Chapter 4: Hemostasis, Sponges, and Drains Flashcards
A shoulder examination under anesthesia is an example of what class of wound? A. Class 1 B. Class 2 C. Class 3 D. No wound classification
D. No wound classification
Choose the TRUE statement about topical hemostatic products.
A. Active hemostatic products include cellulose and gelatins
B. Fibrin sealants increase levels of fibrinogen and thrombin at a bleeding site
C. Flowables contain fibrinogen
D. Passive or mechanical hemostatic products contain thrombin
B. Fibrin sealants increase levels of fibrinogen and thrombin at a bleeding site
A Penrose drain is an example of a:
A. Chest drainage system
B. Closed drainage system
C. Simple drain
C. Simple drain
Choose the TRUE statement about dressings.
A. Certain dressings are definitively associated with improved outcomes
B. Primary dressings are bulkier than secondary dressings
C. Primary dressings are usually made of adherent material
D. Secondary dressings absorb discharge, protect wounds, and promote hemostasis
D. Secondary dressings absorb discharge, protect wounds, and promote hemostasis
Ostomies, burns, chronic venous ulcers, and necrotizing wounds are examples of:
A. Class 1 wounds with low risk of infection
B. Complex wounds that require individualized treatment
C. Superficial surgical site infections that require antibiotic therapy
D. Wounds that require delayed primary closure
B. Complex wounds that require individualized treatment
Use of the Center for Disease Control and Prevention’s Surgical Wound Classification System
A. Adds significant time to operative procedures
B. Enables comparison of infection rates and assessment of infection risk
C. Is recommended primarily for complex or high-risk wounds
D. Must be performed by a surgeon
B. Enables comparison of infection rates and assessment of infection risk
Which statement(s) is/are true about drains (select all that apply): A. Drains are used primarily to obliterate dead space and remove harmful material, and when hemostasis is uncertain B. A hemovac drain is passive, using gravity or capillary action to remove fluid from the wound C. Active drains have a reservoir that can be collapsed to create negative pressure that draws fluid from the wound into the reservoir D. Single lumen sump drains are connected to external suction
A. Drains are used primarily to obliterate dead space and remove harmful material, and when hemostasis is uncertain
C. Active drains have a reservoir that can be collapsed to create negative pressure that draws fluid from the wound into the reservoir
D. Single lumen sump drains are connected to external suction
Mechanical methods to achieve hemostasis include which of the following (select all that apply): A. Hemostats B. Collagen sponges C. Laser D. Ligatures E. Fibrin sealants
A. Hemostats and
D. Ligatures
The perioperative nurse who is circulating for an excisional breast biopsy should anticipate the need to add which type of drain to the sterile set-up: A. T-Tube B. Hemovac C. Jackson-Pratt D. Penrose
C. Jackson-Pratt
Disadvantages of a penrose drain include (select all that apply):
A. Often are manufactured using latex and would be contraindicated in those with latex allergy
B. Allow for active drainage of surgical wounds
C. Provide a pathway for microorganisms to be introduced into the wound
D. Do not allow for accurate measurement of drainage
A. Often are manufactured using latex and would be contraindicated in those with latex allergy
C. Provide a pathway for microorganisms to be introduced into the wound
D. Do not allow for accurate measurement of drainage
Sponges for counting should be arranged in sponge counter bags off the field as follows: A. 10 laps per bag, 5 raytecs per bag B. 5 laps per bag, 10 raytecs per bag C. However the surgeon prefers D. None of the above
B. 5 laps per bag, 10 raytecs per bag
Describe how/what this drain is used for:
Penrose drain
Drainage is pulsed along outside the drain by capillary action and gravity into dressing
Describe how/what this drain is used for:
Nasogastric tube
aspirates gastric contents/decompresses the intestinal tract post op
Describe how/what this drain is used for:
T-tube
drains the common bile duct through the abdominal wall
Describe how/what this drain is used for:
Suction Drain
drains accumulated blood from operative site, uses mechanical suction to pull blood and fluid into the reservoir
Describe how/what this drain is used for:
Chest tube
restores an airtight pleural cavity and maintains negative pressure, uses a water seal system connected to a source of suction
When do you count sponges?
Before procedure, before closure of a cavity, at wound closure, at skin closure, at permanent relief or a scrub or circulator
Describe the specific method to control bleeding:
Mechanical Method: Pressure
Manual using hands, digits, sponges or packs
Describe the specific method to control bleeding:
Mechanical Method: Hemostats
Clamps used to compress blood vessels and hold small amount of tissue
Describe the specific method to control bleeding:
Mechanical Method: Ligating clips
Small staple like devices that are placed around the lumen of a vessel/structure
Describe the specific method to control bleeding:
Mechanical Method: Ligature
Strand of material tied around a blood vessel to occlude the lumen
Describe the specific method to control bleeding:
Mechanical Method: Pledget
Non absorbable suture support that is used when there is a possibility of sutures tearing through tissue
Describe the specific method to control bleeding:
Thermal Method: Argon Beam Coagulator
Delivers radio frequency electrical energy to tissue across a jet of argon gas
Describe the specific method to control bleeding:
Thermal Method: Electrosurgery
monopolar mode is used for coagulation, electrical current applied through patient’s tissue
Describe the specific method to control bleeding:
Thermal Method: Laser
Beam of light that is intense and concentrated and is able to cut and coagulate at the same time with minimal destruction to surround tissue
Describe the specific method to control bleeding:
Chemical method: Microfibrillar collagen
Used as an adjunct to hemostasis when control of bleeding by ligature or conventional methods is ineffective or impractical
Describe the specific method to control bleeding:
Chemical method: Oxidized cellulose
Absorbs 7-8 times its weight in blood, producing a clot
Describe the specific method to control bleeding:
Chemical method: Collagen sponge
Dehydrated hemostatic sponge or foam available compressed or as a powder
Describe the specific method to control bleeding:
Chemical method: Gelatin sponge
Sponge swells forming a clot and absorbs 40-50 times its weight
Describe the specific method to control bleeding:
Chemical method: fibrin sealant
derived from human and animal blood products, forms a stable clot
Describe the specific method to control bleeding:
Chemical method: phenol solution
used for sclerotherapy therapy of hemorrhoids. Some surgeons use it to cauterize the lumen of the appendix stump as it is cut off
Describe the specific method to control bleeding:
Chemical method: thrombin
accelerates coagulation of blood and controls capillary bleeding
Describe the specific method to control bleeding:
Chemical method: styptics
Causes blood vessels to constrict
What are the steps a perioperative RN should take if a count is done and a sponge is missing?
Verbal acknowledgement and inform team, search the area, suspend closure of the wound until found, xray if it cannot be found
