Chart — Perioperative Nursing
Surgical Drain Comparison
Side-by-side comparison of the major surgical drain types — chest tube, Jackson-Pratt, Hemovac, Penrose, and Blake drain: mechanism, suction type, common uses, nursing management, output monitoring, and key complications.
Educational use only. Drain management protocols are individualized and facility-specific. Follow provider orders for all drain care, stripping, milking, and removal. Sudden increases in bright red output from any drain require immediate provider notification. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Chest Tube (Thoracostomy)
Water-seal passive drainage OR regulated suctionMechanism
Three-chamber water-seal drainage system. Chamber 1 collects drainage. Chamber 2 prevents air backflow (water seal). Chamber 3 controls suction level.
Typical Uses
- ✦Pneumothorax
- ✦Hemothorax
- ✦Pleural effusion
- ✦Empyema
- ✦Post-thoracic/cardiac surgery
Output Monitoring
Record drainage per shift. Mark drainage level on collection chamber. Assess tidaling (water rising/falling with respiration = patent tube). Assess for air leak in water-seal chamber.
Management
Keep system below chest level at all times. Do not clamp without order. Prevent dependent loops. Tape all connections.
Complications
- ·Air leak (continuous bubbling in water-seal chamber)
- ·Tube dislodgement or disconnection
- ·Obstruction (no tidaling, no drainage)
- ·Subcutaneous emphysema
Disconnection: submerge end in sterile water. Dislodgement: seal with petroleum gauze (3 sides open).
Jackson-Pratt (JP) Drain
Active — closed negative pressureMechanism
Flat, bulb-shaped reservoir connected to a perforated silicone drain at the surgical site. Negative pressure (suction) is created by compressing and capping the bulb.
Typical Uses
- ✦Mastectomy
- ✦Pelvic/abdominal surgery
- ✦Lymph node dissection
- ✦Major orthopedic procedures
Output Monitoring
Empty when half full or per protocol. Record volume and character. Expected: bright red → serosanguineous → serous over days.
Management
Compress bulb FULLY before capping to re-establish suction. Secure tubing to prevent traction. Mark skin at exit site for migration monitoring.
Complications
- ·Loss of suction (bulb not properly compressed)
- ·Tube obstruction
- ·Infection at exit site
- ·Inadvertent removal
Sudden increase in bright red output: assess for hemorrhage — notify provider STAT.
Hemovac Drain
Active — closed spring-loaded negative pressureMechanism
Flat, accordion-style (spring-loaded) reservoir. Suction is created when compressed flat and capped — spring tension causes reservoir to expand, drawing drainage in.
Typical Uses
- ✦Total joint replacement (hip, knee)
- ✦Large abdominal or orthopedic surgeries
- ✦Higher-volume drainage expected
Output Monitoring
Empty when half full or per protocol. Record output each emptying. Assess that suction is maintained (reservoir remains compressed between empties).
Management
Compress FLAT (squeeze out all air) before capping. Secure and position below surgical site. Higher volume capacity than JP drain.
Complications
- ·Loss of suction (reservoir not fully compressed)
- ·Tube kinking or obstruction
- ·Site infection
Sudden bright red output increase or hemodynamic instability: notify provider immediately.
Penrose Drain
Passive — open drainage (gravity and capillary)Mechanism
Soft, flat rubber tube with no reservoir. Drainage occurs by gravity and capillary action — passive, open drainage. Fluid wicks through the tube and absorbs into surrounding dressings.
Typical Uses
- ✦Abscess drainage
- ✦Superficial wound drainage
- ✦Bile leak after cholecystectomy
- ✦Situations where active suction is NOT desired
Output Monitoring
Drainage absorbs into dressings. Assess dressing saturation. Weigh dressings or estimate saturation to quantify. Assess drainage color and odor.
Management
Frequent dressing changes required (absorptive dressings). Protect periwound skin from maceration. Safety pin or suture secures drain from complete withdrawal. Provider gradually shortens drain as wound heals.
Complications
- ·Skin maceration from continuous drainage
- ·Premature drain withdrawal
- ·Periwound skin breakdown
- ·Foul odor indicating infection
Foul-smelling or purulent drainage: assess for infection — notify provider.
Blake Drain
Active — closed negative pressure (via connected reservoir)Mechanism
Silicone drain with longitudinal fluted channels along the exterior surface. Drainage occurs via capillary action along the flutes and negative pressure from connected reservoir. Less tissue trauma than older designs.
Typical Uses
- ✦Abdominal surgery
- ✦Thoracic surgery
- ✦Hepatobiliary surgery
- ✦Increasingly replacing round drain designs
Output Monitoring
Similar to JP drain. Record output volume and character per shift. Assess reservoir suction. Decreasing output over days is expected.
Management
Connected to closed-suction reservoir (similar to JP). Minimal manipulation — secure and protect from traction. Monitor exit site for infection or tube migration.
Complications
- ·Obstruction (fluted channels can occlude)
- ·Loss of suction (same as JP)
- ·Site infection
- ·Inadvertent removal
Sudden cessation of drainage with persistent symptoms: possible obstruction — notify provider.
| Drain | Suction | How to Empty/Reset | Key NCLEX Point |
|---|---|---|---|
| Chest Tube | Water-seal or regulated suction | Never clamp without order; keep below chest level; mark and document drainage q shift | Tidaling (water rises/falls with breathing) = tube patent; constant bubbling = air leak |
| Jackson-Pratt | Active (bulb suction) | Empty when half full; compress bulb FULLY before capping | Suction is only active when bulb is fully compressed before capping |
| Hemovac | Active (spring-loaded) | Empty when half full; compress FLAT before capping | Squeeze ALL air out before capping — spring creates suction as it expands |
| Penrose | Passive (gravity) | No reservoir to empty; change absorptive dressings frequently | Only passive drain — no active suction; protect periwound skin from maceration |
| Blake | Active (via reservoir) | Same as JP — compress reservoir before capping | Fluted design reduces tissue trauma compared to round drains |
NCLEX Quick Reference — Surgical Drains
Drain with bulb you compress before capping to create suction
Jackson-Pratt (JP) drain — compress bulb fully before capping
Drain with accordion-style flat reservoir — squeeze out all air
Hemovac drain — spring tension creates suction as it expands
Passive drain — gravity only, no reservoir, frequent dressing changes needed
Penrose drain — protect periwound skin from maceration
Chest tube: water rising and falling with patient breathing
Tidaling — normal, indicates tube patency
Chest tube: constant bubbling in water-seal chamber
Air leak — trace from patient to system to find source
Chest tube accidentally disconnected from drainage system
Submerge tube end in sterile water to restore water seal — STAT notify provider
Chest tube accidentally pulled out of patient
Cover insertion site with petroleum gauze (3 sides sealed) — surgical emergency
Sudden bright red drain output increase from any drain
Suspect hemorrhage — apply pressure, notify provider STAT, continuous monitoring
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with AORN Perioperative Nursing Standards; ASPAN Post-Anesthesia Care Standards; Wound Ostomy Continence Nurses Society (WOCNS) Guidelines. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →