Taking Care of Wound with Drain

Taking Care of Wound with Drain

Drain

It is a device used to promote drainage from the wound to the surface.

Purposes

• To prevent accumulation of drainage that may become infected or cause pressure on the operation.
• To hasten the healing of underlying tissues.

Types of Drain

• Corrugated Drain: It is used in case of Incision and Drainage.
• Rubber Tube: It is used in case of chest surgery and the drain is attached to a water seal drainage system by a connecting tube.
• T-tube: It is used in common bile duct in case of choledocholilethotomy.
• Vacuum Drain: vacuum drain

Care of patient with chest tube drainage

Suturing

Suture is thread or metal used to sew body tissues together. Sutures are available in a variety of materials, including silk, steel, cotton, linen, wire, nylon and Dacron. They come with or without sharp surgical needles attached. The patients history of wound healing, the site of surgery, the tissue involved, and the purpose of the sutures determine the suture material used. Suturing is a closure of wound or incision by stitching with a material such as silk or catgot.

Staples: Staples are type of outer skin closure that causes fewer traumas to tissues than sutures and provide extra strength.

The choice of suture technique depends on the following:

• Type and anatomic location of the wound
• Thickness of the skin
• Degree of tension
• Desired cosmetic result

Types of Suturing

Interrupted:

Each individual suture is tied and knotted separately. It can be divided in simple/plain and mattress.

Simple Interrupted Suture: Compared with running (continuous) sutures, interrupted sutures are easy to place, have greater tensile strength, and have less potential for causing wound edema and impaired cutaneous circulation. Interrupted sutures also allow the surgeon to make adjustments as needed to properly align wound edges as the wound is sutured. Disadvantages of interrupted sutures include the length of time required for their placement and the greater risk of crosshatched marks (i.e., train tracks) across the suture line. The risk of crosshatching can be minimized by removing sutures early to prevent the development of suture tracks.

Horizontal Mattress Suture: It is used with poor circulation. It helps eliminate tension on wound edges. It requires fewer sutures to close a wound.

Vertical Mattress Suture: A vertical mattress suture is especially useful in maximizing wound eversion, reducing dead space, and minimizing tension across the wound. One of the disadvantages of this suture is crosshatching.

Continuous: One thread runs in series of stitches with only two knots one at the beginning and one at the end of suture line. Continuous sutures are useful for long wounds in which wound tension has been minimized with properly placed deep sutures and in which approximation of the wound edges is good.

Running Locked Suture: This type of suture should be used only in areas with good vascularization, may be useful on the scalp, especially when additional hemostasis is needed.

Subcutaneous Suture: The running subcutaneous suture is used to close the deep portion of surgical defects under moderate tension. It is used in place of buried dermal sutures in large wounds when a quick closure is desired. Disadvantages of running subcutaneous sutures include the risk of suture breakage and the formation of dead space beneath the skin surface.

Removal of Suture

Remove the suture with lest irritation and discomfort. The timing of stitch removing is usually within 5-10 days depending on the location, condition of wound and type of suture used.

Procedure

• Check physician's order.
• Explain the procedure to the patient and describe the sensation.
• Wash hands.
• Arrange all needed equipment at bed side.
• Provide privacy.
• Position the patient so that the dressing or incision is exposed. 
• Don clean gloves.
• Remove and discard any dressing covering the wound. Inspect the wound for sign of infection.
• Wash if necessary and don sterile gloves.
• Clean sutures with antiseptic swabs moving from proximal to distal end. Discard swabs after wiping each surface once.
• Place dry sterile gauze near the wound. To remove sutures, first check the type of suturing used.
• Remove the suture as follows:

Interrupted

• Grasp the suture at the knot with a tooth forceps and pull it gently to expose the part of suture under the skin. Place the curved tip of the suture scissors under the suture.
• Cut the suture with scissors between the knot and the skin on one side either below the knot or opposite the knot.
• With the forceps, pull the suture out in one piece.
• Inspect the suture carefully to make sure that all suture materials are removed.

Continuous

• Cut the suture at each skin orifice on one side and remove the suture through the opposite side by applying a gentle traction.
• Clean the wound with antiseptic after removing sutures.
• Apply a small dressing if there is any oozing for a day or two.
• Reposition the client, wash and replace articles.
• Wash hands.
• Record the number of sutures removed, the condition of the incision, time of procedure.

Bandaging

Bandage

Bandage is a strip of material used mainly to support and immobilize a part of the body. Bandage is a strip or roll of cloth or other materials that may be bound around a part of the body in variety of ways to secure a dressing maintain pressure over a body part or immobilize a limb or other part of the body. Bandages are available in rolls of various widths and materials, including gauze, elasticized knit, elastic webbing, flannel, and muslin.

Bandaging

Bandaging is the process of covering a wound or injured part using various materials such as gauze, cotton, elasticized knit, flannel. A simple gauze dressing is often not enough to immobilize or provide support to a wound so that binder and bandages applied over or around dressing provide extra protection and therapeutic benefits by creating pressure, supporting wound, and immobilizing a body part.

Purposes

• To support wound
• To immobilize a fracture or dislocation and an injured part so as to relieve pain.
• To maintain direct pressure over a body part or dressing to control bleeding.
• To secure dressing.
• To maintain splints in position.
• To retain warmth e.g. a flannel bandage on a rheumatoid joint.
• To prevent or reduce swelling.
• To assist the patient in lifting and moving.
• To prevent contamination of a wound.
• To improve venous blood flow from lower extremities by applying pressure

Principles 

• Abrasions, edema, discolouration, and exposed wound edges should always be checked for on the skin.
  Use a bandage with the proper breadth that is tightly rolled.
  Throughout the procedure, support the portion that will be wrapped.
  Dress open wounds in a sanitary manner.
  When bandaging a left limb, hold the bandage's end in your right hand, and vice versa.
  Apply the bandage with consistent pressure from below to above, from the inside to the outside.
  Apply the bandage's outside surface to the part while keeping the roll's head in the topmost position. One length of the bandage at a time, unroll.
  Avoid covering the toe or finger tips. These need to be visible.
  Both overly tight and too loose bandages should be avoided.
  Typically, every turn should cover roughly two-thirds of the one before it.
  Examine the underlying dressings for damage and replace them if necessary.
  When bandaging these areas, use padding in the axilla or groin to prevent contact between two skin surfaces.
  A straight turn above the component completes the move. With the safety pin, secure the end while holding it.
  With the exception of when applying a capeline bandage, always stand in front of the patient.
  Finish by making a straight turn above the component, holding the end, and securing it with tape or a safety pin.

Types of Bandage

• Roller bandage
• Triangular bandage
• T bandage
• Many tailed bandage

Articles 

• Bandages
• Padding
• Scissors
• Safety pin/adhesive tape