Can Nurses Remove Drains?

Can Nurses Remove Drains? The Scope of Nursing Practice

Whether or not nurses can remove drains depends heavily on jurisdiction, institutional policy, and the specific type of drain. In many settings and with proper training and orders, qualified nurses can and do safely remove various types of drainage devices.

Background: Drainage Systems and Nursing Roles

Surgical drains are indispensable tools in postoperative care, strategically placed to evacuate fluids – blood, serum, or pus – from surgical sites. These fluids, if left to accumulate, can lead to complications like infection, hematoma formation, and delayed wound healing. The removal of these drains is a crucial step in a patient’s recovery. Historically, drain removal was solely the domain of physicians. However, the expanding scope of nursing practice and the increasing demand for efficient patient care have led to a paradigm shift. Can nurses remove drains? The answer is increasingly yes, but with significant caveats.

Benefits of Nurse-Led Drain Removal

Empowering nurses to remove drains offers numerous advantages:

• Improved Patient Throughput: Streamlines discharge processes, reducing hospital stay duration.
• Enhanced Patient Satisfaction: Allows for quicker relief from drain-related discomfort.
• Cost-Effectiveness: Reduces reliance on physician time, optimizing resource allocation.
• Expanded Nursing Skills: Enhances professional development and job satisfaction.
• Reduced Wait Times: Patients experience faster access to drain removal, minimizing anxiety.

The Drain Removal Process: A Step-by-Step Guide

The typical drain removal process, when delegated to a nurse, involves:

1. Assessment: Evaluating the drainage characteristics (amount, color, consistency) and the surrounding skin for signs of infection or complications.
2. Physician Order Verification: Confirming a valid order for drain removal exists in the patient’s chart.
3. Patient Education: Explaining the procedure to the patient, addressing any concerns, and obtaining informed consent.
4. Gathering Supplies: Assembling necessary materials, including gloves, antiseptic wipes, suture removal kit (if sutures are securing the drain), and dressings.
5. Preparation: Positioning the patient comfortably and creating a sterile field around the drain site.
6. Drain Removal: Carefully removing sutures (if present) and gently extracting the drain, ensuring minimal discomfort to the patient.
7. Wound Care: Cleaning the drain site with antiseptic wipes, applying a sterile dressing, and providing instructions on wound care.
8. Documentation: Recording the date, time, drain characteristics, and patient response in the patient’s medical record.

Types of Drains Commonly Removed by Nurses

The types of drains nurses are typically authorized to remove vary depending on institutional policy and nurse competency. Common examples include:

• Jackson-Pratt (JP) Drains: Bulb-shaped drains that create suction to remove fluid.
• Hemovac Drains: Spring-activated drains that also rely on suction.
• Penrose Drains: Passive drains that rely on gravity and capillary action.
• Sump Drains: Utilize dual-lumen catheters, one to remove fluids and one to provide air.

Potential Risks and Complications

While generally safe, drain removal can carry potential risks:

• Infection: Improper technique can introduce bacteria into the wound.
• Bleeding: Although rare, bleeding can occur if the drain site is not adequately compressed after removal.
• Seroma Formation: Fluid accumulation at the drain site.
• Pain: Some patients may experience discomfort during drain removal.
• Incomplete Removal: Fragment of drain breaking off inside the patient which may require surgical removal.

Factors Influencing Nursing Authority

Several factors influence can nurses remove drains.

• State Nurse Practice Acts: These laws define the scope of nursing practice in each state.
• Institutional Policies: Hospitals and healthcare facilities have their own policies regarding which procedures nurses can perform.
• Nurse Competency: Nurses must demonstrate competency in drain removal through training and experience.
• Physician Orders: A valid physician order is typically required before a nurse can remove a drain.
• Type of Drain: Some drains, particularly those in sensitive areas or with complex insertion methods, may require physician removal.

Training and Competency Verification

To ensure patient safety, nurses must receive adequate training and undergo competency verification before being authorized to remove drains. This typically includes:

• Didactic instruction on drain types, indications, and removal techniques.
• Supervised practice in drain removal under the guidance of experienced nurses or physicians.
• Demonstration of proficiency in aseptic technique and wound care.
• Regular competency assessments to maintain skills and knowledge.

When to Consult a Physician

While nurses can remove drains, certain situations necessitate physician consultation or intervention:

• Excessive bleeding at the drain site.
• Signs of infection, such as redness, swelling, or purulent drainage.
• Unusual pain or discomfort reported by the patient.
• Difficulty removing the drain.
• Concerns about the patient’s overall condition.

