Closures, Sutures and Drains Flashcards
How long are sutures generally left in for?
generally are removed within 7 to 14 days after surgery if healing is adequate (Whitney, 2012). Retention sutures usually remain in place 14 to 21 days. Over 2 weeks and marks are often left behind. Not to be removed if not healed or approximated appropriately.
Types of Sutures
Intermittent, Continuous, Blanket.
Key principle when removing sutures
Nurse removes suture and never pulls contaminated stitch through tissues. lift stitches, Cut close to skin on knot `side and pull out.
what is an open-drain system
e.g., a Penrose drain [Fig. 38-7]) removes drainage from the wound and deposits it onto the skin surface.
What is a closed drain system
Jackson-Pratt (JP) drain (Fig. 38-8) or Hemovac drain relies on the presence of a vacuum to withdraw accumulated drainage from around the wound bed into the collection device
Which drain drains the most drainage?
JP drain collects fluid that is in the range of 100 to 200 mL/24 hr; whereas the Hemovac drain accommo- dates more drainage, usually up to 500 mL/24 hr. Homeric can be hooked to wall suction.
Concerns for drains with confused or pediatric patients
Take measures to prevent a confused patient from pulling out drain collector. Parents can help with kids to teach or supervise to make sure drains are not pulled out
How often do you empty drains
P&P say- Empty drainage collection reservoir every 8 to 12 hours and as needed for large drainage volume. Emptying drainage allows for continued suction
how might you assess functioning of a drainage system
Complete systematic inspection includes insertion site, drainage moving through tubing in direction of reservoir, patency of drainage tubing, airtight connection sites, and presence of any leaks or kinks in system.
When would you use steri strips when removing sutures/staples
any separation greater than two stitches or two staples in width is apparent in order to maintain contact between wound edges. Supports wound by distributing tension across wound and eliminates closure technique scarring.
NOTE: Brainteaser suggests strips are used when separation is greater then 2 sutures LONG (difference?)
What is a common action before removing sutures of staples. (Action at he owned site)
Clean sutures or staples and healed incision with antiseptic
swabs. This removes surface bacteria from incision and sutures or staples
When removing sutures or staples, how might a respiratory issues influence patient outcomes.
Who is specifically at risk?
Coughing is a risk for separation of approximated wounds/incision. MNGMT options include steri strips, controlled coughing/ using a pillow for support on abdomen.
Elderly and obese may be at risk d/t Skin weakness
Where is dehiscence most common
Abdomen wound in which layers below the skin also separate.
Most common complications of wound healing
hemorrhage or hematoma, infection, dehiscence (w/ possible evisceration)
what are the potential risks of using a drain
can be associated with hemorrhage, tissue inflm, retrograde bacterial migration and rain entrapment.
Longer the drain is in, the more likely infection may occur
