The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [645]
Procedure guideline 15.5 Wound drainage systems: changing the vacuum bottle of a closed drainage system
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
Clamp (usually part of the system in place)
Redivac drainage bottle
Marker pen and chart
Procedure
Action Rationale
1 Use aseptic technique and sterile equipment (as listed above).
To prevent infection (Fraise and Bradley 2009, E; Walker 2007).
2 Ensure sterile drainage system is readily available.
To ensure sterility during change of system. E
3 Measure the contents of the bottle to be changed and record this in the appropriate documents.
To maintain an accurate record of drainage from the wound and enable evaluation of state of wound (NMC 2009, E).
4 Clamp the tube with the tubing clamps on the drainage tube and bottle connector and remove the bottle.
To prevent air and contamination entering the wound via the drain. E
5 Clean the end of the tube and attach it to the sterile bottle.
To maintain sterility. E
6 Unclamp the tubing clamps.
To re-establish the drainage system. E
7 Place used vacuum drainage system into the clinical waste bag.
To safely dispose of used system. E
Postprocedure
8 Document in the patient’s notes that the drainage bottle has been changed.
To record the change (NMC 2009, C).
Procedure guideline 15.6 Wound drain removal (closed drainage system, for example, Redivac or concertina)
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
Scissors or stitch cutter (refer to patient notes for directions if dressing in place)
Sterile absorbent dressing to place over drainage site
Wound swab/sterile pot (to be used if infection suspected)
Procedure
Action Rationale
1 Use aseptic technique and sterile equipment (as listed above).
To prevent infection (Fraise and Bradley 2009, E Pudner 2005, E; Walker 2007, E).
2 Release the vacuum (active drainage system) by clamping the tubing with the clamp provided (Walker 2007).
This releases the vacuum and prevents suction and traumatic removal during the procedure which may damage the tissue. E
3 Only clean the wound if necessary, using an appropriate sterile solution, such as 0.9% sodium chloride.
To reduce risk of infection. E
4 If the drain is sutured in place, hold the knot of the suture with metal forceps and gently lift upwards.
Plastic forceps tend to slip against nylon sutures. To allow space for the scissors or stitch cutter to be placed underneath. E
5 Cut the shortest end of the suture as close to the skin as possible.
To prevent infection by allowing the suture to be liberated from the drain without drawing the exposed part through tissue (Pudner 2005, E).
6 Warn the patient of the pulling sensation they will experience and reassure throughout (Walker 2007).
To promote comfort and co-operation. E
7 Grasp the drain close to the skin and remove gently. If there is resistance, place free gloved hand against the tissue to oppose the removal from the wound.
To minimize pain and reduce trauma (E). Drains that have been left in for an extended period will sometimes be more difficult due to tissue growing around the tubing (Walker 2007, E).
8 The edge of the drain should be clean cut and not jagged.
This clean appearance ensures that the whole drain has been removed. E
9 Cover the drain site with a sterile dressing and tape securely.
To prevent infection entering the drain site. E
10 If the site is inflamed or there is a request for the tip to be sent to microbiology, cut it cleanly and send it in a sterile pot.
Recognize and treat suspected infection (Fraise and Bradley 2009, E, Walker 2007).
Postprocedure
11 Measure and record the contents of the drainage bottle in the appropriate documents.
To maintain an accurate record of drainage from the wound and enable evaluation