Documentation and Legal Considerations

Accurate and thorough documentation is crucial. Nurses should record:

• Date and time of drain removal.
• Type of drain removed.
• Drainage characteristics (amount, color, consistency).
• Appearance of the drain site.
• Patient’s response to the procedure.
• Any complications encountered.

Comprehensive documentation is essential for legal protection and continuity of care.

Frequently Asked Questions (FAQs)

Can LPNs remove drains?

• The ability of Licensed Practical Nurses (LPNs) to remove drains varies significantly depending on state regulations and institutional policies. While some states permit LPNs to remove certain types of drains under the supervision of a Registered Nurse (RN) or physician, others restrict this task to RNs or physicians only. It’s crucial to consult specific state nurse practice acts and facility guidelines to determine the permissible scope of practice for LPNs.

What are the key differences between removing a JP drain and a Hemovac drain?

• While both JP and Hemovac drains operate on the principle of suction to remove fluids, their mechanisms differ slightly. JP drains utilize a bulb that is compressed to create suction, while Hemovac drains use a spring-activated mechanism. The removal technique is similar, but nurses need to be familiar with the specific mechanism of each drain to ensure proper re-establishment of suction post-removal, should the drain need to be reinserted.

What if the drain feels stuck during removal?

• If a drain feels stuck or resistant to removal, it’s crucial to stop immediately and notify a physician. Forcing the drain can cause tissue damage or leave a fragment behind. The physician can assess the situation and determine the appropriate course of action, which may involve further imaging or surgical intervention.

How much drainage is considered normal before drain removal?

• The acceptable amount of drainage before drain removal varies based on the type of surgery, drain placement, and individual patient factors. Generally, a significant decrease in drainage, often defined as less than 30 mL per day, is a common criterion. The physician’s order for drain removal should specify the acceptable drainage parameters. Always clarify any ambiguities with the physician before proceeding.

What are the signs of a drain site infection after removal?

• Signs of a drain site infection after removal include increasing pain, redness, swelling, warmth, purulent drainage, and fever. If any of these symptoms are present, the patient should be instructed to contact their healthcare provider immediately. Prompt treatment with antibiotics is often necessary to prevent the infection from spreading.

Can patients remove their own drains at home?

• Typically, patients are not advised to remove their own drains at home, unless explicitly instructed and trained by a healthcare professional. While seemingly simple, the procedure requires aseptic technique and careful assessment of the wound. Premature or improper removal can lead to complications.

What kind of dressing should be applied after drain removal?

• After drain removal, a sterile dressing should be applied to protect the wound and absorb any residual drainage. A simple adhesive bandage or a gauze pad secured with tape is usually sufficient. The dressing should be changed regularly, and the wound should be monitored for signs of infection.

What are the legal implications of nurses removing drains incorrectly?

• Incorrect drain removal can have significant legal implications for nurses. If negligence leads to patient harm, the nurse may face disciplinary action from their licensing board and potential legal action. Adhering to established protocols, obtaining proper training, and documenting the procedure thoroughly are essential to minimize legal risks.

How often should the drain site be cleaned after drain removal?

• The drain site should be cleaned gently with soap and water once or twice a day, or as directed by the healthcare provider. Avoid harsh scrubbing or irritating cleansers. Pat the area dry with a clean towel and apply a fresh dressing.

What if a small amount of fluid continues to leak from the drain site after removal?

• It’s common for a small amount of fluid to continue to leak from the drain site for a few days after removal. This is usually not a cause for concern. However, if the leakage is excessive or accompanied by signs of infection, the patient should contact their healthcare provider.

What specific documentation is required after nurse-led drain removal?

• Beyond the standard documentation requirements, it is particularly important to document: the specific type and size of the drain; the number of days the drain was in situ; the exact location of the drain insertion site; patient tolerance of the procedure; and any post-removal patient education provided. Clear and detailed documentation reinforces accountability and supports patient safety.

Can advanced practice registered nurses (APRNs) remove drains?

• Advanced Practice Registered Nurses (APRNs), such as nurse practitioners (NPs) and certified nurse specialists (CNSs), typically have a broader scope of practice than registered nurses (RNs). Therefore, APRNs are often authorized to remove drains, including more complex types, within their area of specialization and according to state regulations and institutional policies.