Drains and Trach Tubes

Question 1

Why do we use drains in practice?

Answer 1

Remove exudate and fluid from surgical sites especially where the surgery has caused dead space

Allow monitoring of the surgical site ie abdominal surgeries- monitor free fluid composition and amount and replace loses

Aid wound healing and reduce the risk of dehiscence - removes all exudate, avoids fluid seeping out of wound

Question 2

What is Exudate?

Answer 2

Exudate consists of fluid that has leaked out of blood vessels and closely resembles blood plasma

Question 3

Passive drains, how do they work, what type of drain is passive, what are they made of?

Answer 3

Passive drains: Use capillary flow, Gravity

Penrose drains - yellow ones

Made of rubber latex - can go home with it be aware of latex, wrap up with banadeage when walking

Wider= more effective drainage

Increased risk of infection of both the site and surrounding areas

Can cause irritation of the skin when in place of from fluid

Sometimes the end is covered in absorbent material to absorb exudate

Cheap and often used in GP or for minor infected wounds such as bite wounds

Question 4

Jackson Pratt drains, how do they work?

Answer 4

Active suction drains

Fenestrated drain attached to tubing that is then attached to a grenade

Air is removed from the grenade to create the negative pressure

When full or if there is an issue with the drain positive pressure will be present

Reduce dead space, remove air and fluid

Question 5

Jackson Pratt Drain- what are they used for and how long do they stay in?

Answer 5

Used for abdominal surgeries or larger wounds such as STS removal

Stay in until become non productive usually 3-5 days

Question 6

STS?

Answer 6

soft tissue sarcoma

Question 7

Redon/Red O pack drains

Answer 7

Same as Jackson pratt

Not used as to empty they have to be disconnected from the close circuit tubing unlike Jackson Pratt drains that have a separate area for emptying.

Introducing risk of infection

Question 8

Redovac drains - how do they work?

Answer 8

Completely closed active suction drains

Same as above the drain has fenestrated holes

Tubing to the reservoir bottle

This bottle is already primed as a vacuum DO NOT REMOVE THE CLAMP

A seal must be formed usually 4-6hrs post surgery then the clamp can be released allowing the drain to function

The reservoir has numbers to allow for recording volumes

Question 9

How suitable are Redovac drains and when are they used

Answer 9

They are bulky and not well tolerated in smaller species

Can be secured using surgical vests or cardio- vests

Only used when there is significant dead space, should have an ongoing reason for using

Question 10

How are standard jackson pratt drains sutured

Answer 10

Chinease suture trap

Question 11

NPWT

Answer 11

Negative pressure wound therapy

Question 12

VAC?

Answer 12

Vascular Assisted closure

Question 13

When is Negative pressure wound therapy or Vascular Assisted closure used?

Answer 13

Used in large, open and contaminated wounds

Chronic non healing wounds

Surgical wounds that are unable to close

Dehiscence

Prevent oedema or seroma post op

Question 14

What are the contradicitions of Negative pressure wound therapy or Vascular Assisted closure?

Answer 14

Neoplasia, coagulopathies or near major arteries and veins

Neoplasia - you are spreading it
Coagulopathies - they will bleed to death
Near major arteries and veins - too much prressure, can cause rupuring or bleed to death

Question 15

How does Negative pressure wound therapy (NPWT) or Vascular Assisted closure (VAC) work?

Answer 15

Works by- Increasing perfusion, hydrostatic pressure, stimulates granulation tissue

Question 16

What is the usual setting of Negative pressure wound therapy or Vascular Assisted closure?

Answer 16

Usual setting –ve pressure- 125mmhg

Question 17

What problems can occur with Negative pressure wound therapy or Vascular Assisted closure?

Answer 17

Loss of seal, patient interference, kinking of tubing, canister full as incorrectly monitored, battery/power issues are all possible complications - if bleeding or swelling around site something wrong with vaccum

Question 18

What is the standard operating procedure for handling drains both active and passive?

Answer 18

Barrier nurse -high if infectious

Excellent hygiene

Minimum PPE of gloves

If reservoir/canister is full, they must be replaced not emptied and reused

Every time they are emptied, fluid/air volume must be recorded if concerned check sample

Prevent patient interference

Question 19

What is the standard operating procedure for handling PASSIVE drains?

Answer 19

Clean regularly to prevent irritation and infection, ensure environment clean

Question 20

What is the standard operating procedure for handling ACIVE drains?

Answer 20

Active- Empty when +ve pressure, DO NOT EMPTY Q4hrs just because the hospital sheet says drain, check if +ve pressure, empty if –ve pressure, check connections and mark on –ve pressure no requirement to drain