Chapter 17 - Drains, Bandages, and External Coaptation Flashcards
Who first introduced drains in the form of hollow tubes to treat empyemas?
A) Celsus B) Hippocrates C) Galen D) Heisler
B) Hippocrates
In what year did Heisler introduce capillary drainage via a gauze wick?
A) 1719 B) 1859 C) 1882 D) 1952
A) 1719
What is the primary purpose of drains?
A) To facilitate fluid retention B) To channel unwanted fluids and/or air C) To promote infection D) To support tissue growth
B) To channel unwanted fluids and/or air
Which drain type is known for being soft, pliable, and radiopaque?
A) Gauze drain B) Sheet drain C) Penrose drain D) Tube drain
C) Penrose drain
Which of the following is NOT a reason to place a drain?
A) To eliminate dead space B) To enhance fluid retention C) To evacuate fluid collections D) To prevent fluid formation
B) To enhance fluid retention
What material is commonly used for making passive drains?
A) Steel B) Polyethylene C) Rubber D) Both B and C
D) Both B and C
What characteristic of the ideal drain material helps in easy identification during procedures?
A) Flexibility B) Nonreactivity C) Radiopacity D) Sterility
C) Radiopacity
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
B) To rely on suction for fluid removal
What must be maintained under aseptic conditions during drain placement?
A) Only the drain B) The implantation site C) The entire surgical room D) Only the surgical tools
B) The implantation site
Which drain type uses gravity and capillary action primarily for fluid removal?
A) Active drain B) Penrose drain C) Tube drain D) Sheet drain
B) Penrose drain
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
B) Mechanical irritation
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
B) They may cause ascending infection
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
B) 48 to 72 hours
What type of drain is known to collapse under suction?
A) Tube drain B) Penrose drain C) Gauze drain D) Sheet drain
B) Penrose drain
In what condition should tube drains not be used?
A) In contaminated areas B) In large wounds C) In the abdominal cavity D) In superficial cuts
C) In the abdominal cavity
What is a significant advantage of using Penrose drains?
A) They are fenestrated for better drainage B) They are effective for viscous fluids C) They are costly but durable D) They are not prone to blockage
B) They are effective for viscous fluids
What is the primary reason for not using gauze drains in thoracic and abdominal cavities?
A) Cost issues B) Risk of infection C) Risk of tissue adhesion D) They are too difficult to remove
C) Risk of tissue adhesion
What is the main risk associated with passive drains?
A) Excessive cost B) Mechanical irritation C) Inability to remove fluids D) Non-sterility
B) Mechanical irritation
Which of the following types of drains can be made from silastic?
A) Penrose drains B) Tube drains C) Gauze drains D) Sheet drains
B) Tube drains
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
B) They can easily be obstructed
What mechanism does the cigarette drain utilize?
A) Active suction B) Capillary action C) Gravity only D) External pressure
B) Capillary action
Which drain type is specifically mentioned as useful in septic joints?
A) Gauze drain B) Penrose drain C) Tube drain D) Sheet drain
B) Penrose drain
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
C) Tissue adherence to the drain
Which drain type requires frequent bandage changes to maintain sterility?
A) Penrose drain B) Gauze drain C) Tube drain D) Sheet drain
B) Gauze drain
What material should NOT be used for drains due to potential foreign body reactions?
A) Silicone B) PVC C) Red rubber D) Polyethylene
C) Red rubber
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
C) Its shape resists compression
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
B) It creates the egress site
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
C) They primarily rely on gravity and capillary action
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
B) The healing of the incisional sutures
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) Small egress openings
Which type of drain is best suited for small, sensitive areas?
A) Tube drains B) Gauze drains C) Sheet drains D) Penrose drains
A) Tube drains
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
D) They can support bacterial growth
What was developed by Raffle in 1952?
A) Capillary drainage B) Continuous suction C) Passive drainage D) Antibiotic gauze drains
B) Continuous suction
Which drain type is particularly effective in abscess management?
A) Tube drain B) Gauze drain C) Sheet drain D) Penrose drain
B) Gauze drain
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
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
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
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
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
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
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
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.
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.
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.
Figure 17-4. A Flexi-drain folded up in a plastic cup. Twelve single tubes are joined to a single drain system.
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.
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.
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.
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.
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).
Figure 17-10. A Lepage drain designed for drainage of the abdominal cavity with its rigid trocar to help during insertion.
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
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
How quickly can compressible suction bulbs lose suction capacity when filled?
A) 10% to 20% B) 20% to 30% C) 30% to 40% D) 40% to 50%
B) 20% to 30%
In equine practice, where are closed active drains often used?
A) Superficial cuts B) Deep wounds C) Healthy skin areas D) In non-infected joints
B) Deep wounds
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
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
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
What is a primary complication associated with NPWT in human patients?
A) Increased fluid production B) Pain C) Improved healing D) Enhanced granulation
B) Pain
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
Which drain is not functional for abdominal drainage?
A) PVC drain B) Silastic drain C) Penrose drain D) Jackson-Pratt drain
C) Penrose drain
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
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
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
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
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)
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
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
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
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
What can be a consequence of prolonged drainage from a wound?
A) Decreased bacterial load B) Increased risk of tissue irritation C) Faster wound healing D) Higher suction capacity
B) Increased risk of tissue irritation
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
What procedure should be followed if a passive drain becomes obstructed?
A) Backflush the drain B) Remove the drain immediately C) Aseptically prepare and gently widen the egress D) Replace the drain with a larger one
C) Aseptically prepare and gently widen the egress
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.
What is the effect of backflushing a drain?
A) Increases drainage efficiency B) Reduces infection risk C) Risks transporting microorganisms into the wound D) Enhances suction capacity
C) Risks transporting microorganisms into the woun
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
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
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
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
Which material is used in fine mesh gauze drains?
A) PVC B) Silastic C) Fine mesh gauze D) Polyvinyl alcohol
C) Fine mesh gauze
What is a significant advantage of using gauze drains?
A) High cost-effectiveness B) Ability to create negative pressure C) Minimal tissue irritation D) Rapid drainage under high suction
A) High cost-effectiveness
What is a major disadvantage associated with gauze drains?
A) Risk of tissue erosion B) Fraying of the gauze material C) Ineffective drainage D) High cost
B) Fraying of the gauze material
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
