Tuesday, 7 December 2010

CLOSED-WOUND DRAIN MANAGEMENT

Typically inserted during surgery in anticipation of substantial postoperative drainage, a closed-wound drain promotes healing and prevents swelling by suctioning the serosanguinous fluid that accumulates at the wound site. By removing this fluid, the closed-wound drain helps reduce the risk of infection and skin breakdown as well as the number of dressing changes. Hemovac and Jackson-Pratt closed drainage systems are used most commonly.
A closed-wound drain consists of perforated tubing connected to a portable vacuum unit. The distal end of the tubing lies within the wound and usually leaves the body from a site other than the primary suture line to preserve the integrity of the surgical wound. The tubing exit site is treated as an additional surgical wound; the drain is usually sutured to the skin.
If the wound produces heavy drainage, the closed-wound drain may be left in place for longer than 1 week. Drainage must be emptied and measured frequently to maintain maximum suction and prevent strain on the suture line.

Equipment
Graduated biohazard cylinder • sterile laboratory container, if needed • alcohol pads • gloves • gown • face shield • trash bag • sterile gauze pads • antiseptic cleaning agent • prepackaged povidone-iodine swabs.

Implementation
  • Check the physician's order, and assess the patient's condition.
  • Explain the procedure to the patient, provide privacy, and wash your hands.
  • Unclip the vacuum unit from the patient's bed or gown.
  • Using aseptic technique, release the vacuum by removing the spout plug on the collection chamber. The container expands completely as it draws in air.
  • Empty the unit's contents into a graduated biohazard cylinder, and note the amount and appearance of the drainage. If diagnostic tests will be performed on the fluid specimen, pour the drainage directly into a sterile laboratory container, note the amount and appearance, and send it to the laboratory.
  • Maintaining aseptic technique, use an alcohol pad to clean the unit's spout and plug.
  • To reestablish the vacuum that creates the drain's suction power, fully compress the vacuum unit. With one hand holding the unit compressed to maintain the vacuum, replace the spout plug with your other hand. (See Using a closed-wound drainage system.)
  • Check the patency of the equipment. Make sure the tubing is free of twists, kinks, and leaks because the drainage system must be airtight to work properly. The vacuum unit should remain compressed when you release manual pressure; rapid reinflation indicates an air leak. If this occurs, recompress the unit and make sure the spout plug is secure.
  • Secure the vacuum unit to the patient's gown. Fasten it below wound level to promote drainage. Don't apply tension on drainage tubing when fastening the unit to prevent possible dislodgment. Remove and discard your gloves, and wash your hands thoroughly.
  • Observe the sutures that secure the drain to the patient's skin; look for signs of pulling or tearing and for swelling or infection of surrounding skin. Gently clean the sutures with sterile gauze pads soaked in an antiseptic cleaning agent or with a povidone-iodine swab.
  • Properly dispose of drainage, solutions, and trash bag, and clean or dispose of soiled equipment and supplies according to facility policy.


Special considerations
  • Empty the drain and measure its contents once during each shift if drainage has accumulated, more often if drainage is excessive. Removing excess drainage maintains maximum suction and avoids straining the drain's suture line.
  • If the patient has more than one closed drain, number the drains so you can record drainage from each site.
  • NURSING ALERT Be careful not to mistake chest tubes with water seal drainage devices for closed-wound drains because the care of these devices differs from closed-wound drainage systems, and the vacuum of a chest tube should never be released.

Complications
Occlusion of the tubing by fibrin, clots, or other particles can reduce or obstruct drainage.

Documentation
Record the date and time you empty the drain, appearance of the drain site and presence of swelling or signs of infection, equipment malfunction and consequent nursing action, and the patient's tolerance of the treatment. On the intake and output sheet, record drainage color, consistency, type, and amount. If the patient has more than one closed-wound drain, number the drains and record the information above separately for each drainage site.