Chapter 17 - Drains, Bandages, and External Coaptation Flashcards
1
Q
A
Double clove hitch suture pattern
2
Q
What material is commonly used for making passive drains?
A) Steel B) Polyethylene C) Rubber D) Both B and C
A
D) Both B and C
3
Q
A
Chinese finger trap
4
Q
What is the main function of active drains?
A) To utilize gravity for drainage B) To rely on suction for fluid removal C) To prevent fluid accumulation D) To facilitate wound healing
A
B) To rely on suction for fluid removal
5
Q
Which drain type uses gravity and capillary action primarily for fluid removal?
A) Active drain B) Penrose drain C) Tube drain D) Sheet drain
A
B) Penrose drain
6
Q
What can happen if a passive drain is placed too close to delicate tissues?
A) Improved drainage B) Mechanical irritation C) Increased fluid retention D) Enhanced healing
A
B) Mechanical irritation
7
Q
What is the disadvantage of using gauze drains?
A) They are too expensive B) They may cause ascending infection C) They are ineffective in drainage D) They require complex removal
A
B) They may cause ascending infection
8
Q
How long should red rubber sheet drains typically be left in place?
A) 24 hours B) 48 to 72 hours C) 1 week D) 10 days
A
B) 48 to 72 hours
9
Q
What type of drain is known to collapse under suction?
A) Tube drain B) Penrose drain C) Gauze drain D) Sheet drain
A
B) Penrose drain
10
Q
Name the passive drains
A
Gauze drain
Latex Penrose
Silicone Penrose
Rubber tube drains
Sheet drain
Flexi-drain
11
Q
Name the active drains
A
Redon drain
Jackson Pratt
Blake drain
Trochar catheter
12
Q
What is a disadvantage of tube drains in passive systems?
A) They are too expensive B) They can easily be obstructed C) They are difficult to insert D) They are not pliable
A
B) They can easily be obstructed
13
Q
What mechanism does the cigarette drain utilize?
A) Active suction B) Capillary action C) Gravity only D) External pressure
A
B) Capillary action
14
Q
Which drain type is specifically mentioned as useful in septic joints?
A) Gauze drain B) Penrose drain C) Tube drain D) Sheet drain
A
B) Penrose drain
15
Q
What aspect of gauze drains can facilitate effective débridement?
A) Cost-effectiveness B) Local deposition of antibiotics C) Tissue adherence to the drain D) Simplicity of removal
A
C) Tissue adherence to the drain
16
Q
Which drain type requires frequent bandage changes to maintain sterility?
A) Penrose drain B) Gauze drain C) Tube drain D) Sheet drain
A
B) Gauze drain
17
Q
What material should NOT be used for drains due to potential foreign body reactions?
A) Silicone B) PVC C) Red rubber D) Polyethylene
A
C) Red rubber
18
Q
How does the design of a sheet drain facilitate fluid removal?
A) It provides a rigid structure B) It allows for easy trimming C) Its shape resists compression D) It uses suction
A
C) Its shape resists compression
19
Q
What role does the trocar play in active drain placement?
A) It increases suction strength B) It creates the egress site C) It stabilizes the drain D) It helps in suturing
A
B) It creates the egress site
20
Q
Which of the following is true about passive drains?
A) They require active suction to function B) They can be fenestrated for better drainage C) They primarily rely on gravity and capillary action D) They are not effective for viscous fluids
A
C) They primarily rely on gravity and capillary action
21
Q
What is a major consideration for drain removal timing?
A) The patient's comfort B) The healing of the incisional sutures C) The length of the drain D) The type of drain used
A
B) The healing of the incisional sutures
22
Q
What should be avoided to minimize contamination during passive drain placement?
A) Small egress openings B) Direct suturing of the drain C) Aseptic preparation D) Large egress openings
A
A) Small egress openings
23
Q
Which type of drain is best suited for small, sensitive areas?
A) Tube drains B) Gauze drains C) Sheet drains D) Penrose drains
A
A) Tube drains
24
Q
What is the disadvantage of using multi-fenestrated drains?
A) They are more costly B) They have lower drainage capacity C) They can obstruct easily D) They can support bacterial growth
A
D) They can support bacterial growth
25
What was developed by Raffle in 1952?
