dry your hands and put on clean gloves.

Place a waterproof pad or towel under the JP drain to soak up any spills. Place the bulb lower than the wound to prevent fluid from going back into your body. Check the bulb for any holes or cracks.

Remove the plug at one side of the bulb and pour the fluid into a measuring container. Do not touch the tip of the spout with the mouth of the collection cup or anything else. This keeps germs from getting inside the bulb and tubing. Clean the plug with a cotton ball dipped in alcohol, or an alcohol swab.

Squeeze the bulb tightly while the plug is still off. Do not squeeze the bulb if the plug is in place. While the bulb is being squeezed, put the plug back to seal the bulb. If you cannot squeeze it and plug it at the same time, ask someone for help. You may also place the bulb on a hard surface, such as a table. Use your elbow or hand to press down hard on the bulb, and then stick the plug in it.

Measure the amount of fluid that came out of the JP drain bulb. Write down the amount, color, and odor of the fluid, and the date and time that you collected it. Use a piece of paper, a notebook, or JP drainage chart to keep track of this information.

Flush the fluid down the toilet. Throw all used supplies in the trash bag along with your gloves. Wash your hands after you are finished.

What can I do to prevent problems with my JP drain?

Always keep the bulb lower than the wound. This will stop the fluid from going back into your body.

Do not pull on the tubing. This can loosen the stitches holding the drain to your skin, causing the drain to fall out.

When should I call my caregiver?

Call your caregiver if:

The fluid removed by the JP drain is cloudy, yellow, or foul-smelling.

You have more swelling or redness where the drain enters your skin.

You feel more pain in the area of your drain.

You see holes or cracks in the tubing or bulb of the drain, or the drain is leaking.

When should I seek immediate help?

Go to the nearest emergency room if:

Liquid has suddenly stopped coming into the bulb of your JP drain.

The JP drain starts filling up very quickly with bright red blood.

The JP drain stitches come loose or break off.

You have a fever (increased body temperature).

Your bandages are soaked with blood.

Your JP drain comes out.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about Jackson Pratt drains and how they are used. Make sure all your questions are answered. You can then discuss treatment options with your caregivers. Work with them to decide what treatment will be best for you. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.