Dead space and drainage Flashcards
What is dead space?
a space formed between tissues that are normally anatomically connected
What do dead spaces most commonly fill with?
fluid, sometimes gas
What causes dead space?
excessive dissection during surgery or trauma–separation of tissues
What is the classic case of trauma that causes dead space?
big dog picks up little dog by scruff and shakes
What can create dead space during surgery?
- poor technique #1
- mass removal
- reconstruction
What is a seroma?
collection of serum in a tumor like mass
Why do we want to avoid dead space?
- slows healing (can’t get fibrin bridge; blood supply compromised)
- increases risk of infection of the wound–(rich nutrients in seroma)
How do you minimize dead sapce?
- meticulous minimalist technique
- mayo disseciton
- remove only target tissue
How do you manage dead sapce?
- layered wound closure
- tacking sutures
- compression bandage
- drainage
Where should you use surgical drainage?
where there is significant dead space or where expect fluid to accumulation cand cause a problem
Where should you not use drainage?
where the wound shouln’t be closed around a drain
- contamination
- more debridement required
Why is it pointless to sitck a drain in an abscess of guinea pigs, rabbits or birds?
their pus is too viscous
How do passive drains work?
they use capillary action, gravity and/or pressure gradients to remove fluid
What is a penrose drain?
the most commonly used passive drain in vet med
How do passive drains work?
they use capillary action, gravity and/or pressure gradients to remove fluid. the entire tubing acts as a slide.
What is a penrose drain?
the most commonly used passive drain in vet med
How do you use a penrose drain?
- rinse with sterile saline to remove powder
- have a ventral exit that is NOT part of the incision or wound
- cover!!!
- tack in place with a suture or two at exit site
- make sure exit wound is large enough that it will stay open ntil next bandage change
- don’t lose it in the wound
how do active drains work?
they use suction to remove fluid
Why do active drains need to have a closed system?
because suction needs to be generated
What is a “rocket pack”?
An active drain made with a butterfly catheter and red rubber tubes or a syrynge with a plunger fixed in place
Which should be fenestrated, active or passive tubes?
active NOT passive
What is a ready made active drain?
Jackson Pratt
How is the active drain fixed to the skin?
finger trap pattern
Why does the collection system of an active drain need to be emptied using sterile technique?
because any contamination of the collection system means that bacteria will gain entry and crawl up the tubing into the wound
What is compression directly and inversely correlated to?
- direct: tension, layers
2. width, radius of limb
What can cause blockage of a drain?
dibrin
What can cause blockage of a drain?
fibrin
When shoudl drains be removed?
when the quantity of fluid retrieved has decreased and leveled off and the quality of the fluid is clear (
What are three specialized drainage techniques?
- omentization
- open wound drainage
- vacuum assisted closure
What is omentization?
use the omentum as a natural drain and place in abscessed cavities
What is open wound drainage?
open wound that is protected. most effective removal of fluid COVER
What is vacuum assisted closure?
a vacuum set to a specific pressure (125mmHG) is applied to a wound and stimulates angiogenesis and granulation tissue. also rapidly reduces load of microoragnisms. Controls dead space with vacoom action and encourages tissue adherence.
open cell foam is packed into the wound and tubing placed through foam to the vaccume source. occlusive dressing is over everything
Where is vacuum assisted closure contraindicated?
- tumor bed/malignancy
- exposed blood vessels/organs
- necrotic tissue
- active bleeding
- patients treated with anticoagulant
