wounds - drain placement

Question 1

what are the two types of drains?

Answer 1

• passive

- active

Question 2

what is an example of a passive drain ?

Answer 2

penrose drain

Question 3

what is an example of an active drain ?

Answer 3

closed suction drain - jackson pratt most common

Question 4

what is the gold standard closed suction drain?

Answer 4

jackson pratt

Question 5

what concept does a penrose drain rely on ?

Answer 5

gravity so fluid will drain along tubing ventrally

Question 6

does a penrose drain need to be fully closed?

Answer 6

no

Question 7

how long should a penrose drain stay in?

Answer 7

5-7 days then remove to avoid infection

Question 8

where should the exit site of the drain be in relation to the incision?

Answer 8

should be at least 1 cm from incision laterally

Question 9

why do we not place the exit of the drain in the wound incision ?

Answer 9

it increases the chance for wound dehiscience, placing drain lateral to wound edge prevents that

Question 10

what is another reason to place the drain 1 cm or more away from wound edge?

Answer 10

to avoid accidentally catching drain in suture when closing the skin

Question 11

do we cover penrose drains with bandages?

Answer 11

yes to catch drainage fluid

Question 12

true or false.

if there is a large wound a passive drain can have two exits.

Answer 12

false!! only ONE EXIT

Question 13

what is the main concept behind an active drain?

Answer 13

relies on concept of negative suction to remove fluid

Question 14

does an active drain need to be fully closed?

Answer 14

yes! we need to suture it so that there is a seal to create suction

Question 15

how does fluid flow with an active drain?

Answer 15

inside the drain through fenestrations

Question 16

where is the fenestrated end of drain placed?

Answer 16

within the wound bed

Question 17

what is an important part of drain management with active drains?

Answer 17

quantifying drain production

Question 18

when should the active drain be removed?

Answer 18

when fluid production decreases below 5ml/kg/day

Question 19

how much fluid is produced as a reaction from the drain by the body?

Answer 19

1-2 ml/kg/day

Question 20

what are two complications of active drains?

Answer 20

loss of suction and tube obstruction

Question 21

what should be done if tube is obstructed in an active drain ?

Answer 21

check tube isnt kinked, empty grenade then reactivate to maximize suction, if still blocked flush with sterile saline using sterile technique

Question 22

what kind of wounds are candidates for open wound management?

Answer 22

highly contaminated wounds that can’t be treated via primary closure

Question 23

what kind of debridement do wet to dry bandages use?

Answer 23

non-selective, removes tissue adhered to dried dressing

Question 24

what are the components of a bandage ?

Answer 24

primary layer - sterile because touches surface of wound
intermediate layer - loose absorbent material like kling gauze
outer layer - commonly elastikon or vet wrap

Question 25

what is an example of adherent bandages?

Answer 25

wet to dry or dry to dry

Question 26

what are examples of non-adherent bandages ?

Answer 26

telfa, hydrogels, hydrocolloids

Question 27

can we use wet to dry bandaging after granulation tissue forms?

Answer 27

no, only use early in the course of wound management

Question 28

how often do you have to change wet to dry bandages?

Answer 28

every 24 hours

Question 29

when do we use tie over bandages ?

Answer 29

when wound is on a location that would not accept a conventional bandage like extremity, trunk, head, etc.

Question 30

when using a tie over bandage what has to be used as the outer layer?

Answer 30

water proof material, ex. drape material cut to fit

Question 31

what is currently considered the standard of care for wound management?

Answer 31

moist wound healing

Question 32

what type of bandage are moisture retentive dressings?

Answer 32

non-adherent and occlusive so they protect and retain fluid

Question 33

what are advantages of moisture retentive dressings?

Answer 33

• selective debridement because WBCs remain in wound instead of on gauze
• less painful to remove because they are non-adherent
• lower pH under dressing so decreased bacterial growth

Question 34

what are the main moisture retentive dressings we use?

Answer 34

• calcium alginate *
• polyurethane foam
• hydrocolloid
• hydrogel

Question 35

how frequently should we change MRDs ?

Answer 35

during inflammatory phase - Q 2-3 days because most exudative
when granulation tissue forms - Q 5-7 days

Question 36

which MRD has the highest exudate level?

Answer 36

calcium alginate

Question 37

when is manuka honey good to use?

Answer 37

when theres a foot wound or psuedomonas

Question 38

true or false.

when using alternative therapies like manuka honey or sugar for wounds bandages must be changed every 24 hours.

Answer 38

false, sugar dressings need to be changed at least every 24 hours but honey dressings can stay for 3-7 days

Question 39

what is the pressure we use with a vacuum assisted closure ?

Answer 39

125 mmHg for open wounds