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Clinical Studies > Surgical, Wounds, Bandaging & Drains > Flashcards

Surgical, Wounds, Bandaging & Drains Flashcards

1
Q

What are the five duties of surgery?

A
  1. To remove what is superfluous (unnecessary) 2. To restore what has been dislocated 3. To separate what has grown together 4. To reunite what has been divided 5. To redress the defects of nature
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2
Q

What are the 6 key reasons why surgery is performed?

A
  1. Therapeutic e.g. bone breaks 2. Diagnostic e.g. exploratory/ biopsy 3. Increase suitability for use e.g. neutering and dehorning 4. Palliative e.g. amputation - neoplasia, chronic pain, disability, mutilation 5. Biomedical 6. Cosmetic e.g tail docking
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3
Q

-ectomy

A

Cutting out

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4
Q

-otomy

A

Cutting, sharp or separate

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5
Q

-ostomy

A

Creating an opening for discharge of bodily wastes

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6
Q

-plasty

A

To modify or reshape

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7
Q

-pexy

A

To fix or secure

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8
Q

-rrhaphy

A

To strengthen - usually with a suture

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9
Q

-centesis

A

Surgical puncture

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10
Q

-oscopy

A

Viewing of - normally with a scope

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11
Q

What is considered cold steel?

A

Scalpel and Scissors

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12
Q

Scalpel…

A

Best for dense tissue like the skin - Minimises collateral damage and crushing

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13
Q

Scissors…

A

Best for loose tissue like adventitia and fat - More crushing Can be used in dense tissue by slide cutting

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14
Q

What is electro surgery?

A

Cautery (burn) and Cutting - More collateral damage than cold steel

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15
Q

What can cautery be used for?

A

Disbudding of calves Hand-held units - handy for small animal surgery

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16
Q

What can lasers be used for?

A

To remove, vaporise or weld tissue - intense beam of monochromatic coherent radiation in IR, visible or near UV spectrum

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17
Q

What is used for tissue desiccation?

A
  • Cryosurgery - liquid nitrogen - Photodynamic Therapy- oxygen free radicals release by light application
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18
Q

What is an arthroscope?

A

A lensed eyepiece fitted with a camera and a light source

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19
Q

What are the advantages of arthroscopy?

A
  • Minimally invasive - Decreased hospital stay - Better view arthroscopically than operatively due to magnification and field of view plus optimal lighting
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20
Q

What are the disadvantages of arthroscopy?

A
  • More Costly - Can take longer - Some joints e.g. canine stifle are too small
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21
Q

What are the two most common complications of surgery?

A
  • Haemorrhage - Infection Must discuss the potential adverse outcomes and help owners make decisions
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22
Q

What makes a good surgeon?

A
  • One who weighs the risks of a procedure against the benefits - One who fully informs the patient / owner - One who calls on their experience and skill to plan and carry put the procedure safely
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23
Q

What are Halsted’s Principles?

A
  1. Gentle Tissue Handling 2. Eliminate Dead Space 3. Meticulous Haemostasis 4. Close/ normal approximation of tissues 5. Aseptic Technique 6. Minimise foreign bodies 7. Avoid tension on sutures/ tissues
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24
Q

Handle tissues gently… Rough Handling…

A
  • Increases likelihood of post-op infection by creating necrotic tissue - Delays the rate of healing - Increases surgical shock - Increases pain and dysfunction
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25
Q

What does Effective Haemostasis do?

A
  • Allows better surgical conditions - easier to see - Lessens the chance of Haemorrhagic shock - Lessens the chance of post-op infection - Preserves blood supply
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26
Q

What does using aseptic techniques do?

A

Reduces the chance of post-op infection - Performed in theatre to protect the patient from contact and air-borne bacteria

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27
Q

Aseptic Surgery

A
  • Prepare patients skin to protect from their own flora - Surgeons wear protective clothing to protect the patient from us - Use drapes to isolate the surgical area
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28
Q

Avoiding tension on wound areas…

A
  • Tight sutures tear through tissues - this reduces wound strength - Death of tissues increases the risk of infection and delays the healing of the wound (no blood supply = no healing)
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29
Q

Avoiding creating or leaving dead space between tissues…

A
  • Can lead to accumulation of blood and serum in tissue spaces - Delays healing - Greatly increases the likelihood of wound infection
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30
Q

Meticulous approximation of all wound layers…

A
  • Promotes rapid healing - Increases wound strength - Lessens the chances of infection
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31
Q

Minimise foreign material in the wound…

A

Includes suture material and glove powder

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32
Q

Which Halsted’s Principle applies to drains?

