Syringe Suction Vacuum Drain: A Cheap Alternative

Author Information
Dwivedi JS*, Gupta AS**
(* First Year Resident, ** Professor. Department of Obstetrics and Gynecology, Seth G. S. Medical College & K.E.M. Hospital, Mumbai, India.)


Surgical drains are of different types - open and closed type, active and passive drains. Corrugated rubber tubes are examples of open drains. They can increase the chances of infection. Closed drains remain sterile and are hence preferred by most surgeons. Active drains are maintained under suction pressure -high or low.[1] Various types of drains are available in the market that are costly, especially for poor patients. An economical suction vacuum drain can be easily assembled using few basic things which are easily available in a hospital setting. One such drain design to be placed in the subcutaneous tissues in the anterior abdominal wall after laparotomy is being presented.
The materials required are:
1.      One 20 ml syringe
2.      Two 10 ml syringes
3.      One 16 Fr Ryles' tube
4.      A small piece of adhesive bandage.
Steps To Make A Drain & Its Simultaneous Insertion
1.      Using a No. 11 surgical blade mounted on a Bard Parker handle, a small incision is made at the site where the drain is to be inserted.
2.      Ryles tube no.16 Fr is passed through the small incision and its perforations are placed in the subcutaneous tissue. The Ryles' tube is fixed with a linen suture at its point of exit. A hemostat is used to clamp the drain as seen in Figure 1.

Figure 1. Ryles tube clamped with an hemostat.

3.      The hub of the drain is connected to the 20 ml syringe. Suction is created by pulling the piston of the syringe against the clamped  Ryles' tube as seen in Figure 2

Figure 2. Creating the Vacuum in the syringe.

4.       The pistons of two 10 ml syringes are now placed on either side of the central piston of the 20 ml syringe as seen in Figure 3. The two pistons are placed in such a way on the flange of the 20 ml syringe so that the upper end of one piston and the lower end of the other piston rests on the flange.

Figure 3. Placement of the two lateral supports of the central piston. Yellow arrows have marked the Flange. Pink line marks the lower circle of the piston (20 ml syringe) & the pink arrows show where the lower end of the 10 ml syringe piston rests.

5.       All the 3 pistons are now supported and a piece of adhesive bandage is used to bind them to each other as seen in Figure 4.

Figure 4: Bound pistons to maintain the vacuum.

Figure 5: Assembled Syringe Suction Vacuum Drain

6.      Now the haemostat on the Ryles tube which is inserted as mentioned in point 1is released so that the vacuum in the syringe is now continuous with the subcutaneous tissue fluid.
This entire assembly is the design of an easy to assemble, affordable, syringe suction vacuum subcutaneous drain. The drain needs to be charged whenever 10 ml output accumulates in the 20 ml syringe. This drain can be easily dismantled and reinstalled after recreating the vacuum.

Charging the drain (Recreating the vacuum)

1.      The Ryles tube is clamped with a hemostat, the 20 ml syringe is disconnected from it and the hub of Ryles tube is closed.
2.      The adhesive tape is removed.
3.      The sero-sanguineous fluid collected in the syringe is properly discarded.
4.      The Ryle’s tube is reconnected to the hub of the emptied 20 ml syringe and the syringe suction drain is assembled as before.


Surgical sites can have potential dead spaces. These become reservoirs for collection of body fluids. Such collections are best prevented so as to reduce the chances of seroma formation, wound infections and wound disruption. Closed drainage systems are used to drain such potential spaces. Drains available in the market add to the cost of the procedure. Simple designs that are easy to assemble in the operation theatres are documented in literature. Syringes have been used in these designs to create low cost closed drainage systems not only in surgeries on human beings but also in veterinary medicine.[2,3,4] In our drain design we have used two pistons of a 10 ml syringe. The height of these pistons and the inverse direction placement of the two pistons is such that it not only rests snugly on the flange of the 20 ml syringe but also on the edge of the lower circle of the piston of the 20 ml syringe. This is further reinforced by binding all the three pistons with an adhesive tape making it very stable. We used 16 Fr Ryle's tube as the perforations are already present, it is freely available in the operation theaters, and it has a wide bore to adequately drain out fluid containing blood. It does not get easily blocked with small blood clots. The negative pressure generated was measured with a manometer and it is - 600 mm of Hg. Venkatachalapathy's[1]  syringe drain wherein the needle cap is used in the groove of the piston may be adequate for small capacity syringes but the length of the needle cap will fall short when larger capacity (longer) syringes are used and the piston of the syringe will then sit obliquely in the syringe after using the needle cap in the piston groove. They also recommended infant feeding tube or scalp vein cannula[1,4]  as drain tubes. In our opinion this can get blocked as the inner diameter of these tubes will be quite narrow.  Besides, perforations have to be made  in these tubes and this may weaken the tube and while removing, the tube may get fractured and a piece can get retained in the wound requiring surgical incision and extraction. Ryles tube has pre-formed stable perforations and thus has less chance of fracturing in the wound. The steel spring recommended by Singh  is not available in the operation theatre and has to be specially procured.[4] The design by Ellur requires the use of sharp instruments to bore a hole in the piston with a needle as well as with a towel clip.[3] None of these drains documented in literature have measured or mentioned the negative suction pressure that is created by their designs. [2,3,4,5] We would like to highlight certain features of these suction drains.

Negative Pressure
Drain Tubing sizes
Rs. 13/-
Easy and stable
-600 mm of Hg
Large (16 Fr Ryles' tube)
Not stated
Easily but unstable
Not studied
Small (infant feeding tube or scalp vein cannula)
Not stated
Chances of injury while assembly due to use of sharps
Not studied
Small (8 No. infant feeding tube)
Not stated
Steel spring not an item available in the operation theatre.
Not studied
Small ( scalp vein cannula)

Marketed Drains: Mini
-100 to:-150 mm of Hg [5]

Marketed Drains: Standard
Rs. 261/-
-300 to -500 mm of Hg [5]

Our drain is recommended for use only in the subcutaneous tissues and not intra peritoneally due to the high negative suction pressure that is created.


Our syringe drain design is superior as it is not only simple to assemble from easily available material but is also easy to use, is very stable, does not use any sharps and it provides adequate suction pressure to drain the subcutaneous tissue. It uses a wide drain tube which is less likely to get blocked. The cost price of our drain is also only Rs. 13/- that is 9 times less than that of the marketed Mini suction drain.  This drain is highly recommended for its design, material used and for its low cost in low resource health care systems and societies.


1.        Rock, JA., Jones, H W. Incisions for Gynecologic Surgery. In Rock JA, Jones HW III, editors. Te Linde’s Operative Gynecology.10th ed. New Delhi: Wolters Kluwer Health – Lippincott Williams & Wilkins 2008; pp. 253.
2.        Venkatachalapathy TS, Nagendra Babu T, Sreeramulu PN (2012) A Simple Syringe Suction Drain for Surgical Procedures. J Clin Case Rep 2012;2:216.
3.        Ellur S. Syringe suction drain further simplified. Indian J Plast Surg 2007;40:107-9.
4.        Singh A, Singh G (2003) Syringe suction drain-II. Br J Plast Surg 56: 313.
5.        Jain, SK, Stoker, DL,  Tanwar, R Basic Surgical Skills and Techniques: Drains in Surgery,  JP Medical Ltd, 2013 -pg 72-73.


Dwivedi JS, Gupta AS. Syringe Suction Vacuum Drain: A Cheap Alternative. JPGO Volume 1 Issue 4, April 2014, available at: