The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [644]
8 Use of adhesive skin tapes should be monitored and they are usually left in place until they fall off by themselves.
To improve cosmetic effect and support tensile strength of the wound post suture removal, when indicated (Pudner 2005, E).
Wound drains
Evidence-based approaches
The purpose of a drain within the wound is to prevent haematoma formation or excess fluid build-up within the wound bed as these can lead to infection and irritation of the tissues (Walker 2007). Suboptimal conditions put surgical wounds at risk of dehiscence, which can be indicated by a sudden discharge of fluid or cellulites along the suture line (Hampton and Collins 2004), particularly in abdominal wounds where an abscess may develop, or the patient may report a ‘popping’ sensation (Beitz et al. 2008).
Nurses are ideally placed to observe the postoperative patient and often are involved in managing drainage systems (Walker 2007). Surgical wounds will heal rapidly if blood perfusion is maximized (Hampton and Collins 2004).
Preprocedural considerations
Check the patient’s operation notes to establish the number and site(s) of internal and external sutures. Explain the procedure to the patient and gain their consent (NMC 2008a).
Giving information about the proposed procedure helps to relieve anxiety and relax the patient. The easiest way to control pain is via the patient-controlled analgesia (PCA), if in situ (Hampton and Collins 2004). Offer the patient analgesia as per chart or encourage self-administration via the PCA pump to promote comfort. Another member of staff may be needed to reassure the patient during the procedure.
An aseptic technique should always be used and the drainage system should be handled as little as possible to minimize infection risk (Pudner 2005).
Equipment
Open drains, for example Yates, Penrose, corrugated, are usually sutured in place and covered with a dressing (exudates passively ooze into the dressing from the surgical wound bed).
Closed drains, for example Redivac and concertina-type, have perforated tubing along the incision and have a suction mechanism that exerts pressure (active drainage from the wound bed).
Procedure guideline 15.4 Wound drainage systems: changing the dressing around the drain site and observation/management
Essential equipment
Sterile dressing pack containing gallipots or an indented plastic tray, low-linting swabs and/or medical foam, disposable forceps, gloves, sterile field, disposable bag
Fluids for cleaning and/or irrigation
Hypoallergenic tape
Appropriate absorbent dressing
Appropriate hand hygiene preparation
Detergent wipe
Total traceability system for surgical instruments and patient record form
Any other material will be determined by the nature of the dressing; special features of a dressing should be referred to in the patient’s nursing care plan
Optional equipment
Any extra equipment that may be needed during procedure, for example sterile sissors, metal forceps, stitch cutter
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient.
To ensure that the patient understands the procedure and gives their valid consent and participates in care (NMC 2008a, C; Walker 2007, C).
2 Perform procedure using aseptic technique.
To prevent infection (Fraise and Bradley 2009, E).
Procedure
3 Clean the surrounding skin with an appropriate sterile solution such as 0.9% sodium chloride.
To prevent infection and remove excess debris. E
4 Check condition of surrounding skin.
To assess for any excoriation of the skin. E
5 Ensure that the skin suture holding the drain site in position is intact.
To prevent the drain from leaving the wound. E
6 Cover the drain site with a non-adherent, absorbent dressing.
To protect the drain site, prevent infection entering the wound and absorb exudate. E
Postprocedure
7 Tape securely.
To prevent drain coming loose. E
8 Ensure that the drain is primed or that the suction pump is in working order.
To ensure continuity of drainage. Ineffective drainage can result in oedema/haematoma