A
  1. Avoid creating or leaving dead space in between tissue planes, as accumulation of blood and serum in tissue spaces delays healing and greatly increases the likelihood of wound infection
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33
Q

What are the three principle reasons for using drainage in wounds?

A
  1. To obliterate dead space 2. To remove material that could be harmful to a particular anatomical site 3. Where flushing of a solution, antiseptic or antibiotic is needed through the area after primary closure
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34
Q

It is appropriate to use drains when?

A
  • It is impossible to completely debride a wound because vital structures are contaminated - Foreign material must be removed - Massive contamination of the wound is inevitable - The viability of the wound is questionable Dead space needs to be obliterated -There is incomplete drainage - There is anticipated leakage - There is insecure closure of a hollow organ - For treatment of a pneumothorax or to recreate negative pressire in the thoracic cavity after surgery
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35
Q

Why is leaving a wound open useful in some circumstances?

A

It provides natural drainage

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36
Q

What are the 9 principles of drain placement?

A
  1. Placed Aseptically 2. Pass through wound separate from surgical incision 3. Exit at most ventral site possible 4. Exit at two points if passive 5. Exit points large enough to allow drainage 6. Suture to the skin 7. Cover with sterile dressing 8. Record where and how long drain is 9. Fit E-collar if left unbandaged
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37
Q

What is an open drain?

A
  • Forms a wick around which the wound fluid drains away - Should be covered by bandage for sterility
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38
Q

What is a closed drain?

A
  • Collection system attached to the drain - Active or passive
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39
Q

What is a passive drain?

A

A drain that relies on gravity to remove fluids along internal or external surface to the outside of the body - Act by surface area

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40
Q

What is an active drain?

A

Use positive pressure e.g. suction to actively draw fluids out of the body - Require frequent checking to replace or reset vacuum - Rigid tubes - Fenestrated within wound section - Can make homemade ones from winged infusion sets and vacutainers or syringes and needles

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41
Q

Describe a Yeates drain?

A
  • Soft PVC - Drainage through lumen and along exterior - Available in two widths
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42
Q

When do you remove a drain?

A
  • When the the reason for drainage is gone - When wound fluid drainage is minimal (except for drain induced fluid)
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43
Q

What is a sump drain?

A

Multilumen drain consisting of a large tube with a smaller tube within the wall or lumen of the larger tube - allows air to enter, displacing fluid

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44
Q

How are chest drains inserted?

A

Feeding tubes are inserted through the chest wall using a haemostat or at the time of surgery. - Connected by an adaptor to a three way tap to show periodic drainage - Protect against over penetration with fist

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45
Q

What is an intermittent drainage system?

A

Used in most cases of pleural drainage - Drain is in place between periods - Chest tube kept clamped - Air or fluid is drawn off by syringe - Ensure air isn’t accidentally sucked back into the system during attachment of syringes (by three way tap or double clamp) or if the cap comes off the system is still secure - Bandage - E-collar - Good analgesia is essential

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46
Q

When should the chest be drawn?

A

Frequently with the length of time between drainage being increase as the volume being drawn off decreases

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47
Q

What is a continuous drainage system?

A

Used when the rate of accumulation is life threatening - Maintains contact between pleural surfaces - Requires dedicated equipment and constant supervision - Uses either gravity or negative pressure to apply continuous drainage off the chest - Water seal should be used with gravity drainage to prevent air being drawn back into the chest – seal must be lower than patient at all times so water isn’t drawn back into pleural space

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48
Q

What are some complications of drain placement?

A
  • Hospital-Acquired -Infection can result from ascending infection - bacteria may be resistant - Foreign body reaction to the drain reduces the number of bacteria required for infection
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49
Q

What are the advantages of passive drains?

