04 Wound Drainage System

Question 1

What are reasons to use wound drainage systems? (6_

Answer 1

• Post operative incisions – type of wounds
• Decubiti
• Burns
• Types of drains vary depending on the type of surgery done
• Type of drainage needed and how much drainage expected
• Surgeon preference

Question 2

What are 4 types of wound drainage systems?

Answer 2

• Jackson Pratt
• Hemovac
• Penrose Drain
• (Vacuum Assisted Closure (VAC) or similar wound therapy device

Question 3

What are nursing assessments that needs to be done for all drain systems?

Answer 3

• Amount of drainage
• Consistency – bloody at first, then serosanguinous, to serous
• Color
• Odor, if any
• Monitor temperature
• Wound site

Question 4

How does the Penrose Drain work?

Answer 4

• Open drainage system
• Flexible rubber tube/drain that is placed inside the site of the surgery/wound but exits away from the incision site or the incision line.
• Small tab or safety pin is left in place at the end of the penrose on the outside so it cannot slip back into the wound.
• Penrose acts line a straw to pull fluids out of the wound and drain outside the wound.
• Drainage collects on the dressing, letting gravity work to pull the drainage out.
• Measure removed dressing for estimate of drainage amount.
• At high risk to fall out or be pulled out when dressing is changed.
• As healing progresses, the drain may be slowly pulled out, clipped to promote healing in the deepest areas of the wound.

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Question 5

What is the JP drain used for?

Answer 5

• JP drain is used to remove fluids from a surgical area. Placed in/near wound and sutured at conclusion of surgery.
• The JP drain is bulb-shaped device connected to a tube. One end of the tube is inside the incision. The other end comes out through a small cut in the skin. The bulb of the JP drain is connected to this end. Usually a stitch to hold the tube in place.
• The JP drain removes fluids by creating suction in the tube/bulb. The bulb is squeezed flat and connected to the on the outside of the body/wound. The bulb expands as it fills with fluid.

Question 6

How do you empty a JP drain?

Answer 6

• Empty the bulb when it is half full usually every 8 to 12 hours.
• Utilize graduated container/cup to measure drainage
• Perform hand hygiene and don clean gloves.
• Remove the plug from the bulb.
• Pour the fluid into a measuring cup without touching cup or plug/stopper.
• If plug is touched, clean with an alcohol swab
• Squeeze the bulb flat and put the plug back in.
• Measure the amount of fluid in cup.
• Document amount in patient record including consistency, color.

Question 7

When do you remove the JP Drain?

Answer 7

• The amount of fluid that drains will decrease as the wound heals.
• The JP drain usually is removed when less than 30 milliliters is collected in 24 hours.
• Some patients are discharged with JP drains still in.
• Patient education needed

Question 8

What are risks/complications of JP drains?

Answer 8

• Pain – mostly initially after insertion
• Positioning – often on the patient’s side so difficult to lay at the same side as the drain
• Leaking – from the site or the drain
• Accidental – removal
• Tubing may crack, etc- may need occasional milking
• Infection – monitor for increased tempo…generally above 101/38.3, redness, swelling, yellow/foul perulent drng
• Scarring

Question 9

What is a Hemovac?

Answer 9

• •Portable wound suction device that is compressed to provide gentle suction
• A hemovac drain is placed under the skin during surgery usually in a deep wound. Removes any blood or other fluids that might build in the area. Has a larger drain capacity than a JP
• Creates a negative pressure of approximately 45mmHg
• Can be connected to additional suction as needed
• Hemovac drain is a closed drainage system.
• The drainage works by suction that pulls the drainage from the body into a collection tank.

Question 10

How does the VAC device work?

Answer 10

• •Negative pressure wound therapy (NPWT)
• •Removes blood or serous fluid/exudate from a wound bed or operative site
• Uses a piece of foam with an open cell structure placed into the woun/area and a wound drain with lateral perforations is laid atop it
• •Entire area covered with a transparent adhesive membrane secured to the healthy skin around the wound margin.
• When the exposed end of the drain tube is connected to a vacuum source, fluid is drawn from the wound through the foam into a reservoir/device.

Question 11

VAC Therapy

Answer 11

• The plastic membrane prevents the ingress of air and allows a partial vacuum to form within the wound, reducing its volume and facilitating the removal of fluid.
• Foam functions:
• To keep entire surface area uniformly exposed to the negative pressure effect
• Prevents occlusion of the perforations in the drain by contact with the base or edges of the wound
• Eliminates the theoretical possibility of localized areas of high pressure and resultant tissue necrosis

Question 12

The Vac Therapy:

•The application of negative pressure in vacuum-assisted closure removes edema fluid from the wound through suction.

which results in what?

Answer 12

Results in increased blood flow to the wound by causing the blood vessels to dilate and greater cell proliferation

Fluid removal resuced bacterial colonization of the wound, which decreases the risk of wound infections

Vacuum assisited closure enhances the formation of granulation tissue, and important factor in wound healing and closure

Question 13

What are uses and benefits of VAC therapy?

Answer 13

• Chronic wounds
• Faster wound healing
• Decrease in wound dressing procedures
• Reduces the need for materials and qualified personnel.