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RUSVM Small Animal Surgery 1 > Drain Placement > Flashcards

Drain Placement Flashcards

1
Q

What is the purpose of drain placement?

A

Evacuate fluid that would otherwise accumulate due to dead space, inflammation, infection, or necrosis

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2
Q

Why do we want to decrease fluid accumulation in wounds?

A

Acts as a medium for bacterial growth

Separates tissue plants that need to heal together

Create pressure that can cause pain and decrease local blood flow

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3
Q

T/F: drains are a good alternative to debridement and lavage

A

False

Drains cannot replace a good debridement/lavage

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4
Q

What are the types of drains?

A

Passive
-penrose

Active

  • commercial closed suction drain (Jackson Pratt)
  • red top tue and butterfly catheter
  • syringe and safety pin/needle
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5
Q

Where does the fluid drain in a penrose drain?

A

Along drain, NOT inside

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6
Q

How should a penrose drain be placed?

A

ASEPTICALLY

Secured in most dorsal non-dependent region, at least 1cm lateral to edge of wound

Exits at most ventral area at an area SEPARATE from the primary incision
-secured near exit site

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7
Q

How would you maintain a penrose drain postop??

A

Cover with bandage to collect fluid
-frequently change

Remove when amount of drainage has decreased or when exudate has changed to transudate

Generally removed at 3-days

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8
Q

If you are unable to place a PO bandage over your the site where you removed a penrose drain, how would you instruct the owner to manage this site?

A

Apply warm compress —> promote drainage

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9
Q

T/F: double exit passive drains are used in large wounds

A

False

NEVER make double exit drains

  • promotes ascending infection
  • Dr Cavanaugh will never forgive you
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10
Q

Where does the fluid travel in an alive drain?

A

Inside of drain

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11
Q

How is an active drain placed?

A

Fenestrated end placed in wound bed

Drain exits DORSAL to wound in non-dependent region

Requires aspetic technique and wound must have compete seal

Secured with purse string and finger strap suture

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12
Q

How are active drains managed post op?

A

Drain exit site covered with bandage and triple antibiotic ointment

Tacking suture to protect drain from patient and self trauma

Client can quantify fluid production at home

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13
Q

How do you know when it is time to remove your active drain?

A

Body normally produces 1-2ml/kg/day of fluid as a reaction from the drain

Remove when fluid production is below 5ml/kg/day

Keep drain hole covered for 24hours after drain removal

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14
Q

Why might there be loss of suction with an active drain during wound healing?

A

Check attachments and that evacuation port is closed

Check external tubing for holes

Dehiscence -> incision is no longer airtight
- immediate re-suturing indicated if the breakdown is due to trauma or excessive tension

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15
Q

What should you do id you can not re-establish negative pressure in your active drain system?

A

Remove drain and convert to open wound management

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16
Q

Highly contaminated wounds that cannot be primarily closed are managed how?

A

Open wound management

-> involves covering with appropriate dressing and bandage

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17
Q

What is the first step in open wound management ?

A

Removing all contaminants, such as foreign material/bacteria and damaged tissue from the wound

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18
Q

What are the types of debridement from most to least selective ?

A

Autolytic > surgical > mechanical

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19
Q

What are the advantages to bandage therapy for wounds?

A

Maintain clean environment

Reduce edema, hemorrhage and dead space

Promote acid environment at the wound surface by preventing CO2 loss and absorbing ammonia produced by bacteria

Immobilize injured tissue
Minimize scar tissue

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20
Q

What are the disadvantages of bandage therapy for wound management?

A

Pressure sores

Increase cost of care

Frequent changes required

Require expertise

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21
Q

What are the layers of a bandage?

A

Primary (contact) layer (sterile)
-directly touches the wound surface and should remain in contact with it during movement

Intermediate (secondary) layer (non-sterile)
-Common material = loose-weave, absorbent materials

Outer (tertiary) layer (non-sterile)
-contacts secondary layer but not wrapped to limit absorption

22
Q

What type of contact layer is used for mechanical debridement of necrotic tissue and debris ?

A

Adherent

-cause pain on removal and serve little purpose in the absence of nonviable tissue

23
Q

What type of bandage is selected when granulation tissue has formed

A

Non-adherent

24
Q

What is the most commonly used badage in veterinary medicine that allows air to penetrate and exudate to escape from a wound surface?

A

Semi-occlusive

25
Q

How are contact layers selected?

A 
Phase of wound healing
Amount of exudate 
Wound location and depth 
Presence/absence of an eschar
Amount of necrosis / infection
26
Q

What type of bandage is commonly used early int he course of wound management and is never indicated once granulation tissue develops?

A

Wet-to-dry bandage

27
Q

What is the purpose of wet-to-dry bandage?

A

Provide wound protection/coverage

Initially maintain a moist environment

Mechanical debridement

Absorb moderate amounts of exudate

Specifically applicable to wounds with viscous exudate and necrotic debris

28
Q

How often should your wet-to-dry bandage be changed?