A
  • Cheap - Easy to place - Effective
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50
Q

What are the disadvantages of passive drains?

A
  • Messy - Risk of infection - Needs Bandaging - Dependent on gravity - Inefficient for large areas - Difficult to monitor fluid - Difficult to judge removal
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51
Q

What are the advantages of Active drains?

A
  • Vacuum brings tissues into apposition - Easily placed Not gravity dependent - Useful in high motion areas - Collects exudate in container - Doesn’t require bulky bandaging
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52
Q

What are the different ways to apply a vacuum?

A
  • Concertina - Compressible ‘grenade’ - Vacutainer - Suction Machine
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53
Q

What Post-op care is required for closed suction drains?

A
  • Secure drain with sutures and tape - Loosely bandage with stockinette - Use E-collars if necessary - Empty and recharge cannister once over 1/3 or 1/2 full - Measure and record volumes - Monitor fluid carefully - Remove when fluid < 5 ml over 12-24 hours - Straight forward removal
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54
Q

What requires a chest drain?

A
  • Pyothorax - Pneumothorax - Chylothorax - Other Pleural Effusions
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55
Q

What are some complications of chest drains?

A
  • Patient interference - Sepsis / pyothorax - Emphysema - False pneumothorax - Pain - Lung/ pleural injury
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56
Q

When should a chest drain be removed?

A

Depends on: - Degree of fluid production - Nature of the fluid - Clinical response of the patient

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57
Q

How much serum and blood fluid (serosanguinous) should drain into a chest drain per kg?

A

1-3 ml / Kg - does depend on underlying pathological process

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58
Q

What is the importance of draining the abdomen?

A
  • Physical removal of bacteria - clearance of bacterial endotoxins - Improves intra abdominal environment
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59
Q

What is a wound?

A

Any injury to body tissue resulting in variable disruption to normal cellular and anatomical continuity

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60
Q

Damaged or removed body tissues are either …. OR …..?

A

Replaced/ Regenerated or Repaired or a combination of the two

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61
Q

What two tissues heal by regeneration?

A

Liver Bone

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62
Q

What are the four phases of wound healing?

A
  1. Inflammatory Phase 2. Debridement phase 3. Proliferative phase 4. Remodelling phase
63
Q

What occurs in the inflammatory phase?

A

5 hours after injury - Skin Retraction - Vessel Reaction - Vasoconstriction - Cellular Response - Clot and scab formation

64
Q

What occurs in the debridement phase?

A

12- 72 hours after injury Neutrophils accumulate in the wound and phagocytose debris - about 6 hours after injury

65
Q

What occurs about 1 day after injury?

A

Epithelial and endothelial migration

66
Q

What occurs about 3 days after injury?

A

Formation of fibrous and granulation tissue

67
Q

What occurs about 7 days after injury?

A

Vessels become apparent (angiogenesis)

68
Q

What occurs between days 7-21 after injury?

A

Contraction becomes apparent Fibroblasts become re oriented

69
Q

What occurs after 21 days of injury?

A

Collagen quantity stabilises Cross- linking occurs

70
Q

What occurs in the proliferative (repair) phase?

A
  • Formation of skin of the wound surface - Migration of fibroblasts into collagen - Formation of granulation tissue - Wound Contraction
71
Q

When does the proliferative phase begin?

A

Within the first 12 hours after injury - proceeds at variable rate depending on factors like blood clots, necrotic tissue, debris and infection

72
Q

When is wound contraction disadvantageous?

A
  • When formation of a tight web over a flexor surface may limit its movement - Stenosis of a body opening - Insufficient contraction, resulting in large areas of thin epithelium - Increased skin tightness limiting body movement
73
Q

What is epithelialization?

A

Formation of skin - Completion of the proliferative stage

74
Q

What is Second Intention healing?

A

Spontaneous Healing - wound left open to granulate and fill in on their own - Granulation tissue eventually becomes epithelialised - Resulting tissue is a scar - Usually has no hair - Can contract and prevent normal gliding motion of adjacent muscles and joints - Otherwise perform secondary closure using grafting

75
Q

What occurs in the proliferative stage?

