The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [646]
12 Dispose of used drainage system in clinical waste bag.
To ensure safe disposal. E
Procedure guideline 15.7 Wound drain shortening (open drainage systems, for example, Penrose, Yates or corrugated)
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 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
3 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).
4 Using gloved hand, gently ease the drain out of wound to the length requested by surgeons.
To allow healing to take place from base of wound. E
5 Using gloved hand, place a sterile safety pin through the drain as close to the skin as possible, taking great care not to stab either yourself or the patient.
To prevent retraction of drain into the wound and minimize the risk of cross-infection and sharps injury. E
6 Cut same amount of tubing from distal end of drain as withdrawn from wound.
So there is a convenient length of tubing to drain into the bag. To ensure patient comfort. E
7 Place a sterile, suitably sized dressing or drainage bag over the drain site (depending upon the expected amount of exudates).
To allow effluent to drain, prevent excoriation of the skin and contain any odour. E
8 Check dressing/bag is secure and comfortable for the patient.
For patient comfort. E
Postprocedure
9 Record by how much the drainage tube was shortened, or example 1–2 cm every 24–28 hours (Pudner 2005, E).
To ensure the length remaining in the wound is known (NMC 2009, C).
Postprocedural considerations
Check wound and drain site for signs of infection and obtain a wound swab if appropriate. Report any unusual signs or complications and record (Fraise and Bradley 2009, NMC 2009).
Plastic surgery
Definition
Plastic surgery is the collective term that refers to surgical procedures that are performed to restore function and assist in the healing of exposed or non-union fractures, soft tissue defects or to improve natural contours (McCarthy 1990).
This is achieved by using flaps and skin grafts for reconstruction purposes, in addition to using the natural elasticity and mobility of the skin. Surgical reconstruction is often required following extensive surgery for cancers of the breast, head and neck, skin, soft tissue and genitourinary system. The aim is to perform a simple procedure that will provide the best aesthetic and functional outcome (Achauer and Eriksson 2000).
Anatomy and physiology
A surgical flap is a strip of tissue, usually consisting of skin, underlying fat, fascia, muscle and/or bone, which is transferred from one part of the body (known as the donor site) to another (known as the recipient site) (Storch and Rice 2005).
A skin graft is living but devascularized (separated from its blood supply) tissue consisting of all or some of the layers of the skin which is removed from one area of the body and applied to a wound on another area of the body. The common methods of skin grafting are full-thickness skin grafts (FTSG), in which the entire epidermis and dermis is removed, split-thickness or split skin graft (SSG), which consists of the epidermis and the upper part of the dermis only (Giele and Cassell 2008).
Evidence-based approaches
Principles of care