A

Every 24 hours

29
Q

What technique is used to bandage anatomic sites that would not accept a conventional bandage

A

Tie over

—> heavy gauge suture loops circumferentially around wound at 2-4cm intervals

—> wound packed with desired material then dry lap sponge as secondary larger

—> water impervious tertiary layer

—> umbilical tape placed in figure 8 fashion through suture loops to secure bandage

30
Q

What is the purpose of moist wound healing?

A

Create a wound environment that optimizes the body’s inherent wound-healing abilities using specialized primary layers (moisture retentive dressings)

31
Q

What makes a moisture retentive dressing?

A

Process related to moisture vapor transmission rate

Transepidermal water loss is movement of water through skin (4-9 g/msq/hr)

Low MVTR correlates with positive wound healing outcome

Dressing with MVTR <35 g/msq/hr are moisture retentive)

32
Q

What are the advantages to using a moisture retentive dressing (MRD)?

A

WBC remain in wound -> selective autolytic debridement

Lower incidence of infection -> barrier to exogenous bacteria and prevention of tissue desiccation and necrosis

Wound maintained a physiological temp, supporting functions of cells, proteases, and growth factors

Maintain proper moisture level > limit expansion of necrosis

Low oxygen tension under occlusive dressings lowers pH —> decrease bacterial growth and favor collagen synthesis

Non-adherent
Water-proof
Longer interval between bandage change

33
Q

What are the disadvantages to MRD?

A

More costly to purchase dressings initially

Excess exudate from wound can damage peri-wound skin and the wound bed by way of maceration (softening caused by trapped moisture) or excoriation (damage caused by excessive proteolytic enzymes in chronic wound fluid)

Requires more intellectual planning during wound management to select most appropriate dressing.

34
Q

What type of MRD should you use in a wound with high level of exudate that requires debridement/granulation?

A

Calcium alginate

35
Q

What type of MRD would you use in a wound with moderately high exudate that requires debridement/ granulation?

A

Polyurethane foam

36
Q

What type of MRD would you use in a wound with moderate levels of exudate requiring debridement/granulation ?

A

Hydrocolloid

37
Q

What type of MRD would you use in a wound with moderately high exudate that requires epithelization/contraction ?

A

Polyurethane foam

38
Q

What type of MRD do you use on a wound with moderate levels of exudate that requires epithelization and contraction?

A

Hydrocolloid

Saline-moistened polyurethane foam

39
Q

When are hydrocolloid bandages indicated?

A

Low to moderate exudate

Good for autolytic debridment, granulation, and epithelization

Occlusive cover to dressing

40
Q

When is hydrogel indicated?

A

Low to no exudate

Dry wounds requiring autolytic debridement, granulation, or epithelization

May enhance contraction on limb wounds

Cooling effect may decrease pain

41
Q

When are calcium alginate MRD indicated?

A

High exudate level

Autolytic debridement
Simulator of granulation tissue
Need hemostasis in oozing wounds

42
Q

When is polyurethane foam MRD indicated?

A

Moderate to high exudate

Good for epithelization
Autolytic debridement and granulation

Can wick moisture out of macerated skin

Premoisten with saline for low exudate wounds

43
Q

How often do you change MRDs?

A

During inflammatory phase: 2-3days

Once granulation tissue forms: 5-7days

Dressing should be changed before it becomes oversaturated or dries out and should be changed immediately if strike-through or soiling occurs

44
Q

What are the benefits of manuka honey?

A

Antimicrobial/ anti-fungal

  • high osmolarity —> draws lymph
  • creates acidic environment —> deleterious to bacteria and promotes oxygen release and fibroblasts
  • glucose oxidase produces hydrogen peroxide

Accelerates the sloughing of necrotic tissue
Provides local nutrition to wound
Abates inflammatory response
Improve epithelialization

45
Q

What are the benefits of using sugar in open wound management ?

A

Antimicrobial

High osmolality draws H2O and nutrient rich lymph into wound to promote healing

High osmotic stress interferes with bacterial cell signaling

Enhance superficial debridement

46
Q

What are the goals of treatment with negative pressure wound therapy?

A 
Remove wound exudate 
Decrease interstitial edema 
Draw wound edges together 
Promote blood supply to the wound 
Stimulate cells involved with modulating the inflammatory and proliferative response to injury
47
Q

What is the MOA of negative pressure wound therapy?

A

Benefits maybe result for cycling of increased blood flow (facilitating oxygenation and nutrient supply) and decreased blood flow (hypoxic stimulation of angiogenesis and fibroplasia)

48
Q

What pressure is commonly used in NPWT?

A

125mmHg

49
Q

What are the indications for NPWT?

A

Ideal for large open and effusive wounds devoid of granulation tissue

Chronic non-healing wounds

Extremist wounds tx by 2nd intention

Post-op mgt of tissue flaps/grafts

Open abdominal mgt for septic abdomen

50
Q

When is NPWT contraindicated?

A

Poor peri-wound skin condition

Necrotic or clearly devitalized tissue

Coagulopathy
Exposed major blood vessels

Open joint

Neoplastic malignancy
Untreated osteomyelitis

Unexplored draining tract

RUSVM Small Animal Surgery 1 (39 decks)

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