A

After ~ 3 weeks there is a reduction in fibroblast numbers and equilibrium develops between collagen production and lysis - The collagen fibres become aligned - Increases tensile strength of the wound - Decrease in blood vessels and collagen fibres

76
Q

What are the tissue features during the stages of wound healing over time?

A
  • Swelling - Receding around the edges - Exudative - Reduced tissue strength - Pink, cobblestone appearance - Thin, Whitish edges - “Puckered” edges - Restored tissue strength
77
Q

What are some examples of complicated wound healing?

A
  • Infection - Excess motion - Self- mutilation - Excess tension - Horses - Debilitated patient e.g. systemic disease - Recumbency - Poor vascularity
78
Q

What are the classifications of wounds?

A
  • Clean - Clean- contaminated - Contaminated - Dirty
79
Q

Why are wounds classified?

A

To predict the likelihood of complications and put in place appropriate wound management - A good surgeon knows when a wound can be dealt with by primary closure and when secondary closure or second intention healing is indicated

80
Q

Describe a ‘Clean’ wound?

A
  • Non- traumatic - No inflammation present - No entry into lumen of viscera - Drains not used e.g. removal of skin tumor aseptic technique
81
Q

Describe a ‘ Clean- Contaminated’ wound?

A
  • Entry into the lumen of viscera without infection - No gross spillage - Minor break in sterile technique e.g. ovariohysterectomy
82
Q

Describe a ‘Contaminated’ wound?

A
  • Traumatic wound - <4-6 hours old - Spillage of GIT into infected urogenital tract e.g. cystotomy for urolithiasis with active infection
83
Q

Describe a ‘Dirty’ wound?

A
  • Infection present - Incision into inflamed tissue/ pus encountered - Traumatic wound - > 4-6 hours old e.g. pyometra
84
Q

What is open wound management?

A

Wound is left to drain to the environment

85
Q

What are the two types of wound closure?

A

Primary Secondary

86
Q

What is primary wound closure?

A

When wound is closed immediately First intention - More rapid - Aesthetically better - Cheaper - Minimal complications

87
Q

What is secondary wound closure?

A

When wound closure is delayed for a few days

88
Q

What are the factors that influence the magnitude of wound infection?

A
  1. Degree of bacterial contamination 2. Virulence of the organism 3. Type of injury 4. Vascular insufficiency 5. Foreign Material 6. Free fluid accumulation 7. Immunological incompetence
89
Q

What are seromas and when do they form?

A

Pocket of clear, serous fluid - Tissue rich in lymph vessels has been transected - Excessive movement is present in wound - Tissues respond to suture material as foreign material

90
Q

What are the three basic considerations of wound care?

A

Cleansing Closing Covering

91
Q

What do dirty wounds require?

A
  1. Prevent further contamination 2. Lavage 3. Debridement 4. Drainage 5. Selection of closure method 6. Selection of bandaging method
92
Q

How do you prevent further contamination?

A

Open wounds should be covered with sterile and clean dressing to prevent desiccation Wet saline dressings are ideal Broad- spectrum antibiotics may be used but it’s better to swab first to determine which bacteria are present.

93
Q

What is a lavage?

A

Washing out of a body cavity - May be applied using low pressure bulb syringes or high pressure water pik systems - Tap Water - Saline - Ringers - Antiseptics

94
Q

What is Debridement?

A

Removal of all debris, necrotic tissue or obviously devitalised tissue - essential in preparing the wound for suturing - Use a sharp scalpel for incisions - Lavage may be needed as debridement progresses

95
Q

What solutions can be used for debridement and lavaging?

A

Chlorhexidine Betadine Hydrogen Peroxide Saline

96
Q

What are the 11 functions of bandaging?

A
  1. Exert pressure to eliminate dead space 2. Pack the wound 3. Debride the wound 4. Absorb exudates 5. Protect the wound from the environment 6. Protect the environment from the wound 7. Immobilise the wound and support fractures 8. Provide comfort by reducing pain 9. Serve as a vehicle for the application of antibiotics and antiseptics 10. Serve as an indicator of wound secretions 11. Provide an aesthetic appearance
97
Q

What are the three key functions of applying bandages?

