Drain Placement And Bandage Care Flashcards
When do we usually remove passive drains?
wound-dependent!
- remove when amt of drainage steadily decreases or turns from
- exudate—>transudate**
usu. 3-7 days
How far from the incision should you plan the exit site in placing a passive (penrose) drain?
At least 1cm from incision
And slightly lateral
T or F:
Precise quantification of drainage fluid is a major advantage of active drains.
TRUE
REMEMBER,
when removing a JP drain, consider:
_body produces 1-2mL per kg per DAY
remove drain when fluid production decreases to
less than 5mL per kg per DAY or =0.2mL per kg per HOUR_
How should we treat highly contaminated wounds that cannot be treated via primary closure?
Open Wound Management (OWM)
Which type of debridement is the most selective (only UNhealthy tissue removed)?
Autolytic:
performed by WBCs during the first 3-5 days after wound occurs
How does bandage therapy promote an acid environment at the wound surface?
By preventing CO2 loss and absorbing ammonia produced by bacteria
(increases oxygen dissociation from hemoglobin and subsequently increases oxygen availability)
What are some common intermediate (secondary) layer materials in a bandage?
Loose-weave, absorbent materials (cast padding, bulk roll cotton)
What are some common outer (tertiary) layer materials in a bandage?
Porous surgical adhesive tape (Elastikon), elastic adherent or self-adherent material (vetwrap), and stockinette
What type of bandage therapy is commonly used EARLY in the course of wound mgmt, but is NEVER indicated once granulation tissue develops?
Wet-to-dry;
goes on wet, wicks fluid (non-selectively) onto gauze
What is the process of creating a wound env’t that optimizes the body’s inherent wound-healing abilities using specialized primary layers called moisture retentive dressings (MRD)?
- *Moist Wound Healing (MWH)** -
- wound fluid provides a physiologic ratio of proteases, protease inhibitors, GFs, cytokines at each stage of wound healing*
What is currently considered the standard of care for wound management?
MRDs (Moisture retentive dressings)
as they are usually non-adherent and occlusive thereby protecting and retaining wound fluid
____(quantity) Moisture vapor transmission rate (MVTR) strongly correlates w/ positive wound healing outcomes and is predictive of healing when all other variables are held constant.
LOW!
Dressings with an MVTR of =35 g/m2/hr are considered Moisture Retentive!!
What are the Big 4/ Arsenal MRDs?
Calcium Alginate,
Polyurethane foam,
Hydrocolloid,
Hydrogel
How frequently should you change MRDs during the inflammatory phase (most exudate)?
q2-3 days
How frequently should you change an MRD once granulation tissue has formed?
q5-7 days
*change to a less absorptive dressing (i.e. hydrocolloid)*
