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Flushing a JP drain?

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Posted 11/4/2012 9:41 PM (GMT 0)
I know I have been asking a lot of questions... but hope you guys don't mind. :)

A nurse from his surgeon called us and said that his right side was looking really good but that his surgeon wanted us to start flushing his JP drain... I'm like huh?  How the hell do you flush that thing?  He has a 'simple' drain that is easy to flush you just disconnect the tube and attached a seringe of saline and boom you're done.  But, the JP drain is one of those little grenade thingies that uses suction to pull the crud out of him.  The nurse proclaimed ignorance and said she didn't know anything about what I was saying and just said she was relaying a message.  I told her to ask the surgeon what he meant or how we do it and she said she'd have to page him.  But, we never heard back.

Do you guys with j-pouches know anything about what I'm talking about?  Am I supposed to be flushing the JP drain?  And if so... how? :D

Posted 11/4/2012 10:52 PM (GMT 0)
     I don't have a j-pouch, I have a permanent ileo but I know exactly what you are referring to when you speak of the JP tube.  I believe your doctor just wants you to empty it.  Do you have to measure the contents?  I can remember the nurse measuring how much she emptied every time she did it.  My JP tube was removed before I was discharged from the hospital but in some cases they do leave them in for awhile.
Posted 11/4/2012 11:32 PM (GMT 0)
Hrmmm, perhaps. I have been emptying it daily. So, that's not an issue. I really hope he gets these things removed soon... he has two drains and a bridge in his stoma still. :(
Posted 11/4/2012 11:52 PM (GMT 0)
My daughter had a jp drain for a little over 3 months that I had to flush. We were sent home without instructions on how to do it, but we had a home health nurse and our family doc's nurse help me out. There should be a little stopcock valve that has a screwtop. We ordered a box of sterile saline syringes to use. You unscrew the valve screwtop, twist on the saline syringe, flush with amount they said to flush with. If there is no stopcock, they should be able to add one in the interventional radiology department. (We had to go there to get her drain reinserted when she caught her tubing on a drawer and yanked it out!) Good luck, it is not hard to do. Once you do it a couple times, it is no big deal.
Posted 11/4/2012 11:53 PM (GMT 0)
I had my JP drain in when I left the hospital and took care of it for about a week on my own, so I got your back on this one!

The only things you have to do to maintain a JP drain:

1) Empty it when it starts to fill up. ESPECIALLY if the bulb is all the way round and the divot is gone. After emptying you always want to be sure to squish the bulb with one hand while replacing the cap with the other so it is always compressed and creating like a vacuume suction through the tube at all times. Keep track of how much output you have a day - once it goes below 75 mL a day consistently, you can get it removed.

2) Stripping the drain (which is probably what she was referring to). At least once a day - or any time it may be clogged like if flow seems to have slowed or stopped or if you start feeling bloated - you should strip it. To do this you take one hand and hold the drainage tube in place as close to your incision as possible, just to keep it steady. Use your thumb and index finger of your other hand to pinch the tubing tightly, as close to your incision and first hand as possible. Then drag those pinched fingers down the entire length of the tubing, as if you were trying to squeeze toothpaste out of it. The nurses did this quickly when they did it, but I was a little more slow/gentle once I took over the job for myself. Make sure you're holding the tube firmly at the incision site with the first hand so you don't tug at the incision. This "stripping" action creates even more of a vacuum effect in the tubing and can get things flowing again if it has slowed or stopped from a possible clog.

Caution: this stripping action doesn't bother most people, but for me I could feel the vacuum effect in my surgical site which was pretty uncomfortable and even a bit painful the first several days after surgery, so I was just careful and went kind of slow, making sure I was up on my pain meds. After about five days though this went away and I could strip it with no problem.

That's it. There is no real way to "flush" it like you would a simple drain, because there is always a sort of vacuum pressure within the tubing, so you're not going to put any fluids back into it or anything.

Hope this helps, please let me know if you have any other questions or if any part of my instructions were hard to understand. I also have other tips for getting it to flow again if you think it's not draining properly. Mine would stop sometimes making me bloated, uncomfortable, and in pain, so I had to use several strategies along with the stripping to get things moving again.
Posted 11/4/2012 11:56 PM (GMT 0)
Hm, I just saw SweetPea's post about the flushing... wonder why they have you do that; don't know if it's really necessary. I never did with mine and it worked just fine. Maybe other people don't know about the stripping technique and use a flush instead?
Posted 11/5/2012 12:10 AM (GMT 0)
P.S. - I can totally relate to the feeling of not being able to wait to get those drains removed. They do get really annoying after a few days. He will feel SO much better once they are out! One thing I didn't realize was how far it went in there... I didn't realize that some of the discomfort I felt when I was moving around was actually from the tubing that was inside my abdomen.

If you want to see a description of what it looks like (the part that's inside) and what it was like to have it removed, check out my blog post here:
ronnielee-fightingforit.blogspot.com/2012/10/recovery-week-two.html

I also mention how the incision did after the drain was removed in some of my later posts as well, so feel free to browse while you're there. :)
Posted 11/5/2012 1:15 AM (GMT 0)
The way sweetpeasmom describes the flushing is how I was instructed to do the flushing when I had my JP. I was never told to do the stripping but, I've head of people doing it. If you don't see a place to attach the syringe of saline (should be near the bulb) then call your surgeon back and tell them this. They will be able to advise you further.
Posted 11/5/2012 3:26 AM (GMT 0)
Ok, thanks... So you just unscrew the grenade from the tube and do it like I do the simple drain? I guess it just didn't look like a seringe would attach to it.