A

Pressure Protection Support

98
Q

What are the layers in a bandage?

A
  1. Primary (contact) layer 2. Secondary (intermediate) layer 3. Tertiary (outer) layer
99
Q

What is the function of the primary wound layer?

A
  • Lies against the wound - Allows tissue fluid to pass through to the second layer
100
Q

What dressings can be used in the primary layer?

A
  • Adherent dressings - Nonadherent dressings
101
Q

Describe an Adherent dressing…

A
  • Open Weave - Used when it’s desirable to mechanically debride the wound surface e.g. in infected wounds - Wet-to-dry or dry-to-dry
102
Q

Describe a Nonadherent dressing…

A
  • Used when the underlying tissue is healthy granulation - This tissue is ready to epithelialize without debridement
103
Q

How does the adherent primary layer act as a debrider?

A
  • The open weave arrangement allows wound fluid and exudate to enter the dressing and solidify as it dries - Necrotic tissue and exudate is pulled from the wound with the dressing when it is changed
104
Q

How do you determine whether to use wet-to-dry or dry-to-dry adherent primary dressings?

A
  • Determined by the state of the wound - Heavily exudating wounds don’t need the extra moisture so dry-to-dry is used - Most wounds benefit from some moisture to liquify necrotic tissue and aid absorption
105
Q

What are the disadvantages of adherent dressings?

A
  • Removal can be painful –Dressing changes are usually OAD - The dry layer can pull off healthy cells and cause damage to budding vessels in granulation bed - Need to time change from adherent to nonadherent well
106
Q

What are some brands of nonadherent dressings?

A
  • Release - Melolin - Allevyn (foam)
107
Q

What advantage does a Allevyn foam nonadherent dressing have?

A
  • A dynamic breathable top film for faster fluid removal - Modified foam has a faster fluid uptake
108
Q

Describe the secondary (intermediate) bandage layer…

A
  • Must be absorbent enough to move tissue fluid away from the primary layer - Must be thick enough to store exudate until bandage change - Must be conformable to mold primary layer to contour of body - Must provide pressure to reduce haematoma and odema formation
109
Q

What material tends to be used for the secondary bandage layer?

A

Synthetic cast padding or absorbent cotton wool

110
Q

What is secondary layer bindings?

A

A gauze layer wrapped around the secondary cotton layer to prevent fraying

111
Q

Describe the Tertiary layer…

A
  • Should prevent contamination from external environment - Somewhat waterproof - Should be adherent to itself and hair above the dressing - Tight enough to hold the secondary layer in place but not constrict blood supply
112
Q

What are some brand examples of tertiary bandage layer?

A
  • Co-plus - Vet-Wrap - Elastoplast
113
Q

What are protection/ Support bandages used for?

A
  • Decreasing post-op swelling - Support fractured limbs before surgery - Casts - Immobilising joints
114
Q

What is a classic example of pressure bandaging?

A

Robert- Jones - Heavily padded cotton wool - Conforming Gauze applied tightly and evenly to create pressure on the cotton wool - Outer protective layer - Monitor! - Remove if wet or cold toes

115
Q

Where can a Robert-Jones bandage be used and not used?

A

Can: Fractures below the knee or stifle Cannot: Femoral or humeral fractures

116
Q

What are some signs of bandage complications?

A
  • Toe swelling - Discomfort - Odour or discharge
117
Q

How many toes should be kept exposed in a limb bandage?

A

Only leave tips of middle two toes exposed

118
Q

What occurs if bandages aren’t kept dry?

A

Tissue may begin to waste away

119
Q

How often do you tell the owner to check their animal’s dressing?

A

Twice a day

120
Q

What is a modified Robert-Jones bandage?

A
  • Less padding - Fluid absorbance is needed without pressure
121
Q

What is a splint?

A

Soft padded bandage reinforced with cast material or aluminium bars - After secondary layer - For rigid support

122
Q

Describe a cast…

A

Minimal cast padding over a stockinette with layers of rigid cast material

123
Q

What is the procedure used when splinting a limb?

