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Surgical drainage

Terms in this set (22)

Classifications - In the aim pursued
Prevention - to establish if the operating conditions of a plague make us to suspect the possibility of an infection or accumulation of bloody or serous secretions (inflammation, imperfect haemostasis, tissue debridement and takeoffs during the surgery).
- Besides the fact that these secretions can infect secondary, they relax tissues or cavity walls impeding scarring.

Curative - to establish when it comes to evacuate purulent collections or other collections formed in various tissues or cavities. This also ensures the gradual diminution of the cavity by nearing the walls, filling them with granulation tissue and secondary scarring.
Classification - Depending on how to apply
Simple (passive)- liquids drain depending on the laws of capillary, gravity and mechanics of functional tissue or that cavity involves.
- a variant of simple drainage is postural drainage, when the body position allow easy drainage of secretions through the drain by simple action of gravity.

Aspiration (active)- acting through drainage devices or systems producing active absorption of fluids and secretions from the cavity through the drain.
Classification - Depending on the method of evacuation
Open drainage - Secretions drain into the bandage.
Raise the danger of self infection;
also, from the wound germs spread in the environment, being the source of infection for other patients.

Drainage half open - the secretions are drained into a sterile collection container.
Changing the container and the risk of reflow, are important sources of contamination.

Closed drainage - the drain tubes are connected to a reservoir through a intermediate piece and a one-way valve prevents the wound secretions reflow.
What are the indications of surgical drainage ?
Prophylactic
Therapeutic
Prophylactic indications of surgical drainage ?
- Delabrante, contusive wounds that were contaminated with foreign bodies and requiring extensive debridement.

- Areas requiring large takeoffs or areas not covered by peritoneum which can produce abundant serous discharge (renal area, retropancreatic area, pelvis)

- Sutures or unsafe anastomosis (bleeding from the tranche of suture, tension, infections or biologicaly degraded patient)

- Prevention of generalized peritonitis in abdominal interventions or abdominal fluid leak after takeoff from the parenchyma (aberrant bile duct in the gallbladder bed) or by dissolution of digestive sutures.

- Helping to close the remaining cavities after evacuation of superficial and visceral collections that have a secretory potential and whose walls are thin and can merge
Therapeutic indications of surgical drainage ?
- Infections or collections of the soft tissues (abscesses, flegmons, gas gangrene).

- Suppurated collections in various serous cavities (pleura, peritoneum, synovial joint), parenchyma (liver, pancreas) or cell space (ischiorectal, pelvic - subperitoneal)

- Effusions through pathological hole in cavitary organs (bile, gastric, or intestinal content).

- Interventions on organs with acute inflammation purulent content (acute appendicitis, acute cholecystitis, piosalpingite)

- Interventions on the pancreas or in case of acute pancreatitis to evacuate pancreatic secretions.

- Infected pleural effusions, encysted collections, pneumothorax, in all interventions on thoracic organs
Advantages of surgical drainage ?
- Prevent accumulation of secretions in the cavity or wound.

- Ensure evacuation and prevent pathological secretions diffusion in neighboring tissues.

- Shortens the healing of infected wounds.

- Allows reduction and closure of pathological cavities.
Disadvantages of surgical drainage ?
- The external communication promotes wound infection

- Irritant to tissues passing by.

- Its trajectory is a weakness of the wall.

- Favors the appearance of adhesions.
neccessary materials
Tubes of rubber or plastic:
Blades of rubber or plastic
Gauze
Setolină or nylon wires - Use in small bundles to form a series of capillary spaces
Container collectors
Connecting tubes
Suction system
Tubes of rubber or plastic:
- Are commonly used, with different shapes and sizes, depending to the aim pursued.
- With one or more side holes at the tip inserted into the cavity, placed in a spiral line from a distance equal with the tube diameter and length must not exceed the diameter of the tube as no longer effective

Types of tubes :
- Simple tube - described above
- Cigarette tube (Penrose) - its lumen is crossed by a gauze mesh, which ensures good drainage capillary
- A similar principle with modern operating system presents the easy-flow in which mesha gauze is replaced by fine longitudinal striations of the inner wall of the tube
- Double lumen tube - formed either of two different diameter tubes attached together or a thicker tube surrounding another thinner; thicker tube provides drainage of secretions from the outside, and the other allows air to enter or infusion with liquid
- Tubul Redon tube - plastic, has a thicker wall and multiple side holes point, is often used in the vacuum drainage.
Disadvantages of drain tubes ?
- Are irritating to tissues
- They are easily compressible blocking flow secretion, which is why some are made with thicker walls and are reinforced with metallic mesh
- Can cause decubitus damage with the appearance of fistulas or secondary bleeding
- Allow entry of germs from the outside, which can lead to infection of that tissues
- It can block with tissue debris or plugs of fibrin becoming ineffective. Therefore, their permeability should be reviewed periodically.
- Produce reaction from the surrounding tissues and organs, they are isolated, decreasing capacity of drainage and increasing the risk of
Blades of rubber or plastic
- Can be smooth or curled, of various lengths and widths
- It is mainly used in surface drainage or as a transfixiant drainage
- Alternatively you can use pieces of rubber gloves as blades
Advantages of blades of rubber/plastic?
- No collapses and no blocks
- Not adhere to neighboring tissues and can not be isolated as tubes
- The curled also allow air to enter, ensuring a better evacuation of secretions
Disadvantages of blades of rubber/plastic?
With air allow germs into the wound
You can not use them in vacuum drainage
Gauze
It is used in various widths and lengths depending on the purpose
Advantages of gauze
Provide drainage of secretions by capillary
By pressing serves as hemostatic
Disadvantages of gauze
It quickly block with fibrin mesh fabric that clog, reducing or even annihilating function of capillary
Can block the hole cavity and allowing the development of infection in the cavity
Container collector
Can be of various shapes and sizes, adapted to the purpose and amount of secretion which is discharge
Connecting tubes
Connect the drain with collection containers, being made ​​of rubber or plastic
Drain position is based on?
- the location of collection and drainage mechanism
The collections in the superficial or the secretions gather latch, inner end of the drain is placed at the bottom of the cavity
The cavities in which secretions gather latch but their removal is done by positive pressure in the cavity (pelvic drainage), the drain must go to the lowest part of the collection
Lumen tube should be based on?
- on consistency of secretions
If evacuation viscous secretions rich fibrin thick tubes are used
For fluid or serous fluid collections can be used narrower lumen tubes or curled blades, aiming to periodically drain permeability
Track drain
- The track drain from the cavity to the skin should be as short and not wider than the thickness of the tube to prevent leakage of -secretions past him
- Shall be free of bend because secretions do not stagnate
- Drain should avoid the vicinity of blood vessels, the nerve trunks or bodies, because they can compress or ulcers
- it is advisable to drain out through the wound, because it can become infected by secretions flowing past him and lowers resistance leading to the appearance of scars operators eventrations
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