Sx Skills- Drains

untimely's version from 2015-05-06 18:39


Question Answer
CQ: most appropriate suture material and surgical needle combination for closure of an enterotomy incision?absorbable, monofilament, taper needle
what's the function of drainage of a wound?To facilitate healing by reducing dead space or removing unwanted materials
what is dead space?abnormal space between tissue layers where blood and serum may accumulate
three ways we can try to address dead space?Suture obliteration, Compression bandage, Drainage
5 indications for drains(1) Wounds --> bite (pockets), laceration, skin avulsion (2) Sx where good closure of dead space is not possible (ex: radical masectomy) (3) Seroma (4) Infected wound, abscess (5) Thoracic and peritoneal effusion
what are the two functional reasons for a drain?either PREVENTATIVE or THERAPEUTIC
CQ: most commonly used type of passive drain?penrose drain
two types of drains based on type of flow?passive or active
explain how a passive drain worksFlow by gravity
explain how an active drain worksFlow by vacuum (can be continuous or intermittent!)
how many exit sites should there be for a drain?ONLY ONE EXIT SITE-- more sites= more chances for infxn
FLAT drains--> passive or active flow? where does the flow flow?PASSIVE FLOW drain, where there is usually extraluminal flow (if you don't fold down the top of the inserted portion though, there MIGHT be intraluminal flow)
when should you remove a flat drain?2-5 days! (longer carries higher risk of infection)
what two perperities of the drained fluid might indicate it's time to remove the drain?if it changes to serous or serosnaguinous, OR if the amount dec
what is a flat drain usually used to drain?SQ spaces
how do you secure a flat drain? how do you fenestrate it?secure top and bottom of drain-- and TRICK QUESTION: NEVER EVER FENESTRATE A FLAT DRain
**which kid of drain should you NEVER fenestrate?flat drains
*best example of a flat drain?penrose drain
explain how you place a penrose drainat top folded over, then placed inside, then use retention suture (in skin, tissues, bites through drain, then back out and tie to secure in there) Then exit it though separate incision that isn't the wound incision
*How should you make the drain exit the wound?***DOESN'T exit wound!! make an exit incision and push it through there-- MUST BE VENTRALLY DEPENDENT EXIT
*when do you want to use a tube drain?Use in deeper tissues or body cavities
is a tube drain passive or active? what kinda flow does it have? what are some variations in tube drains you can have?can be PASSIVE OR ACTIVE, and can have INTRA and/or EXTRA luminal flow. The tube can be soft or rigid, and there may or may not be fenestrations
penrose is a...flat passive drain
jackson-pratt is a...closed suction tube drain
what is the example of an active draining system (what does it look like/ how does it work?)Jackson-Pratt closed suction drain. Tube with a little plastic blub on the end, squeeze bulb and attach to tube after drain placed to cause negative pressure for active suction
CQ: which suture pattern is least appropriate when doing a double layer closure of a hollow organ?on inner can do full or partial, but on outer lay can only do a partial, least appropriate is...lembert + connel (bc Connell is full thickness and its implied to be on outer layer from the question)
two examples of when you can make a DIY active drainage system(1) butterfly to red top tube (bc tube have some vacuum in them) (2) syringe with tube
how should you protect the drain?Protect drain with sterile dressing & bandage (where applicable)
Drain should never be in contact with...haired skin
*Drains are typically removed within...2-5 days of placement!!
if you are concerned about the microbes in the wound, when you remove the drain what can you do?Culture buried tip of drain as it is removed
which has a bigger chance of causing a FB reaction-- silicone or laytex?Laytex has a greater chance of causing a reaction
what are three complications you can have from a drain?(1) Foreign body reaction (latex > silicone) (2) Ascending infection (3) Pneumothorax ( from thoracotomy drains)
what is Vacuum-assisted wound closure?Active wound management system which uses subatmospheric pressure to enhance wound healing... Uses open-cell foam & continuous or intermittent negative pressure
when is Vacuum-assistant wound closure most effective (in terms of the phases of wound healing)Most effective during repair (proliferative) phase of wound healing
Vacuum-assisted wound closure is usually used in what kinda wounds? (exs?)For use in acute & non-healing chronic wounds. Exs: Degloving injuries, skin flaps & grafts, surgical dehiscence
what must you do before you do vacuum-assisted wound closure?wound debridement (where necessary)
what are potential complications of vacuum-assisted wound closure?pain, dermatitis, ingrowth of granulation tissue into foam