A) Capillary drainage
B) Continuous suction
C) Passive drainage
D) Antibiotic gauze drains
B) Continuous suction
26
Which drain type is particularly effective in abscess management?
A) Tube drain
B) Gauze drain
C) Sheet drain
D) Penrose drain
B) Gauze drain
27
What is essential for drain selection?
A) The color of the drain
B) The surgeon’s preference
C) The expected activity level of the patient
D) Both B and C
D) Both B and C
28
Which of the following should be avoided when placing drains?
A) Local anesthetic infiltration
B) Aseptic preparation
C) Placing drains near blood vessels
D) Ensuring proper drain length
C) Placing drains near blood vessels
29
What is one key function of a trocar in active drains?
A) To increase flexibility
B) To create an incision site for drainage
C) To prevent blockages
D) To maintain sterility
B) To create an incision site for drainage
30
What should be the characteristic of the drain end to facilitate fluid evacuation?
A) It should be soft and pliable
B) It should be long enough to prevent retraction
C) It should be rigid and inflexible
D) It should be thin and fragile
B) It should be long enough to prevent retraction
31
What is the primary advantage of a closed active drain system over an open system?
A) Greater fluid capacity
B) Increased risk of infection
C) Easy monitoring of evacuated fluid quantity
D) More complex setup
C) Easy monitoring of evacuated fluid quantity
32
For a closed active drain to function effectively, the fenestrations must be placed into what type of cavity?
A) Open cavity
B) Airtight cavity
C) Semi-permeable cavity
D) Ventilated cavity
B) Airtight cavity
33
Which of the following drains is known for its multifenestrated design?
A) Penrose drain
B) Blake drain
C) Jackson-Pratt drain
D) Heimlich valve
C) Jackson-Pratt drain
34
Figure 17-1. Proper placement of a Penrose drain for passive postoperative wound drainage. A distal egress portal is made and the most proximal aspect of the drain is secured within the wound with a simple interrupted suture tied on the outside of the skin. The wound is subsequently closed.
35
Figure 17-2. Suture patterns used to secure a drain to the body wall. (A) The “Chinese finger trap” suture pattern. (B) The “double-clove hitch” suture pattern.
36
Figure 17-3. Frequently used passive drains. (a) Gauze drain soaked with Triclosan (antibacterial agent). (b) Latex Penrose drains. (c) Red rubber sheet drain. The sheet is folded over. (d) Easy-flow silicone drain.
37
Figure 17-4. A Flexi-drain folded up in a plastic cup. Twelve single tubes are joined to a single drain system.
38
Figure 17-5. A 4-mm diameter, fenestrated Redon drain (polyvinyl chloride) with a non-fenestrated extension attached to a trocar used to place the drain through the skin.
39
Figure 17-6. (A) A flat 7-mm Blake drain (silicone) with a trocar (covered by a rubber protection) to place the drain through the skin. (B) Cross-sectional image of a flat (top) and round (bottom) Blake drain showing the slits and protected spaces allowing fluids to be channeled away from the wound.
40
Figure 17-7. Evacuators used in active drainage systems. (a) Syringe-adapted closed suction device made from a 60-mL syringe, a three-way stopcock, an extension set attached to the syringe and fixed to a drain. The syringe is held open by a 14-gauge needle with a ground flat tip, placed across the plunger shaft and locking the plunger in place. (b) Grenade-shaped compressible bulb attached to a flat, silicone fenestrated drain. (c) Snyder Hemovac 400-mL evacuator.
41
Figure 17-8. (A) Materials used for negative-pressure wound therapy. (a) Vacuum unit. (b) Vacuum pad and tubing, which are attached to the vacuum unit. (c) Adhesive occlusive dressing to cover the foam and all skin edges around the wound. (d) Foam for placement into the wound. (e) Double-sided adhesive strips for placement on the skin edges around the wound. (B) A chronic, infected wound on the palmar aspect of the metacarpophalangeal region involving the digital flexor tendon sheath treated with negative-pressure wound therapy (NPWT). The hair surrounding the wound has been shaved, degreased using alcohol, and double-sided adhesive strips have been placed around the wound. A polyurethane foam has been cut to fit into the wound. (C) The foam is fixed to the skin surrounding the wound with an adhesive occlusive drape. A small hole is cut into the adhesive drape over the foam. (D) The vacuum pad with the suction tubing is applied over the hole to connect the foam to the vacuum unit by the tubing. (E) A half-limb bandage has been placed to secure the tubing, protect the device and help to maintain a tight seal. The vacuum unit has been attached to the horse using a lunging girth.
42
Figure 17-9. Top: A spontaneous pneumothorax aspiration system (Heimlich valve) used to prevent access of ascending air and microorganisms into the cavity to be drained. Bottom: A polyvinyl chloride thorax drain (Trocar Catheter).
43
Figure 17-10. A Lepage drain designed for drainage of the abdominal cavity with its rigid trocar to help during insertion.
44
What type of suction reservoir utilizes an internal spring?
A) Grenade-shaped suction bulb
B) Rigid evacuator
C) Compressible suction bulb
D) Passive drain
B) Rigid evacuator
45
Which suction method generates greater initial suction according to the text?
A) Compressible drains
B) Rigid drains
C) Passive drains
D) Open drains
B) Rigid drains
46
What is a potential disadvantage of using excessive suction in wound drainage?
A) Reduced fluid production
B) Increased fluid production
C) Faster healing
D) Lower risk of infection
B) Increased fluid production
47
What mechanism does Negative-pressure wound therapy (NPWT) utilize?
A) Continuous irrigation
B) Subatmospheric pressures
C) Thermal application
D) High-frequency vibrations
B) Subatmospheric pressures
48
What is the optimal duration for keeping NPWT dressings in place?
A) 12 to 24 hours
B) 24 to 48 hours
C) 48 to 72 hours
D) Over 72 hours
C) 48 to 72 hours
49
What is the purpose of the Heimlich valve in open drainage systems?
A) Facilitate fluid drainage
B) Prevent inflow of air
C) Increase suction capacity
D) Remove tissue debris
B) Prevent inflow of air
50
Which drain is not functional for abdominal drainage?
A) PVC drain
B) Silastic drain
C) Penrose drain
D) Jackson-Pratt drain
C) Penrose drain
51
What common problem can arise from using a passive drain with a too-small egress portal?
A) Increased fluid flow
B) Obstruction of the drain
C) Enhanced infection risk
D) Drain leakage
B) Obstruction of the drain
52
In the context of equine surgery, what is a critical risk of leaving a portion of a drain in the wound?
A) Increased healing time
B) Persistence of drainage
C) Reduced risk of infection
D) Decreased tissue irritation
B) Persistence of drainage
53
What should be done if the quality of fluid retrieved from a drain changes significantly?
A) Ignore the change
B) Continue monitoring
C) Obtain wound fluid cultures or cytology
D) Remove the drain immediately
C) Obtain wound fluid cultures or cytology
54
Which of the following can decrease the risk of infection when using drains?
A) Minimizing the drain size
B) Increasing the number of drains
C) Extending the time a drain is in place
D) Using a rigid drain
A) Minimizing the drain size
55
What type of foam is most commonly used in NPWT for equine patients?
A) Silver-impregnated foam
B) Polyvinyl alcohol foam
C) Polyurethane foam (black foam)
D) Antimicrobial-impregnated gauze
C) Polyurethane foam (black foam)
56
When preparing a wound for NPWT, how far should hair be shaved around the wound edges?
A) 5 cm
B) 8 to 10 cm
C) 12 cm
D) 15 cm
B) 8 to 10 cm
57
What type of drain is most suitable for treating peritonitis in equine patients?
A) Passive drain
B) Sump drain
C) Multifenestrated drain
D) Heimlich valve
C) Multifenestrated drain
58
What is an economic alternative to an active suction apparatus mentioned in the text?
A) Gravity-based drainage
B) Smooth tubing connected to a syringe
C) Passive suction drains
D) Compressible bulbs
B) Smooth tubing connected to a syringe
59
How does the application of a three-way stopcock benefit the suction apparatus?
A) Increases suction
B) Allows interruption of suction
C) Enhances drainage efficiency
D) Reduces infection risk
B) Allows interruption of suction
60
When utilizing NPWT, what negative pressure is typically applied?
A) −75 mm Hg
B) −100 mm Hg
C) −125 mm Hg
D) −150 mm Hg
C) −125 mm Hg
61
Which statement is true regarding the drainage of thoracic cavities?
A) Passive drains are preferred.
