Hemovac, Jackson-Pratt & Vascular Graft.

Dr. O’Shea’s Tutorial.Valmiki Seecheran.

Surgery Senior Clerkship.

UWI Cave Hill | Class of 2015.

Closed-Active Drains.

• Hemovac.

• Jackson Pratt.

• J-Vac.

• Chest tube on suction. (*Passive)

Closed-Active Drains.

• Indications.

• Large potential dead space.

• Necrotic or infected tissue.

• Uncertain hemostasis.

• Fistula.

• Significant amount of fluid accumulation.

• Examples:

• Abdominal surgery.

• Breast surgery.

• Mastectomy.

• Thoracic surgery.

Anatomy.

• A drainage tube that is inserted at the site of incision with multiple fenestrations that allow for fluid to flow in.

• A tube connected to a flexible bulb that acts a s a reservoir for collected fluid.

• An ejection hole and plug to remove drained fluid.

• May have a ring to allow hanging from patient’s clothes.

Jackson Pratt Drain.

• Is an active close drain.

• Drains about 100cc.

• Care• Drain should be emptied when half full to avoid discomfort by weight.• Plug is removed and care must be taken not to touch ends to minimize

contamination.• Bulb should be squeezed in and the plug and ejection hold wiped with an alcohol pad

then recapped to restore vacuum.• Removed on a 24 hour basis.

• Complications.• Clot.• Infection.

Anatomy.

• A drainage tube, which can be single or dual, that is inserted at the site of incision with multiple fenestrations that allow for fluid to flow in.

• A large cylindrical reservoir that collects the fluid

• Springs inside the reservoir that can be compressed to create negative pressure and allow suctioning.

• An ejection hole and plug to empty drained fluid.

Hemovac.

• Is an active closed drain.

• Drains about 200, 400 & 800ccs.• Because it is closed there is less likely to be secondary infection.

• Care -• Drain should be emptied when half full, contents measured and recorded.

• Ends should be wiped clean before recapping to minimize contamination.

• Complications.• Clots

• Infection – site of incision becomes red, swollen or tender and the fluid is yellow tinged or foul smelling. Patient may have a fever.

Vascular graft.

• Redirect blood flow in a region of body.

• Autograft/ Allograft.

• Synthetic.• ePTFE, dacron.

• Dacron grafts are frequently used in aortic and aorto-iliac surgery. • E.g.. Aneurysm.

• Venous grafts have a superior result to synthetic grafts when used below the inguinal ligament.*

Medical uses.

• Cardiac bypass.

• Lower extremity bypass – manage PVD, aneurysms, trauma.• ‘Fem-fem’ – No inflow to one fem artery but there is aortic flow.

• ‘Aorto-Bi-Fem’- Aortic to bilateral femoral arteries. Disease @ aortic bifurcation/ iliac arteries.

• ‘Fem-Tib’ –Fem to 1 of 3 tibial arteries. Used for disease of femoral/ tibial arteries.

• ‘DP’- Distal target is dorsalis pedis artery.

• Hemodialysis access.• Arteriovenous fistula – connects a vein to an artery without synthetic material.

• Cerebral artery bypass.

Contraindications.

• Lack of an adequate venous conduit.

• Medical co-morbidities increase risk of surgery.

• ‘High risk’ – candidate for angioplasty.

Technique.

• Obtain proximal and distal control.

• Exposure of furthest and nearest extents of vessel where bypass is to be created – minimize and visualize blood loss.

• Intervening occlusion – no blood flow through target vessel, no hemostasis.

Complications.

• Acute Graft Occlussion.• Blockage of vascular bypass graft shortly after procedure.

• Perforation, dissection.

• Requires reoperation.

• Hemorrhage.

• Infection.

• Embolism.

PTFE (polytetrafluroethylene).

• Gortex is a synthetic vascular graft.

• Indications:• As a vascular prosthesis for replacement or bypass of diseased vessels in

patients suffering occlusive or aneurysmal disease.

• In trauma patients requiring vascular replacement.

• For dialysis access or for other vascular procedures.

PTFE (polytetrafluroethylene)

• Contraindications:• Should not be used as a patch leaking.

• Should not be used for CABG or cerebral reconstruction procedures.

• Complications:• Graft occlusion.

• Graft infection.

• True and false aneurysms at the site of anastomosis.

• Distal embolization.

• Erosion into adjacent structures e.g. aorto-enteric fistulae.

Thank you.