A Jackson-Pratt drain (also called a JP Drain) is a closed suction drain that is commonly used as a post-operative drain for collecting bodily fluids from surgical sites. The device consists of an internal drain connected to a grenade-shaped bulb via plastic tubing.

If the drainage tubing becomes clogged or otherwise clotted off, the benefits are not realized from drainage.

The flexible bulb has a plug that can be opened to pour off collected fluid. Each time fluid is removed, the patient, caregiver or healthcare provider squeezes the air out of the bulb and replaces the plug before releasing the bulb. The resulting vacuum creates suction in the drainage tubing, which gradually draws fluid from the surgical site into the bulb. The bulb may be repeatedly opened to remove the collected fluid and squeezed again to restore suction. It is best to empty drains before they are more than half full to avoid the discomfort of the weight of the drain pulling on the internal tubing.

JP drains come in flat and round forms, and these are available in varying sizes. The flat drains are measured in millimeters, and the round drains are measured in French sizes.

Patients or caretakers can “strip” the drains by taking a damp towel or piece of cloth and bracing the portion of the tubing closest to the body with their fingers, run the cloth down the length of the tube to the drain bulb. One can also put a little bit of lotion or mineral oil on their fingertips to lubricate the tube to make stripping easier. The portion of the tube closest to the exit point of the drain from the body should be gripped first, and once the length of the drain is stripped, the end closest to the surgical site should then be released. This increases the level of suction and helps to move clots through the drainage tube into the bulb.

It is important to watch the skin around the drain for signs of possible infection: increased redness, pain, or swelling; fever greater than 101 °F; cloudy yellow, tan, or foul-smelling drainage.

Any closed suction drain system, like the Jackson-Pratt, can become clogged with fibrin or clot. This results in loss of drain patency and thus fluid, blood or infected material can build up in the wound resulting in a wound hematoma and or abscess. Careful attention should be directed to make sure the drains do not clot or become clogged when they are still in use. This risk can be reduced by a daily subcutaneous injection of low-molecular-weight heparin (LMWH) until the surgical drain is removed.

The Jackson-Pratt Drain (informally referred to as the “brain drain”) was named after its inventors Drs. Fredrick E. Jackson (Chief, Department of Neurosurgical Surgery, Naval Hospital, Camp Pendleton, San Diego County CA) and Richard A. Pratt. First publications mentioning this device appeared in 1971 - 1972. ^{1) 2)}.

For the management of chronic subdural hematoma ³⁾.

In select cases, prolonged JP drainage in the setting of postoperative cerebrospinal fluid leakage may be a useful technique ⁴⁾.

Commonly employed in pediatric craniofacial surgery to reduce postoperative wound complications, although the benefits of this practice remain unclear ⁵⁾.

Intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery ⁶⁾.

Brain penetration and intracerebral hemorrhage ⁷⁾.

Factors affecting hospital length of stay of patients undergoing laminectomy were examined by replicating a study by Sutcliffe and Vincent. Results were similar, indicating that hospital stays were longer for patients unemployed prior to admission and for those who lived alone, had previous medical diagnoses, and had a Jackson Pratt drain ⁸⁾.

Gazzeri et al. present a technique for the management of chronic subdural hematoma which is a variation of a closed drainage system. After evacuation of the haematoma through a single burr hole, they inserted a Jackson Pratt drain into the subgaleal space, with suction facing the burr hole, allowing for continuous drainage of the remaining haematoma.

They used the method for over 4 years to treat 224 patients. Seventeen patients (7.6%) needed a second operation for a recurrence of the haematoma no patient required a third operation. Postoperative complications developed in 3 patients. Two patients died while in the hospital, a mortality rate of 0.9%.

The use of suction assisted evacuation, is followed by results that compare satisfactorily to reports of previous methods, with a low rate of recurrence and complications. It is relatively less invasive and can be used in high risk patients ⁹⁾.

A 72-year-old woman was admitted for elective L4/L5 laminectomy. The operative procedure was extradural, and a Jackson-Pratt (JP) drain was placed in the tissue bed and set to wall suction during skin closure. During closure, the patient developed a 15 s period of asystole. The patient was haemodynamically stable, but was comatose for 3 days postoperatively. Cardiac enzymes and EEG were unrevealing. Head CT showed traces of subarachnoid haemorrhage and signs suggestive of cerebral anoxia. JP drain at the incision produced 170-210 mL/day of fluid, positive for beta 2 transferrin, indicating cerebrospinal fluid (CSF). The patient fully returned to baseline on hospital day 10. MRI on hospital day 8 normalised. The reversible coma and radiographic findings were most consistent with acute intracranial hypotension relating to acute loss of CSF. Because radiographic findings can mimic hypoxic-ischaemic injury, acute intracranial hypotension should be considered in the differential diagnosis of postoperative coma after cranial or spinal surgery ¹⁰⁾.