B) Rigid tube drains are necessary.
C) Open suction systems are the most effective.
D) Suction is not required.
B) Rigid tube drains are necessary.
62
In treating wounds with NPWT, what are the proposed mechanisms of action?
A) Enhanced local cooling
B) Increased perfusion and reduced bacterial levels
C) Decreased blood flow
D) Increased tissue edema
B) Increased perfusion and reduced bacterial levels
63
How long should drains ideally remain in place after surgical intervention?
A) Less than 24 hours
B) 24 to 48 hours
C) 48 to 72 hours
D) Over 72 hours
C) 48 to 72 hours
64
What type of wound healing is NPWT NOT proven effective for?
A) Distal limb wounds
B) Clean surgical incisions
C) Traumatic neck wounds
D) Wounds in septic conditions
A) Distal limb wounds
65
What is the primary mechanism of action for gauze drains?
A) Suction
B) Gravity and capillary action
C) Negative pressure
D) Ventilation
B) Gravity and capillary action
66
In gauze drains, "step-by-step removal" refers to:
A) Removing all gauze at once
B) Gradually withdrawing portions of the drain
C) Immediate removal after placement
D) No specific removal techniquee
B) Gradually withdrawing portions of the drain
67
What is a notable disadvantage of the Latex Penrose drain?
A) High cost
B) Kinking easily
C) Non-reactive properties
D) Effective suction capability
B) Kinking easily
68
What action does the silicone Penrose drain primarily utilize?
A) Suction
B) Gravity
C) Capillary action
D) Negative pressure
C) Capillary action
69
What is a primary advantage of the red rubber tube drains?
A) No foreign body reaction
B) High flexibility
C) Rarely compressed or occluded
D) Economical
C) Rarely compressed or occluded
70
What is a significant disadvantage of using rubber tube drains?
A) Increased risk of infection
B) Limited drainage capacity
C) High cost
D) Difficult to remove
A) Increased risk of infection
71
What is the action mechanism for a sheet drain?
A) Suction
B) Gravity and capillary action
C) Negative pressure
D) Extravascular pressure
B) Gravity and capillary action
72
Which of the following is an advantage of the sheet drain?
A) High flexibility
B) Rarely compressed or occluded
C) Effective in body cavities
D) Minimal foreign body reaction
B) Rarely compressed or occluded
73
What disadvantage is commonly associated with the sheet drain?
A) Limited size options
B) Increased foreign body reaction
C) High cost
D) Ineffective drainage
B) Increased foreign body reaction
74
What is the unique feature of a Flexi-drain?
A) Made of rigid materials
B) Cut to various sizes
C) Can only be used for suction
D) Utilizes only negative pressure
B) Cut to various sizes
75
Which of the following drains is known for good drainage along the tubes where they join?
A) Gauze drains
B) Latex Penrose drains
C) Flexi-drain
D) Sheet drain
C) Flexi-drain
76
What is a significant characteristic of passive drainage systems?
A) They require continuous monitoring
B) They depend on gravity and capillary action
C) They can provide suction
D) They are suitable for all body cavities
B) They depend on gravity and capillary action
77
In which situation are passive drains typically not applicable?
A) Externally draining wounds
B) Intra-abdominal procedures
C) Thoracic drainage
D) Soft tissue drainage
B) Intra-abdominal procedures
78
What type of drainage does the Redon drain provide?
A) Extraluminal drainage
B) Intraluminal drainage
C) Interstitial drainage
D) External drainage
B) Intraluminal drainage
79
Which of the following is a significant advantage of the Redon drain?
A) Low cost
B) Minimal tissue irritation
C) Excellent for evacuation of fluids from body cavities
D) Lightweight design
C) Excellent for evacuation of fluids from body cavities
80
What is a notable disadvantage of the Redon drain?
A) It can collapse
B) Fenestrations may occlude
C) Requires constant suction
D) High risk of infection
B) Fenestrations may occlude
81
What is the primary function of the Jackson-Pratt drain?
A) Suction drainage only
B) Extraluminal drainage
C) Intraluminal drainage
D) Both A and B
C) Intraluminal drainage
82
What feature of the Jackson-Pratt drain minimizes tissue irritation?
