Friday, June 19, 2015

Proper Surgical Drain Management Procedures

By April Briggs

General surgeries, cardiac and orthopedic procedures in many cases demand the use of a drain. However, the success of the entire procedure depends on proper surgical drain management. Proper management will reduce the level of pain, promote faster healing and minimize the possibility of infections. Failure to manage the tubes properly will lead to infections that compromise the entire procedure.

With the existence of different types of drains, each requires unique attention. They are used to get rid of fluids such as blood, serum and lymph which are likely to accumulate on the bed or around the wound. These fluids exert unnecessary pressure on the area where surgery has been conducted causing vessels, nerves and organs to malfunction. The pressure causes a decrease in perfusion which slows down the rate of healing. The area where fluid has buildup is perfect for bacteria buildup.

Fluid removal can either be through active or passive drainage. Passive takes advantage of natural force of gravity while active drainage requires the use of a vacuuming machine. A wall sanction may also be used in place of the vacuuming device. The choice of active or passive drainage depends on availability and the level of flooding that needs to be contained. The decision is made by the surgeon.

The use of drains during surgery and healing processes comes with a host of complications. The process of inserting the tube, maintaining it in position and removing it is very painful. Neighboring tissues are destroyed as tubes rub against them. This leads to further complication. The tubes and the area where there is an incision are also prone to bacterial attack leading to infections.

The dangers of using a drain get worse with time. By the third or fourth day, the risk of infection has risen several folds. There is significant damage to the tissues that come into contact with the draining tubes. It is advisable to use the shortest and safest route between the wound and the exit. This will reduce pressure on surrounding tissues and minimize the number of organs coming into contact with the tube.

It is natural for the body to resist the drain by encasing it. This is because it is regarded as a foreign body. The reaction by the body reduces the effectiveness of the tubes. This is best handled through constant monitoring to ensure that the tube is still functioning optimally. The drains must be labeled clearly to make management consistent.

Strict monitoring of drains is necessary for the success of any procedure. The features that should be noted include the consistency of fluid flow, its color and quantity of drainage. It is expected that the initial drainage will be sanguineous. This is caused by a large quantity of fluid leftovers during surgery. The staff managing the patient should know the kind of flow to expect based on wound location and nature of operation.

With time, the fluid becomes thinner and reduces in volume. The changes should be tracked, documented and reported so that appropriate action can be taken in case of a problem. Care should never be delegated to a trainee and sterile techniques must be used during handling. Removal should only be approved by a qualified surgeon and according to prescribed procedure. The amount of drainage is also recorded for monitoring and comparison so that further action can be taken.

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