How Much Blood Could a JP Suck If a JP Could Suck Blood?

Abstract

Objective: Active surgical drains minimize fluid accumulation in the postoperative period. The Jackson-Pratt (JP) system consists of a silicone drain connected by flexible tubing to a bulb. When air in the bulb is evacuated, negative pressure is applied at the surgical site to aspirate fluid. The objective of this study was to determine if the evacuation method and volume of accumulated fluid affect the pressure generated by the bulb.

Methods: Bulbs were connected to a digital manometer under various experimental conditions. A random number generator determined the initial evacuation method for each bulb, either side-in or bottom-up. Subsequent evacuations were alternated until data was collected in triplicate for each method. Predetermined amounts of water were placed into the bulb; air was evacuated; and pressure was recorded. The digital manometer was allowed to equilibrate for 1 minute prior to data acquisition.

Results: The average amount of pressure after a side-in evacuation of a JP bulb was 87.4 cm H₂ O compared to 17.7 cm H₂ O for a bottom-up evacuation (P < 0.0001). When the drain contained 25 mL, 50 mL, 75 mL, and 100 mL of fluid, the pressure applied dropped to 72.6, 41.3, 37.0, and 35.6 cm H₂ O, respectively.

Conclusions: JP drains generate negative pressure in order to reduce fluid accumulation at surgical sites. Although its function is frequently taken for granted, this study demonstrates that both the specific method for evacuating the bulb as well as the amount of fluid in the bulb significantly affect the performance of this device.

Level of evidence: NA Laryngoscope, 129:1806-1809, 2019.

Keywords: JP drain; Jackson Pratt; surgical drain.

Figure 1 –. A typical Jackson-Pratt drain.

1A) The Jackson-Pratt drain consists of a reservoir bulb (A) that transmits negative pressure through flexible tubing (B) to the drain (C), which contains internal ridges and multiple perforations along the sides. 1B) Close up view of the drain. Note the internal ridges and multiple holes along the tubing.

Figure 2 –. Methods of bulb compression.

2A) JP bulb with labeled axes of compression. The red arrows indicate compression via the side-in method along the bulb’s horizontal axis. The yellow arrows indicate compression via the bottom-up method along the bulb’s longitudinal axis. 2B) Compression of the bulb via side-in method. 2C) Compression of the bulb via the bottom-up method. Note how in this configuration the drain remains stented in its compressed form without requiring a clamp or attached tubing.

Figure 3 –. Setup to record drain pressure.

The JP bulb was connected to the manometer using 10 cm of flexible silicone tubing.

Figure 4 –. The performance of the JP drain can be significantly affected by the methods of charging the bulb as well as the amount of fluid that has accumulated.

A) Maximum negative pressure generated by bulb compression via side-in and bottom-up compression methods. B) Negative pressure measurements with increasing amounts of JP bulb filling. The dashed line represents approximate level of suction accomplished by low intermittent wall suction for comparison (47.5 cm H₂O). Error bars represent 95% confidence intervals.