A) Material composition
B) Design of the multifenestrated drain
C) Size options
D) Shape of the drain
B) Design of the multifenestrated drain
83
Under what condition is suction function possible with the Jackson-Pratt drain?
A) When placed in an airtight space
B) Only during external drainage
C) In large body cavities
D) With an external suction source
A) When placed in an airtight space
84
Which drain is designed with longitudinal slits for drainage?
A) Redon drain
B) Jackson-Pratt drain
C) Blake drain
D) Trocar catheter
C) Blake drain
85
What is a notable feature of the Blake drain?
A) It collapses easily
B) Multifaceted slits reduce the risk of occlusion
C) It is only used for external drainage
D) It is made of rigid material
B) Multifaceted slits reduce the risk of occlusion
86
What is a disadvantage associated with the Blake drain?
A) Minimal tissue irritation
B) It is voluminous and expensive
C) It cannot be used in body cavities
D) It is prone to dislodgement
B) It is voluminous and expensive
87
What is the action mechanism for the trocar catheter?
A) Capillary action
B) Gravity
C) Intraluminal drainage
D) Extraluminal drainage
C) Intraluminal drainage
88
Which of the following is a primary advantage of the trocar catheter?
A) Excellent for external drainage
B) Minimal tissue irritation
C) Easy insertion
D) It can collapse
B) Minimal tissue irritation
89
Which active drain is known for having a radiodense marker?
A) Redon drain
B) Jackson-Pratt drain
C) Blake drain
D) Trocar catheter
C) Blake drain
90
What is the primary application of the Redon drain?
A) Draining superficial wounds
B) Evacuating fluids from body cavities
C) Reducing swelling in limbs
D) Providing suction for external wounds
B) Evacuating fluids from body cavities
91
What is a characteristic of the Jackson-Pratt drain that contributes to its effectiveness?
A) Its rigid structure
B) Multifenestrated design
C) Longitudinal slits
D) Large diameter
B) Multifenestrated design
92
What type of drainage is common to both the Blake drain and Jackson-Pratt drain?
A) External drainage
B) Extraluminal drainage
C) Intraluminal drainage
D) Suction drainage
C) Intraluminal drainage
93
Which type of drain is specifically designed to be nonfenestrated at the extension?
A) Blake drain
B) Jackson-Pratt drain
C) Redon drain
D) Trocar catheter
C) Redon drain
94
What is a common use for the Jackson-Pratt drain in clinical settings?
A) Wound healing
B) Drainage of deep tissue abscesses
C) External drainage only
D) Supporting tissue scaffolding
B) Drainage of deep tissue abscesses
95
What is a shared characteristic of both the Blake and Jackson-Pratt drains?
A) They are both rigid
B) They both utilize suction
C) They have a multifenestrated design
D) They are made from latex
C) They have a multifenestrated design
96
What is a critical factor to consider when using the Redon drain?
A) Its size
B) The risk of occlusion
C) The need for airtight conditions
D) Its rigidity
B) The risk of occlusion
97
Which active drain is particularly designed for minimizing tissue irritation?
A) Redon drain
B) Jackson-Pratt drain
C) Blake drain
D) Trocar catheter
B) Jackson-Pratt drain
98
Which of the following describes the use of a Blake drain in clinical applications?
A) Suitable for external drainage only
B) Can be used for both lavage and drainage
C) It requires special handling
D) It can only be used in large cavities
B) Can be used for both lavage and drainage
99
What is the function of the nonfenestrated extension tube in a Redon drain?
A) To provide suction
B) To enhance drainage capacity
C) To prevent occlusion
D) To maintain an airtight seal
D) To maintain an airtight seal
100
What is the primary reason for the use of longitudinal slits in the Blake drain?
A) To increase strength
B) To enhance flexibility
C) To reduce the risk of occlusion
D) To allow for easy insertion
C) To reduce the risk of occlusion
101
What is the maximum thickness of each layer in a Robert Jones bandage?
A) 1 cm
B) 2 cm
C) 3 cm
D) 4 cm
B) 2 cm
102
How long should a stent bandage be removed after surgery to prevent contamination?
A) 12 hours
B) 24 hours
C) 48 hours
D) 72 hours
B) 24 hours
103
The main benefit of CM hernia belts compared to nylon abdominal binders is:
A) Lower cost
B) Higher subbandage pressure
C) More comfort
D) Easier application
B) Higher subbandage pressure
104
Which bandage type should not be applied to extend to the shoulder or hip?
