Drains Flashcards
What are 3 indications for surgical drains?
- Dead space cannot be obliterated
- Fluid accumulation
- Infection
What is a disadvantage to surgical drains?
Increased risk of secondary infection.
What are 3 ways to try to reduce dead space?
- Tacking sutures
- Drains
- Compression bandage
Drains should never exit through where?
Incision line
Drains should not lie where?
Why?
- Directly under the suture line.
- Increased risk of dehiscence.
Tacking drains with what is discouraged?
What is preferred?
- Tacking drain with buried sutures.
- Percutaneously placed sutures which can be removed prior to drain removal are preferred.
What are 2 main categories of drains?
- Passive
- Active
Which category of drain depends on gravity and capillary action to move fluid?
Passive
Which category of drain requires a suction device to pull fluid from the wound?
Active
With which category of drain is the surface area of the drain important?
Passive
Passive drains must exit dependent of where?
Dependent of wound
Which is preferred, a single exit site or two exit wounds?
Why?
- Single exit site
- Decrease risk of ascending infection.
The drain exit must be kept what 2 things?
Why?
- Clean and dry
- Minimize maceration of surrounding skin.
A bandage is applied in most instances for what purpose?
To absorb fluid coming from wound.
What type of drain consists of soft latex tubing that collapses easily?
Penrose drain
Do Penrose drains conform well to wounds?
Yes
What is sometimes done to a Penrose drain that may decrease effectiveness by reducing surface area?
Fenestrating the drain.
A fenestrated Penrose drain modified with gauze strip inside is known as what?
Cigarette drain
The wicking action of gauze inside a cigarette drain may improve what?
Effectiveness of drain
What is increased with a double exit Penrose drain compared to a single exit?
Increased risk of infection.
How should a double exit Penrose drain be removed?
Prep skin, apply traction to drain, cut suture, cut drain below exposed portion, pull remaining portions as with single exit.
Which has greater efficiency, a passive or active drain?
Active drain
There is a decreased risk of what with active drains?
Decreased risk of macerating surrounding skin.
Is risk of infection lower with passive or active drains?
Active drains
What is the primary cause of active drain failure?
Obstruction
Active drains enhance what?
Healing
Fenestrations made in drains should not be greater than what length?
Should not be more than 25% of circumference of drain.
The exit site of an active drain can be where?
Wherever it is convenient to secure the suction canister.
Why must the exit hole of an active drain be kept small?
To minimize air leakage.
What type of closure is necessary for an active drain?
Airtight skin closure
With an ingress/egress system, do they share the exit hole or have separate holes?
Ingress drain should have separate access.
What is the ingress drain used for?
Only used for flushing.
What should be done to the ingress drain when not in use?
Should be capped off.
Are ingress/egress systems used with active or passive drains?
Both
What do you NOT do with the egress drain?
Do NOT inject into egress drain.
What are 2 determiners for when a drain is typically removed?
- Usually 3-7 days
- Drainage decreases
Does a drain typically stop completely within 3-7 days?
No
The drain should be removed if what happens?
Discharge becomes serous or serosanguineous.
If taking a sample for a culture, where is a good place to take it from?
Cut off/swab end of drain from deepest part of wound after removal.
