Surgical Wounds & Drains Flashcards
Lpn role around staples and sutures?
Removal
How does vacuum assisted closure work?
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
How do surgical wounds normally heal?
Primary intention
-healing by approximation (direct union of skin edges)
Purpose of staples and sutures?
To close surgical wounds
To repair lacerations
Promote healing by primary intention
Benefits of healing by primary intention?
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
Healing for primary intention?
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
What is the key to wound healing?
Blood supply
Factors that affect wound healing?
Pulling or tension on wound edges Malnutrition Impaired inflammatory response Infection Foreign bodies Age
Incision vs lacerations?
Incision: purposeful cut into tissues for surgical purposes
Laceration: wound or irregular tear of flesh or other body tissue
Staples?
Common for surgical wound closure
Generally removed after 7-10 days
Staple removal?
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
Types of sutures?
Continuous
Interrupted
Retention
Continuous sutures?
One lone piece
Advantage of even distribution
Disadvantage if suture or knot breaks wound may dehisce
Not in LPN scope
Interrupted sutures?
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
Retention sutures?
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
What to do before removing sutures?
Doctors order Preparing patient -ABCs, safety, comfort/pain Gather supplies Collaborate with team Document
What do you document after suture removal?
Wound assessment Patient response Amount removed Intactness Any complications Teaching
4 types to wound closure?
Skin glue
Steristrips
Staples
Sutures
Purpose of drains?
Removes air or fluid from peri-wound area
Enhances healing the
Gentle suction closed drainage systems examples?
HMV
Davol
JP
Passive open drainage system examples?
Penrose
- lets air and gas escape
- no suction
- drain shortened daily as healing precedes
- kept in place by safety pin
Gentle suction drains characteristics?
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
Nursing interventions around drains?
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
Things to document about drains?
Position of drain Patency Characteristics of drain Reporting any increase in amount of drainage Removal
Process of drain removal?
Physician order Analgesic Empty drain and release suction Sterile gloves Clean site Remove suture Apply counter pressure Remove gently but firmly Dry dressing Document
Complex/chronic wounds?
Prolonged healing time
(Weeks, months, years)
Primarily secondary intention healing
Multifactoral, multi steps
More sophisticated thinking
Example of chronic wounds?
Diabetic neuropathy Pressure ulcer Venous stasis and arterial ulcer Eviseration, dehiscence of a surgical wound Surgeon left body open on purpose
Complex wound assessment?
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
Multidisciplinary team involved in complex wounds?
OT
Vascular doctor
Dietician
Plastic surgeon
What does a wound assessment include??
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
Scope of LPNs with complex wounds?
Must be able to see wound bed
No tunnelling
Irrigating and packing of wounds?
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
Why do we not over pack a wound?
Cells cannot grow or mature
-need O2
Pulls good tissue out on removal
Purpose of irrigating?
Remove debris and pathogens
Concentration ordered is key
How to manage pain during packing wounds?
Pre analgesic before packing and irrigating
What does dry packing indicate?
Increased frequency of dressing changes
-cells need moisture
Purpose of packing?
Loosely fill dead space
Facilitate the removal of exudate and debris
Encourage the growth of granulation tissue
What is dead space?
The space left in the body as a result of tissue loss
The wound area that is packed
Define packing?
The process of loosely filling a wound cavity or dead space with appropriate packing material
Define sinus or tunnelling?
A channel that extends from any part of the wound and tracks into deeper space
Define undermining?
A separation of tissue that occurs underneath the intact skin of the wound perimeter
Scope for wound care?
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