wounds - drain placement Flashcards
what are the two types of drains?
- passive
- active
what is an example of a passive drain ?
penrose drain
what is an example of an active drain ?
closed suction drain - jackson pratt most common
what is the gold standard closed suction drain?
jackson pratt
what concept does a penrose drain rely on ?
gravity so fluid will drain along tubing ventrally
does a penrose drain need to be fully closed?
no
how long should a penrose drain stay in?
5-7 days then remove to avoid infection
where should the exit site of the drain be in relation to the incision?
should be at least 1 cm from incision laterally
why do we not place the exit of the drain in the wound incision ?
it increases the chance for wound dehiscience, placing drain lateral to wound edge prevents that
what is another reason to place the drain 1 cm or more away from wound edge?
to avoid accidentally catching drain in suture when closing the skin
do we cover penrose drains with bandages?
yes to catch drainage fluid
true or false.
if there is a large wound a passive drain can have two exits.
false!! only ONE EXIT
what is the main concept behind an active drain?
relies on concept of negative suction to remove fluid
does an active drain need to be fully closed?
yes! we need to suture it so that there is a seal to create suction
how does fluid flow with an active drain?
inside the drain through fenestrations
where is the fenestrated end of drain placed?
within the wound bed
what is an important part of drain management with active drains?
quantifying drain production
when should the active drain be removed?
when fluid production decreases below 5ml/kg/day
how much fluid is produced as a reaction from the drain by the body?
1-2 ml/kg/day
what are two complications of active drains?
loss of suction and tube obstruction
what should be done if tube is obstructed in an active drain ?
check tube isnt kinked, empty grenade then reactivate to maximize suction, if still blocked flush with sterile saline using sterile technique
what kind of wounds are candidates for open wound management?
highly contaminated wounds that can’t be treated via primary closure
what kind of debridement do wet to dry bandages use?
non-selective, removes tissue adhered to dried dressing
what are the components of a bandage ?
primary layer - sterile because touches surface of wound
intermediate layer - loose absorbent material like kling gauze
outer layer - commonly elastikon or vet wrap
what is an example of adherent bandages?
wet to dry or dry to dry
what are examples of non-adherent bandages ?
telfa, hydrogels, hydrocolloids
can we use wet to dry bandaging after granulation tissue forms?
no, only use early in the course of wound management
how often do you have to change wet to dry bandages?
every 24 hours
when do we use tie over bandages ?
when wound is on a location that would not accept a conventional bandage like extremity, trunk, head, etc.
when using a tie over bandage what has to be used as the outer layer?
water proof material, ex. drape material cut to fit
what is currently considered the standard of care for wound management?
moist wound healing
what type of bandage are moisture retentive dressings?
non-adherent and occlusive so they protect and retain fluid
what are advantages of moisture retentive dressings?
- 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
what are the main moisture retentive dressings we use?
- calcium alginate *
- polyurethane foam
- hydrocolloid
- hydrogel
how frequently should we change MRDs ?
during inflammatory phase - Q 2-3 days because most exudative
when granulation tissue forms - Q 5-7 days
which MRD has the highest exudate level?
calcium alginate
when is manuka honey good to use?
when theres a foot wound or psuedomonas
true or false.
when using alternative therapies like manuka honey or sugar for wounds bandages must be changed every 24 hours.
false, sugar dressings need to be changed at least every 24 hours but honey dressings can stay for 3-7 days
what is the pressure we use with a vacuum assisted closure ?
125 mmHg for open wounds
