How do I manage the drain?

Care of Drain

The one thing which most breast cancer patients (who have undergone surgery), associate the recovery period with - is the 'suction drain'.

Why is this drain kept?

To make it simple to understand, read the following points about normal lymphatic system in the hand:
All of us have 'lymph nodes' in the armpit. Some may have 10 nodes, some may have 15, and some even more, or some may have less. Number is not fixed. These lymph nodes are small 'bean shaped' structures, normally less than a centimetre in size each.
Blood flows from the heart upto the hand and from hand back to the heart. In this process of blood flow as it reaches smaller and smaller blood vessels of the arms and hand, some blood gets filtered out into a clean fluid called - 'lymph'
There are lymphatic channels all over the body; these channels 'drain' the lymph from organs into the 'lymph nodes'. In the arms and hands, these lymph channels lie just below the skin. All the lymph generated around the hand, comes back by these channels, into those 'lymph nodes' in the armpit. They are the first 'relay' stations. From the nodes, further lymphatic channels take it to 'secondary' nodes (around the wind pipe) and finally, via one main channel, the lymph enters the blood.

Apart from hand, the lymphatic channels from the breast also, go into these lymph nodes in the armpit. Hence, in a breast cancer surgery, we 'remove' the lymph nodes in the arm pit, as we need to check if the cancer cells have reached there.
Now that we have removed the nodes in breast cancer surgery, what will happen to the 'lymph' generated at the hand? The lymph from the hand will reach the arm pit and find the channel is broken (it is open) and there are no nodes; it will start 'spilling out' into the arm pit! It will keep on collecting there till it finds a way out (and it does find new channles over time). Usually, in a few weeks, the lymphatic collection reduces, as new channels open up.
But till the time new channels open up, all lymph will collect in the arm pit. Daily, about 100 to 200 ml of lymph can form. In some it is less, and in some, it can be more. And over a few days, almost 400 to 500 ml lymph can collect in the arm pit. This will cause a strong pressure on the stitches and wound can open up. We want to avoid this wound opening up. Hence, we keep a tube there, and an actively sucking container, so that all lymph collecting in arm pit is brought out and there is no pressure on wound, so it can heal (usually takes 2 weeks to heal).
That is why , till wound heals in 2 weeks, we keep the drain in place. Once the wound has heled, if we remove drain, and fluid still collects, the wound will have strength to withstand the collection and will not open up.

How do we empty the drain?

There are five steps, see the images for guidance:

Step 1: Note the amount of fluid in the drain - there are markings in 'ml' in the container at the bottom. Keep a diary, with note of daily output.
Step 2: Close the 'stopper' on the tube (to block the tube).
Step 3: Rotate the tube from the container at the valve. Empty the container in the bathroom. No ned to wash it.
Step 4: Now fully 'compress' the empty container and re thread the tube on to it.
Step 5: Open the 'stopper' on the tube (which was cloed in step 1)