Surgical Wound Management and Drainage Systems

Surgical Wound Care Principles

Surgical wounds are typically managed under clean and aseptic conditions. In contrast, other wounds, such as those resulting from firearms or animal bites, are considered "dirty wounds" due to a higher risk of contamination.

Objectives of Wound Management

• Remove or prevent bleeding.
• Encourage wound healing (cicatrization).
• Prevent infection.
• Promote the drainage of secretions.

Wound Care Methods

Open Method:

No dressings are used. Only cleaning and asepsis of the wound are performed, leaving it exposed to dry.

Closed Method:

Aseptic cleaning of the wound is performed, and dressings are applied and secured.

Essential Elements for Wound Care

• For Cleaning and Asepsis: Saline solution, sterile water or sterile soap solution, gauze swabs or cotton swabs, dissecting forceps, Pean forceps or Kocher forceps, and blunt scissors.
• For Covering the Wound: Dressings.
• For Securing Dressings: Adhesive plaster (cloth or paper), tubular mesh bandages, or elastic bandages.

Role of Auxiliary Personnel in Wound Care

• Open sterile packages without touching their contents and hand them to the nurse.
• Open bottles of antiseptics, ointments, or medications.
• Soak gauze or sterile swabs in liquids.
• Open and close containers or waste bags.
• Provide psychological support and patient monitoring.
• Arrange, collect, and dispose of materials.

Understanding Surgical Drains

Surgical drains are devices used to remove fluids from a wound to the exterior. They are broadly categorized into simple (gravity) and aspiration (vacuum) drains.

Types of Surgical Drains

Simple (Gravity) Drains

These drains are used for surgical wounds of moderate size and less complex nature, where fluid drains by gravity action.

• Penrose Drain: A soft latex tube of varying size and diameter.
• Cigarette Drain: Similar to a Penrose drain but filled with gauze.
• Tile or Canopy Drain: A soft, flexible rubber sheet.
• Kher T-Tube: Made of rubber or silicone, shaped like a 'T'.
• Silaxtic Tube.

Vacuum (Suction) Drains

These are closed systems that create a vacuum to suction secretions.

• Redon Drain: A well-known type, it is a PVC or silicone tube with multiple holes at the end inserted into the wound. It has an extension that connects to a glass or plastic container with a graduated scale and a bellows to create suction.
• Saratoga Tube: A type of vacuum drain with an air intake.
• Jackson-Pratt (JP) Drain: A bulb-shaped drain with a thin rubber tube inserted under the skin. It can remain in place for 24 hours to several weeks. Patients sometimes go home with the drain. The surgeon removes it after the secretions have ceased.

A potential problem with drains is that they can facilitate the entry of microorganisms, increasing the risk of infection.

Potential Complications of Drains

Complications associated with surgical drains can include:

• Drain malfunction or displacement.
• Wound infection.
• Swelling or necrosis around the drain site.
• Hemorrhage.
• Evisceration or incisional hernia.

Jackson-Pratt (JP) Drain Care

JP Drain Care Instructions

1. Wash your hands thoroughly.
2. Squeeze the drain bulb, then remove the cap.
3. Pour the collected discharge into a measuring cup.
4. Squeeze the bulb completely and replace the cap to re-establish suction.
5. Empty the bulb three times a day.
6. Note the date, time, and amount of discharge.
7. Discard the discharge after measuring (if odorless) and wash your hands.
8. If the bulb loses compression, open the cap and re-empty it to restore suction.
9. Bring these records to your doctor at your next appointment.

When to Contact Your Doctor

Contact your doctor immediately if you observe any of the following:

• Swelling, redness, or unusual discharge around the tube.
• The bulb fills immediately after emptying.
• You are unable to crush the bulb to create suction.
• The tube falls out.
• Fever.