Surgery Immersion Flashcards
What is the purpose of surgical drainage?
A drain will prevent the accumulation of fluid or air that could : serve to hinder healing , provide an environment favorable to bacteria, or result in the need for further surgery.
What are drains NOT for that many medical students think they are?
- Preventing infection (if left in for >7 days increase the risk of secondary infection)
- Stopping bleeding (blood clotts and plugs drains)
- Drains can not drain the entire abdomen (The abdomen will grow to wall off any drain within ~48 hours)
- Drains can not be relied on without maintenance – they need to be continually assessed for patency and functionality.
Passive drains
- Allow the build up of fluid or air a simple tract by which to exit
- Ex: Foley catheter
Closed suction drains
- Function by pulling fluid out of a cavity
- They can develop excessive suction
- Ex: Chest tube
Sump suction drains
- Utilize a built in air port to keep the tissue from plugging the drain
- Ex: Nasogastric tube
What forces do passive drains rely on for their action?
- Gravity
- Pressure
- Surface tension
What forces do suction drains rely on for their action?
- Gravity
- Applied force (generation of low pressure for suction)
Purpose of an air port in suction drains
The addition of an air port allows air to be pulled into the tube to help prevent the development of excessive suction and tissue intussusceptions into the drain
Excess suction can both potentiate continued leakage by facilitating flow and can pull surrounding tissue into the drain and plug it.
Examples of sump and closed suction drains
Examples of passive drains
When to use suction vs passive drains
Guidelines to placing a drain
Daily management of drains
- Patency
- Monitor for sudden changes in output
- Check connections & bulb/ suction for function
- Empty collection container when ½ to ¾ full
- Character of drainage
- Sudden presence of blood may indicate drain erosion into tissue
- Sudden change in the color of the drainage may indicate a fistula or abscess
- Special considerations for sump drains
- Do you hear air moving?
- Is there fluid in the air port?
When are drains removed?
- When they are no longer needed (fluid is gone or has reached acceptable level)
- When the risk benefit ratio is exceeded (Risk of secondary infection, Possible tissue erosion)
- When they are non-functional
Steps to taking drain out
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Other C section scars
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Plan organized by systems