Where is the JP connected to? Is it actually inside the j pouch or just outside of it?
Posted 11/5/2012 6:57 AM (GMT 0)
It is not inside the pouch. It is just inside the abdomen, in between organs.
Posted 11/5/2012 4:01 PM (GMT 0)
Gotchya.

Well, I tried to flush it...but it did not go well. Not a few seconds after I started putting the saline in, it started coming out of the hole in his stomach. So, I stopped and put the drain back together again.

I'm not exactly sure what that means... if there is a lot of tubing inside of him then how did it immediately start back washing out of the hole in his tummy?
Posted 11/6/2012 1:34 AM (GMT 0)
It could be that his tummy is already full of other fluids, and it the saline is just mixing with and pushing the other clear fluids out, not necessarily just the saline itself coming out. I had a lot of fluid gushing out of that incision in addition to the JP drain filling up for several days in a row around the time I was discharged, and the doctors and nurses weren't at all concerned - it's all just fluid that needs to come out somehow, so I just made sure to change the bandages frequently so they weren't sitting there soaked. (It would go right through the bandages and soak my hospital gown.)

If flushing doesn't work that well for you, try stripping instead. It sounds like people here were given instructions for either one or the other, so they probably serve the same purpose. Mine worked out well without the flushing, so as long as it's still draining consistently, that's all you really need to worry about. How many days has it been in? (How many days since his surgery?)
Posted 11/6/2012 1:55 AM (GMT 0)
It sounds to me like maybe his JP is not set up for flushing. You shouldn't have to remove the grenade from the tube in order to flush. There would be a stopcock on the tubing line that you turn to shut off flow to the drain and slowly introduce the saline into the line toward the wound. It will look sort of like this (though only a two way thing, not three). http://catalog.bd.com/bdCat/viewProduct.doCustomer?productNumber=394910

If you don't have anything like that on the tubing, I would not attempt to do anymore flushing. Call the surgeon's office back, tell them about the instructions you were given, and explain that you don't have a flushable drain. They may have meant stripping and will advise you, etc. I would also let them know about the fluid coming from the insertion site when you tried to do your flushing. Just to make sure they know. Are you guys getting good output into the drain?
Posted 11/6/2012 3:59 AM (GMT 0)
Cool, yea it doesn't have a stopcock thingy on it.  So, yea I don't think I was supposed to flush it... hope I didn't hurt anything.

We have an appointment with his surgeon tomorrow... so, that should lay everything to rest. :)

His drain has been steadily slowing down in output.  I may get 15-20 cc's a day now from it.  The simple drain he has on the other side of his stomach is doing way more.  But we had a CT scan for that last week and they said there was just a little bit of a collection left in there and he is going back to interventional radiology on Thursday to see if we can remove the simple drain.

It seems like more stuff is actually coming out of his bum now...which from another post I asked in, you guys said that was normal.  Its the same color stuff that is coming out of his JP drain.  Its not a whole lot but just a little bit every couple of days.

His surgery was on Oct. 12th for the other person that asked.  He developed sepic shock and almost died on me but is doing sooooooo much better now.  Today, he was up walking around a lot more than he has been and cooking (he made me food today instead of the other way around!) and just seems like he's almost back to his old self.  Was even able to gain a few pounds back the last few days.  So, I'm really hopeful that the worst is behind us and we have nipped this abdominal infection in the bud. 

Posted 11/6/2012 3:27 PM (GMT 0)
So he is almost exactly a week behind me. Yeah I remember hearing about the septic shock.

The same thing happened with me: when my JP drain slowed down is around the time that my J-pouch "draining" sped up. Sounds like he may be ready to have those drains removed! The JP drain at least... as long as it's not clogged. Anything below 75cc per day is low enough to have it removed. He will feel so much better once those drains are gone - I am excited for him to get to that step. Let us know how he does when he finally gets those suckers out!
Posted 11/6/2012 8:26 PM (GMT 0)
Well, we just got back from the doctor... not the news he wanted to hear.

So, he tried to flush the JP as well and got the same response I did ... the saline just started leaking out the hole in his stomach. He said this may or may not be a good thing. He can't have his JP removed yet... he said because of all the complications and he thinks the stuff coming out is still puss like, we need to keep it in.

Also, he has an appointment Thursday with the Interventional Radiology department and his surgeon wants them to do a study on the JP side and put in a simple drain instead of the JP. And wants them to check to see if anything is coming out of his intestine.

I guess because of the horrible complications we had, we have to go really slowly... which I suppose is a good thing, just disappointing. He was hoping that he would have a take down by the end of the year but the surgeon said today it will not be this year. He wants to be absolutely sure there are no leaks in his pouch before we turn it on. Which as I said, is a good thing ...but he just really hates having this ostomy bag.

But, he is doing super great ... his appetite is back and he's eating and drinking well and getting around ok. Doc did say we can stop the antibiotics. Maybe can take out the PICC line in another week.

They will probably remove the drain he has on his left side on Thursday but he'll still have one on his right side to make sure everything gets flushed out of there.
Posted 6/15/2014 11:53 PM (GMT 0)
Hello everyone! My first time to join you guys. My brother was diagnosed of sarcoma in the abdomen. Was operated, undergone radiation. Was cleared, then again operated of hernia and internal by pass. Now he is coping up well in the grace of The Lord. But, it has been a month time and his jp drain output fluctuates from 140 cc to 180 cc. I asked his surgeon and said to wait until it goes down to 50cc. Am just so worried. Is it ok for him to have the drain for a month and still fluctuate to 140cc to 180cc? Looking forward to all your answers. Many thanks.
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