A) Robert Jones bandage
B) Full-limb bandage
C) Fiberglass casting tape splints
D) Half-limb bandage
C) Fiberglass casting tape splints
105
Fiberglass casts are how many times stronger than plaster of Paris casts?
A) 10 times
B) 20 times
C) 30 times
D) 40 times
B) 20 times
106
What is the main disadvantage of plaster of Paris casts compared to fiberglass casts?
A) Heavier weight
B) Less durable
C) Poor molding capability
D) All of the above
D) All of the above
107
What is the ideal immersion temperature for fiberglass tape before application?
A) 15°C to 20°C
B) 21°C to 27°C
C) 28°C to 35°C
D) 36°C to 40°C
B) 21°C to 27°C
108
What is the typical setting time for fiberglass casts?
A) 1 to 2 minutes
B) 4 to 5 minutes
C) 10 to 15 minutes
D) 20 to 30 minutes
B) 4 to 5 minutes
109
What percentage of horses show clinical signs of complications from casts?
A) 50%
B) 60%
C) 77%
D) 90%
C) 77%
110
How much lighter are fiberglass casts compared to plaster casts?
A) 2 times lighter
B) 3 times lighter
C) 4 times lighter
D) 5 times lighter
C) 4 times lighter
111
What is the preferred application position for casting a horse?
A) Lying down
B) Standing
C) Sitting
D) In a sling
B) Standing
112
Which part of the limb is most susceptible to pressure sores from casts?
A) Proximal metacarpus
B) Distal metatarsus
C) Palmar/plantar aspect
D) Dorsal aspect
C) Palmar/plantar aspect
113
What is the range of thickness for a properly applied fiberglass cast?
A) 5 to 6 mm
B) 7 to 8 mm
C) 9 to 10 mm
D) 11 to 12 mm
B) 7 to 8 mm
114
What is the primary reason for using cool water during fiberglass application?
A) To save time
B) To reduce exothermic reaction
C) To allow longer application time
D) To improve molding
C) To allow longer application time
115
What is the risk associated with casting a limb in a flexed position?
A) Reduced blood flow
B) Increased risk of cast sores
C) Limited movement
D) Increased temperature
B) Increased risk of cast sores
116
What is a common complication following cast removal?
A) Inflammation
B) Infection
C) Cast sores
D) All of the above
D) All of the above
117
Which material is recommended for reducing cast sores?
A) Iodine solution
B) Zinc oxide
C) Orthopedic felt
D) Polyurethane foam
D) Polyurethane foam
118
What is the maximum weight limit for casting a horse?
A) 500 kg
B) 600 kg
C) 700 kg
D) No limit
D) No limit
119
Which joint is particularly at risk when applying a hind limb cast?
A) Hock
B) Knee
C) Ankle
D) Coxofemoral joint
D) Coxofemoral joint
120
What is the preferred stocking size for adult horses when applying a cast?
A) 5 cm (2 in)
B) 7.5 cm (3 in)
C) 10 cm (4 in)
D) 12.5 cm (5 in)
B) 7.5 cm (3 in)
121
Which factor increases the risk of dermal pressure necrosis in casts?
A) Age of the horse
B) Duration of casting
C) Tight application
D) All of the above
D) All of the above
122
What is the recommended length for a full-limb cast application?
A) 3 to 4 rolls
B) 4 to 6 rolls
C) 10 to 12 rolls
D) 15 to 20 rolls
C) 10 to 12 rolls
123
Which component is crucial for stabilizing a cast?
A) Splints
B) Molding
C) Padding
D) Color
A) Splints
124
What is the average percentage of limb weight a cast should carry?
A) 30%
B) 50%
C) 60%
D) 80%
B) 50%
125
What is the optimal humidity level for curing fiberglass casts?
A) 30%
B) 50%
C) 70%
D) 90%
C) 70%
126
Which type of horse is most likely to require a cast?
A) Mature horses
B) Foals
C) Racehorses
D) Show horses
B) Foals
127
How does the weight of a fiberglass cast change when it becomes wet?
A) Increases by 1.5 times
B) Remains the same
C) Decreases by 1.5 times
D) Doubles
A) Increases by 1.5 times
