Drainage is a method of removing the contents (pus, exudate ) from a wound, body cavity, hollow organ with the help of tubes, rubber and gauze strips, gauze tampons. When draining conditions are created for the constant outflow of the contents.
Gauze tampons and gauze strips are of limited use for drainage, since, impregnated with discharge, quickly lose their hygroscopicity and cease to display the contents. Rubber bands (for example, from glove rubber) are used in some cases in the postoperative period to drain wounds. As the amount of discharge from the wound decreases, they are removed. The most commonly used for drainage are tubes made of synthetic materials and rubber of various diameters with several openings at the end inserted into the drainable cavity. Before the introduction of the drainage tube is washed, check their permeability and strength in order to avoid separation and sterilized. A drainage tube is inserted through a wound or an additional incision - counteroperture (see). To prevent falling out, the drainage tube is sometimes attached to the skin with a suture or plaster . To the outer end of the drainage tube, introduced into the cavity (peritoneum, pleura , etc.), tie a gauze cloth so that it does not go into the depths. The tube at the level of its removal from the wound tightly tied with thread; when the drainage tube comes out of the wound, the thread will be higher than the skin level; with a deeper dive it will not be visible. Siphon drainage is used to evacuate the exudate from the pleural cavity (Fig. 1). Through a puncture by an intercostal space trocar, a drainage tube is inserted into the pleural cavity, the end of which is immersed in a vessel with an antiseptic fluid. In some cases, when draining the pleural cavity, in order to avoid air suction from the outside, a finger from a rubber glove with a cut off tip falling down during inhalation (so-called valve drainage) is put on the outer end of the drainage tube.
Fig. 1. Drainage of the pleural cavity
Fig. 2. Drainage of the bladder (1) and para-bladder tissue (2)
For drainage of the kidneys, a drainage tube is inserted into the pelvis through its wall ( pyelostomy ) or through the kidney parenchyma (nephrostomy). During drainage of the bladder, the drainage tube is brought out through the extraperitoneal part of its front wall (Fig. 2, 1). When extraperitoneal bladder ruptures and urethral injuries to prevent urinary leakage after high bladder cross section and suprapubic fistula overlap, periubuclear cellulose is drained through the obturator orifice to drain the drains to the inner surface of the upper third of the thigh (Fig. 2, 2).
Through the drainage tube can be produced and active drainage (see. Aspiration drainage).
The doctor sets the drainage tube, the subsequent observation of the condition of the tube, the amount and nature of the discharge, the color of the sediment is carried out by the nurse . After the operation, it is necessary to ensure that the drainage tube does not squeeze, does not bend, does not press on the skin. Care must be taken to ensure that the drainage tube is well fixed and does not fall out. The dropped-out tube should be entered immediately. This manipulation is performed only by a doctor. To observe the amount and nature of the discharge (especially after operations on the organs of urine and biliary tract), it is most convenient to lower the outer end of the drainage tube into a graduated vessel of colorless glass. With a sharp increase in the amount of discharge, a change in his character, the nurse should immediately inform the doctor.
The duration of the drainage tube in a wound or cavity depends on the nature of the surgical intervention (the timing is determined by the doctor). Having found out during the dressing that the drainage tube inserted into the wound is missing, the nurse should immediately inform the doctor.Go