A
  1. Contact layer against wound 2. Stirrups on foot 3. Stockinette over limb 4. Layer of cast padding 5. Conform padding with stretch gauze 6. Splint against leg 7. Conform splint with stretch gauze 8. Tertiary Layer
124
Q

Why is a splint used?

A

To protect joints or limbs before or after surgery

125
Q

When should a Spica Splint be used?

A

Injury above the stifle or elbow

126
Q

Describe a Spica Splint…

A
  • Cast padding and gauze are taken high over the shoulder or trunk and around opposite limb in a figure 8 pattern - Cast material taken to at least the dorsal midline
127
Q

What are some broad-spectrum antimicrobial topical wound preparations?

A
  • Bacitracin - Neomycin - Polymixin - Framycetin - Nitrofurazone
128
Q

What are some other forms of topical wound treatments?

A
  • Hydrophilic gels useful for early stages of wound healing by moistening and stimulating debridement and scab desloughing - Enzymatic agents used where vital to spare normal tissue - Aloe vera for burns, frostbite and dying flaps
129
Q

What does application of aloe vera gel do to burns. frostbite and dying skin flaps?

A
  • Prevents vasoconstriction - Prevents ischaemia - Prevents progression of tissue necrosis
130
Q

Are ointments usually used on clean wounds?

A

No - but certain ointments may be useful

131
Q

What is intrasite gel?

A

A hydrogel - helps support epithelial cells in granulating or epithelialising wounds

132
Q

What is silverzine cream?

A

Useful in wounds with surface bacterial contamination - especially with pseudomonas (type of gm-ve bacteria) Helps clear the inital infection

133
Q

What is a tie over bandage?

A
  • Suture loops created around the edge - At each bandage change a pad ( primary and secondary layers) can be tied over the area using the loops - Used where area can’t normally be bandaged
134
Q

What type of gauze is this?

A

Primary Layer

Gauze

135
Q

What type of bandaging is this?

A

A tie-over bandage

  • used to bandage somewhere that can’t normally be bandaged
136
Q

What type of bandage is this?

A

A Splica Splint

137
Q

What layer and type of dressing is this?

A

Non-adherent

Primary Layer

138
Q

Would you use a Robert-Jones bandage for this animal’s injury?

A

No

RJB’s shouldn’t be used in fractures above the elbow/ stifle

139
Q

What layer is this used in?

A

The tertiary (outer) layer

140
Q

What is this?

A

Secondary layer binding gauze

141
Q

What layer is this used in?

A

The secondary (intermediate) bandage layer

142
Q

What type of drain is this? What is its name?

A

Passive Drain

Penrose Drain

143
Q

What type of drain is this?

A

Chest Drain

144
Q

What type of drains are these?

A

Passive drains

L: Yeates Drain

R: Penrose Drain

145
Q

What type of drain is this? What is its name?

A

Active Drain

Uno Drain

146
Q

What type of drain is this? What is its name?

A

Active Drain

Butterfly catheter and vacutainer

147
Q

What type of drain is this? What is its name?

A

Active Drain

Grenade drain

148
Q

What is this?

A

Heimlich Valve

  • One way valve used with a chest drain
  • Stops air entering chest through the chest drain tube with breaths
149
Q

What do wet-wet/ wet-dry/ dry-dry orders mean?

A

Refers to how the layer is when it is applied and when removed

150
Q

Describe a wet-dry adherent dressing…

A
  • Allowed to dry
  • Removes debris
  • Most common in vet med
  • Antibacterial may be used if it doesn’t harm cells
  • Use for 3-5 days
151
Q

Describe a wet-wet adherent dressing…

A
  • Stays wet through to next bandage change
  • Moist environment helps clean the wound but doesn’t debride
  • Used with large amounts of viscous exudate
  • May macerate the wound
152
Q

Describe a dry-dry adherent dressing…

A
  • Used with loose debris or a large amount of low viscosity exudate e.g. burns
  • Primary layer allowed to dry
153
Q

What is a non-adherent contact layer?

A
  • Simplest is petroleum impregnated gauze - actually slows epithelialisation
  • Others have a film covering over the absorbant padding with many small pores (instead of open weave)
  • Must use after fibroplasia and epithelialisation have begun

Clinical Studies (19 decks)

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