Surgical Wounds & Drains

Question 1

Lpn role around staples and sutures?

Answer 1

Removal

Question 2

How does vacuum assisted closure work?

Answer 2

Assist with healing by negative pressure (continual gentle suction)

• removes copious amounts of exudate, drainage, and draws wound edges together (secondary intention)
• promotes granulation
• it’s a specialty wound care nurse

Question 3

How do surgical wounds normally heal?

Answer 3

Primary intention

-healing by approximation (direct union of skin edges)

Question 4

Purpose of staples and sutures?

Answer 4

To close surgical wounds

To repair lacerations

Promote healing by primary intention

Question 5

Benefits of healing by primary intention?

Answer 5

Attempts to:

• bring the wound edges together neatly and evenly
• stop bleeding
• preserve function of the tissue
• prevent infection
• restore cosmetic appearance
• promote rapid healing

Question 6

Healing for primary intention?

Answer 6

Inflammatory phase: 0-4 days

• hemostatsis
• blood to area and phagocytosis by WBCs
• epithelial cell migration

Proliferation phase: 5th day- 3 weeks
-pink granulation tissue fills wound

Maturation: up to 1 year
-collagen scar gets stronger

Question 7

What is the key to wound healing?

Answer 7

Blood supply

Question 8

Factors that affect wound healing?

Answer 8

Pulling or tension on wound edges
Malnutrition 
Impaired inflammatory response
Infection 
Foreign bodies
Age

Question 9

Incision vs lacerations?

Answer 9

Incision: purposeful cut into tissues for surgical purposes

Laceration: wound or irregular tear of flesh or other body tissue

Question 10

Staples?

Answer 10

Common for surgical wound closure

Generally removed after 7-10 days

Question 11

Staple removal?

Answer 11

Ensure order for removal

Remove alternate staples first
Remove the rest of staples of incision line remains closed, if edges separate discontinue removal and notify RN

Count # of staples for documentation

Apply steristrips to prevent wound dehiscence

Question 12

Types of sutures?

Answer 12

Continuous

Interrupted

Retention

Question 13

Continuous sutures?

Answer 13

One lone piece

Advantage of even distribution

Disadvantage if suture or knot breaks wound may dehisce

Not in LPN scope

Question 14

Interrupted sutures?

Answer 14

Individual sutures, cut separately

Most commonly used

Give better security

Removed by LPNs

Knots places on the sides of the wound to avoid wound depression

Question 15

Retention sutures?

Answer 15

Wire sutures covered in rubber to provide greater strength

Use in patients with impaired healing or suffering from conditions of increased abdominal pressure

For patients debilitated d/t malnutrition, old age, immune deficiency or advanced cancer

Removed by doctor

Question 16

What to do before removing sutures?

Answer 16

Doctors order
Preparing patient 
-ABCs, safety, comfort/pain
Gather supplies
Collaborate with team 
Document

Question 17

What do you document after suture removal?

Answer 17

Wound assessment
Patient response
Amount removed
Intactness
Any complications 
Teaching

Question 18

4 types to wound closure?

Answer 18

Skin glue
Steristrips
Staples
Sutures

Question 19

Purpose of drains?

Answer 19

Removes air or fluid from peri-wound area

Enhances healing the

Question 20

Gentle suction closed drainage systems examples?

Answer 20

HMV
Davol
JP

Question 21

Passive open drainage system examples?

Answer 21

Penrose

• lets air and gas escape
• no suction
• drain shortened daily as healing precedes
• kept in place by safety pin

Question 22

Gentle suction drains characteristics?

Answer 22

Perforated tubing connected to a portable vacuum unit
Surgeon places 1 end in or near area to be drained and the other passes through the skin
Usually sutured in place
Suction is lost as drainage accumulates

Question 23

Nursing interventions around drains?

Answer 23

Empty drain when half full using clean gloves
Re-establish suction after draining
Pin to gown
Assess site and suture
Cleanse site with NS PRN and apply dry dressing
Documentation
Removal

Question 24

Things to document about drains?

Answer 24

Position of drain
Patency 
Characteristics of drain 
Reporting any increase in amount of drainage 
Removal

Question 25

Process of drain removal?

Answer 25

``` Physician order Analgesic Empty drain and release suction Sterile gloves Clean site Remove suture Apply counter pressure Remove gently but firmly Dry dressing Document ```

Question 26

Complex/chronic wounds?

Answer 26

Prolonged healing time (Weeks, months, years) Primarily secondary intention healing Multifactoral, multi steps More sophisticated thinking

Question 27

Example of chronic wounds?

Answer 27

``` Diabetic neuropathy Pressure ulcer Venous stasis and arterial ulcer Eviseration, dehiscence of a surgical wound Surgeon left body open on purpose ```

Question 28

Complex wound assessment?

Answer 28

Look for trends Frequent wound assessment based on type, cause and characteristics of the wound to stern one type of treatment required to manage wound effectively Always compare to previous assessment to determine progress

Question 29

Multidisciplinary team involved in complex wounds?

Answer 29

OT Vascular doctor Dietician Plastic surgeon

Question 30

What does a wound assessment include??

Answer 30

``` Location Type of wound Extent of tissue involvement Type and % of tissue in wound base Wound size Wound exudate Presence of odour Peri wound area Pain ```

Question 31

Scope of LPNs with complex wounds?

Answer 31

Must be able to see wound bed No tunnelling

Question 32

Irrigating and packing of wounds?

Answer 32

Type of packing is based on wound assessment, wound goals and management objectives Do not over pack Most common solution used is NS Irrigation done with each dressing change

Question 33

Why do we not over pack a wound?

Answer 33

Cells cannot grow or mature -need O2 Pulls good tissue out on removal

Question 34

Purpose of irrigating?

Answer 34

Remove debris and pathogens Concentration ordered is key

Question 35

How to manage pain during packing wounds?

Answer 35

Pre analgesic before packing and irrigating

Question 36

What does dry packing indicate?

Answer 36

Increased frequency of dressing changes | -cells need moisture

Question 37

Purpose of packing?

Answer 37

Loosely fill dead space Facilitate the removal of exudate and debris Encourage the growth of granulation tissue

Question 38

What is dead space?

Answer 38

The space left in the body as a result of tissue loss The wound area that is packed

Question 39

Define packing?

Answer 39

The process of loosely filling a wound cavity or dead space with appropriate packing material

Question 40

Define sinus or tunnelling?

Answer 40

A channel that extends from any part of the wound and tracks into deeper space

Question 41

Define undermining?

Answer 41

A separation of tissue that occurs underneath the intact skin of the wound perimeter

Question 42

Scope for wound care?

Answer 42

Cleansing, irrigating, packing and dressing wounds where the wound bed can be visualized Limit: do not carry out sharps debridement and also limited to wound whose care needs follow expected path Condition: additional training and can care for tunnelled wound, apply compression dressings and provide negative pressure therapy