What are indications for wound drainage? (9)
- elimination of dead space
- removal of unwanted materials
- decrease wound infection
- contaminated wounds/ incomplete debridement
- soft tissue trauma
- oncologic sx
- orthopedic injury
- abdomen- focal sites of infection/ peritonitis
- thorax- pleural effusion, free air
What factors contribute to surgical dehiscence? (4)
- wound closure under tension
- loss of blood supply to wound edges (sutures too tight)
- inflammatory response(degranulation of mast cells after mast cell tumor removal)
- accumulation of fluid or blood at wound site
What should you never do with a drain?
DRAINS SHOULD NEVER EXIT A PRIMARY SURGICAL INCISION; it will lead to a dehiscence; make a separate stab incision to have the exit for the drain
What kind of drainage do pemrose drains allow for?
passive intraluminal and extraluminal drainage
Passive drains function by... (3)
gravity, overflow, capillary action
With passive drainage, __________ is critical because...
drain placement; flow of drainage is related to gravity...put the drain at the lowest point of the pocket
Why shouldn't you fenestrate a penrose drain?
flow of drainage is related to surface area of the drain; fenestration lowers surface area
What are characteristics of penrose drains? (4)
- low reactivity
- soft latex rubber that is pliable and inert
- exit drain from a separate stab incision at most gravity dependent site
- ALWAYS KEEP COVERED (to prevent ascending infection)
Describe suction drains. (2)
- semisolid tube attached to continuous or intermittent suction
- mild suction (80 mmHg) will obliterate dead space
When are suction drains indicated?
ideal for deep wound or where dependent drainage is not possible
Rate of infection around the drain is ________ with suction drains than passive drains.
Describe sump drains.
- drains with 2 or more lumens, with the primary lumen allowing wound drainage and second lumen venting air to prevent the drainage lumen from collapsing
- do not rely on gravity alone, suction can be applied if needed
- reduce ascending infection
What is a Foley catheter?
balloon tip catheter with an extra port to inflate the balloon
How do you use drains to flush a wound?
- must use a combined drainage system- permits instillation of an irrigating solution and a separate drain for suction removal of the solution
- NEVER FLUSH A PASSIVE DRAIN OR UP A SUCTION DRAIN
When using a drain, NEVER... (6)
- try to drain against gravity
- exit a drain through a surgical wound
- prematurely remove a drain, esp if its copious or purulent drainage
- allow patients to remove their own drain
- leave a drain without suturing it to skin
- use a drain to flush a wound unless an adequate ingress-egress system has been established