Module 7 - Advanced Wound Care Flashcards
What are the 7 principles of sterile asepsis?
• A sterile object remains sterile only when touched by another sterile object. • Only sterile objects may be placed on a sterile field. • A sterile object or field out of the range of vision or an object below a person’s waist is contaminated. (Remain tripod stance) • A sterile object or field becomes contaminated by prolonged exposure to air. • When a sterile surface comes in contact with a wet, contaminated surface, the sterile object or field becomes contaminated by capillary action. • Fluid flows in the direction of gravity. • The edge of a sterile field or container is considered to be contaminated.
Sterile vs clean technique
o Sterile – Absence of microorganisms Ex. Hospital o Clean – minimizing microorganisms Ex. home
What are the four phases of wound healing and body processes?
1- inflammatory phase (hemostasis and phagocytosis) 2 - Proliferative phase (Collagen strengthens wound, produces scar tissue Granulation tissue is highly vascular) 3 - maturation phase early (Collagen reorganized into more orderly structure) 4 - maturation phase late (Scar tissues has ≤ 80% of original tissue strength)
Describe wound healing by Primary intention
- wound is clean with straight edges (surgical wound). - edges can be approximated - healing is rapid and primarily collagen synthesis -scar usually thin and flat
Describe wound healing by secondary intention
- wound is large and irregular with considerable tissue loss (pressure ulcer, deep abrasion)
Describe wound healing by tertiary intention
When would you use a wet to dry dressing? Action?
- Mechanical wound debridement
- Disrupts wound bed, pulls healthy granulation tissue with non-viable tissue
When would you use a wet to moist dressing? Action?
- Frequent dressing changes
- Cools wound bed
- Disrupts granulation tissue
When is a transparent film dressing used?
Small superficial wounds - Trap moisture, self adhesive
2 Benefits of a nonadherent contact dressing?
- Protects granulation tissue
- Allows moisture to evaporate
Uses of a soft silicone dressing
- Removed without trauma to wound or periwound
- Decreases pain
Benefits of a hydrocolloid dressing
- Maintains wound bed moisture
- Impermeable to external contaminants – Adhesive and occlusive
- Can be left in place 5 to 7 days
- Preventive dressing for high friction area
Use of Hydrogel dressing
- Give moisture to wound bed (water, glycerin-based)
- Absorbs small amount of exudate
- Soothing
- Softens necrotic tissue
uses of foam dressing
- Nonadhesive
- Left intact for up to 7 days
- Useful for large amounts of drainage or autolytic debridement
Examples:
- Calcium Alginate – Highly absorbent
- Hydrofibers – Highly absorbent, may contain silver
What is the purpose of surgical drains?
- To permit drainage of fluids and air
- To promote healing
- Prevent infection/abscess formation
- To drain a known/anticipated fluid collection
Describe a Penrose drain
- Simplest type of drain
- Soft, open tube
- Used for thicker drainage
- Drainage absorbed into outer dressings
- May or may not be sutured
- Sterile safety pin is placed to prevent slippage back into wound
- Shortened as per physician’s orders
Describe a T-Tube drain
- Biliary drain
- Named because of it’s shape
- Used following cholecystectomy (or exploration of the CBD)
- Placed in common bile duct
- Drainage bag hangs outside the body
- Bile is highly irritating – need to prevent contact with patient’s skin
- Average drainage 700-1200 ml/day
- Generally sutured to the skin
- May have a 3 way valve to allow flushing
examples of passive drainage systems (2)
- Penrose drain
- T-Tube
- Drainage is by gravity, capillary action
- No suction
examples of Closed drainage systems
- Hemovac
- Jackson Pratt
- Blake Drain
- V.A.C. – Vacuum assisted closure
- Negative pressure (suction) in a closed system
- Advantages
- Decreased risk of infection due to closed system
- Ability to accurately measure drainage
What type of drainage system is used for a larger volume (500ml) and what type for small volume (100ml)
Hemovac - Larger
Jackson Pratt - smaller
hemovac drain is used for…
- abdominal & orthopedic surgeries
Jackson Pratt drain is used in a variety of surgeries and is placed where?
- Placed in a separate puncture site or at the edge of the surgical wound
- sutured in place
The Blake drain is used in….. describe
- Used in abdominal and thoracic surgeries
- Tubing has 4 channels along the sides, with a solid core center
- Drains by gravity or attached to reservoir bulb suction
- May or may not be sutured to the skin
- No flushing
- Notify physician if drainage exceeds 300 ml/shift
