If you have a mastectomy (with or without reconstruction), you’ll come home with at least one Jackson-Pratt (JP) drain. If you have axillary lymph node dissection, that will mean an additional drain. I had a bilateral mastectomy as well as the lymph node surgery, so I came home with three drains.
The JP drain consists of a flexible plastic tube inserted under the skin near your incisions; a suture (stitch) will hold it in place.
The tube dangles outside of your body with a bulb attached to it. The exact placement depends on the type of surgery and where your lymph nodes were removed.
Your nurse will teach you how to empty your drain before you leave the hospital.
What does the JP drain do?
The JP drain prevents fluid build up in a post-surgical site, minimizes the risk of infection, and speeds healing. It also minimizes swelling and pain. It operates via suction. As healing occurs, the fluid changes in color from bloody red to straw yellow. The quantity declines over time as well.
Keep them from dangling
When I woke up in the hospital, I discovered the three drains pinned to the super ace bandage that encircled my chest. Each was numbered, because the contents of each bulb need to be measured each day. This is the simplest — and least expensive — way to manage the drains: use large safety pins to attach each bulb to your clothes.
The important thing is that the bulbs should not dangle freely. If you have a fanny pack or belt bag, that might be more comfortable than safety pins.
My pre-op care team at Seattle Cancer Care Alliance gave me a prescription for a post-surgical camisole that I filled at Nordstrom (covered by my insurance). The camisole includes pouches for drains (yeah, velcro) and soft foam for a temporary prothesis if desired.
If you are having a bilateral mastectomy, I recommend going “up” in size. It’s hard to imagine what it’s going to fit like without breasts, so trust me on this.
My fitter used the company’s bra-size-to-Amoena-size guide, which was far too tight across and around the chest after surgery. My care team was shocked, at my one-week post-op visit. Thankfully, Nordstrom being Nordstrom, they exchanged both my unopened package and my used camisole for a more comfortable one.
In addition, if you have a bilateral mastectomy you don’t have to stick with your pre-surgery cup size; you can go up or down (A/B or C/D).
Going out in public with your JP drains
Regardless of whether you have one drain or four, you’re going to want button up not pull-over-your-head shirts to wear. Whether you have pinned the drains to your clothing or use a post-surgical camisole, considered adding oversized to that requirement as the number of drains increases.
I chose Hawaiian shirts, some from my husband’s side of the closet and some from Goodwill.
When you’re getting dressed, be careful not to let the drain tubes catch on anything.
Sleeping with your JP drains
If you normally sleep on your back, sleeping with the drains will be a non-event (relatively speaking).
If you normally sleep on your side, not so much.
The first week, I slept on my back, even though it’s not the best sleeping position for my sleep apnea (even with a CPAP). Eventually, I was able to sleep somewhat on my side by using a pillow for support. However, even at two weeks, I was not comfortable sleeping flat; I used a wedge pillow. And slept in 3-4 hour bursts/shifts.
You are likely to wake up — at least momentarily — if you turn over.
Managing your JP drains
Empty the bulb twice a day
You will empty your JP drains twice a day, measuring the contents each time. Your care team should give you a sheet to record each drain before your discharge. Shoot for approximately 12-hour intervals.
- Alcohol wipes
- Measuring cup
- Drainage logs
- Pen or pencil
How to empty the drain
- Wash your hands well with soap and water.
- Use your thumb and forefinger to pinch the tubing close to where it goes into your skin a few times.
- Milk the tube to help move clots by moving your thumb and forefinger a bit away from the body. Hold the tube in place. With your other hand, pinch your thumb and forefinger together, then slide them down the tubing, pushing any clots toward the drainage bulb.
- Repeat if needed. Be sure not to pull on the insertion site.
- Unplug the stopper on top of the bulb; the bulb will expand. Do not touch the inside of the stopper or the inner area of the opening on the bulb.
- Turn the bulb upside down and gently squeeze the bulb to release its contents into a measuring cup.
- Clean the plug with your alcohol wipe.
- Then squeeze the bulb flat, and insert the plug back into the bulb. The bulb should remain flat after it is plugged so that the vacuum suction can restart.
- Measure how much fluid you collected. Once you get below about 25 or 30 cc, use a 10 cc syringe to measure contents.
- Record the amount of drainage, the date and time you collected it, its color as well as its smell on its drainage log.
- Flush the fluid down the toilet.
- Rinse the measuring cup (and syringe if used) thoroughly.
- Repeat for each drain; each should have its own record.
- Wash your hands.
Inspect the drain dressing
You might have a dressing around the drain at the insertion site. If so, you’ll need to keep it dry and replace it periodically.
- Alcohol wipes or cotton swabs
- Gauze bandage
- Paper tape
How to change the dressing
- Wash your hands well with soap and water.
- Gently remove the existing gauze and tape
- Use alcohol wipes or a cotton swab dipped in the soapy water to clean the skin around the drain.
- Put a new gauze bandage around the drain tube site.
- Use surgical tape to secure the gauze.