Drain Placement Flashcards
What is the purpose of drain placement?
Evacuate fluid that would otherwise accumulate due to dead space, inflammation, infection, or necrosis
Why do we want to decrease fluid accumulation in wounds?
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
T/F: drains are a good alternative to debridement and lavage
False
Drains cannot replace a good debridement/lavage
What are the types of drains?
Passive
-penrose
Active
- commercial closed suction drain (Jackson Pratt)
- red top tue and butterfly catheter
- syringe and safety pin/needle
Where does the fluid drain in a penrose drain?
Along drain, NOT inside
How should a penrose drain be placed?
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
How would you maintain a penrose drain postop??
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
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?
Apply warm compress —> promote drainage
T/F: double exit passive drains are used in large wounds
False
NEVER make double exit drains
- promotes ascending infection
- Dr Cavanaugh will never forgive you
Where does the fluid travel in an alive drain?
Inside of drain
How is an active drain placed?
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
How are active drains managed post op?
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
How do you know when it is time to remove your active drain?
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
Why might there be loss of suction with an active drain during wound healing?
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
What should you do id you can not re-establish negative pressure in your active drain system?
Remove drain and convert to open wound management
Highly contaminated wounds that cannot be primarily closed are managed how?
Open wound management
-> involves covering with appropriate dressing and bandage
What is the first step in open wound management ?
Removing all contaminants, such as foreign material/bacteria and damaged tissue from the wound
What are the types of debridement from most to least selective ?
Autolytic > surgical > mechanical
What are the advantages to bandage therapy for wounds?
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
What are the disadvantages of bandage therapy for wound management?
Pressure sores
Increase cost of care
Frequent changes required
Require expertise
What are the layers of a bandage?
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
What type of contact layer is used for mechanical debridement of necrotic tissue and debris ?
Adherent
-cause pain on removal and serve little purpose in the absence of nonviable tissue
What type of bandage is selected when granulation tissue has formed
Non-adherent
What is the most commonly used badage in veterinary medicine that allows air to penetrate and exudate to escape from a wound surface?
Semi-occlusive
