Drainage tubes after intestinal surgery
When to remove drains and probes after surgery?
The task of monitoringis possible early registration of physiological disorders, so as soon as possible to appoint corrective therapy. Invasiveness of monitoring depends on the severity of the disease in a particular patient: the heavier the patient, the more sensors and probes are used and the less likely to survive.
Comprehensive discussion of ever-increasingmethods of physiological monitoringis beyond the scope of this chapter. Nevertheless, please tick the following:
• In order to respond in a timely manner to the warning signals of the monitor, you must perfectly orient yourself in the technique used and must clearly distinguish the truly acute physiological deviations from mechanical and technological artifacts monitoring.
• It should be understood that all monitoring methods are fraught witha myriad of potential errors. associated with either one or another technology, and with the characteristics of the patient. Alertness and sound clinical judgment are of paramount importance!
• Thanks to the introduction of new technologies,monitoring ofit becomes more and more difficult (and more expensive). Moreover, the monitoring technique causes a large number of iatrogenic complications in surgical BIN. Use monitoring selectively, without succumbing to the Everest Syndrome: "I climbed it, because it's there". First of all, ask yourself: "Does this really matter to the patient?" Recall that there are safer and cheaper alternatives to invasive monitoring. For example, in a stable patient, remove the arterial catheter, since blood pressure can easily be measured by the usual sphygmomanometer, and p02 and other blood counts can be taken in the traditional way. Each time, when examining a patient, ask yourself which of the installed catheters and probes can be removed: nasogastric tube, Svan-Ganz catheter, central venous, arterial, peripheral venous or uric?
Nasogastric tube. The prolonged abandonment of this probe, supposedly to fight paralytic ileus in the postoperative period, is a generally accepted, but completely unreasonable ritual. The concept that the nasogastric tube "protects" the intestinal anastomosis located below is ludicrous, since several liters of intestinal juice is released every day below the unloaded stomach. The nasogastric tube extremely irritates the patient, making breathing difficult, causing erosion of the esophagus and supporting gastroesophageal reflux. Traditionally, surgeons leave it until the discharge from the stomach reaches a certain limit (for example, 400 ml / day); often it's just unnecessary torture. It has been repeatedly shown that the majority of patients after laparotomy, including after interventions on upper gastrointestinal tract, do not need nasogastric decompression at all, or only 1-2 day. In unconscious patients, when it is necessary to protect the upper respiratory tract from accidental aspiration, a nasogastric tube can be used selectively. After emergency abdominal interventions, its use is mandatory in patients who are on ventilator, unconscious and operated on for intestinal obstruction. In all other cases, remove the nasogastric tube the morning after the operation.
Drainages. Despite the general belief that it is impossible to effectively drain the free abdominal cavity, drains are not only used everywhere, but they are even abused (Chapter 10). To top it off, a false sense of security and safety (which they supposedly provide) drains can cause bedsores of guts or blood vessels and contribute to infectious complications. We believe that you use drains only to evacuate the contents from the cavity of the dissected abscess to drain the potential a source of visceral secretion (eg, bile or pancreatic secretion) and to control intestinal fistula when the gut can not be exteriorized. Passive open drainage does not exclude bacterial contamination in both directions, and therefore should not be used.
Use only activeclosed drainage system with tubes. which are out of contact with the visceral hollow organs. The location of the drainage directly at the anastomosis in the hope that a possible leakage of intestinal contents is realized sooner in the intestinal fistula, than in peritonitis, is an obsolete dogma; It is shown that the drains contribute to the divergence of the anastomotic sutures. Saying: "I always drain the area of the large intestine anastomosis for at least 7 days" - refers to the dark days of surgical practice. Remove drains as soon as they have completed their role.
Drainage in medicine: what it is, how and for what it is used
What is drainage? You will find the answer to this question in the materials of this article. In addition, we will tell you about how this method is implemented inmedical practice and for what it is necessary.
Drainage in medicine is a therapeutic method, which consists in removing the contents of wounds, hollow organs, abscesses, as well as pathological or natural cavities of the body.
Full and proper drainage is able to provide sufficient outflow of exudate and create the best conditions for the fastest rejection of dead tissue with the transition of the healing process to the regeneration phase.
Drainage in medicine has practically no contraindications. By the way, this method has one more indisputable advantage in the process of purulent antibacterial or surgical therapy, which consists in the possibility of a targeted fight against infection of wounds.
Effective drainage conditions
To produce effective drainage (in medicine), specialists determine its character, choose the optimal one for each case, the method of drainage, as well as the use of medicinal means for rinsing the cavities (respectively microflora). An important role in this practice is played by the maintenance of the drainage system and compliance with aseptic rules.
By what is carried out?
Drainage in medicine is carried out with the help of glass, rubber or plastic tubes of various diameters and sizes. In addition, glove graduates, specially manufactured plastic strips, gauze swabs, as well as catheters and soft probes that are inserted into the drained cavity or wound are sometimes required.
How is it produced?
You already know what drainage is. However, not everyone knows how this procedure is carried out. It should be noted that the methods for carrying it out are always different and depend on the type of wound formed and the device used. So, for the treatment of deep and large wounds, draining with gauze tampons is used. To do this, a square piece of gauze is injected into the purulent cavity, which is sewn with a silk thread in the center. It is carefully straightened, and then cover all the walls and the bottom of the wound. Further, the cavity is loosely tamponized with gauze tampons, previously soaked in a hypertonic sodium chloride solution. In this case, they are recommended to be changed every 4-6 hours, in order to prevent damage to the tissue. In the end, gauze should be removed from the wound by pulling the silk thread.
Other ways of drainage
It should be specially noted that gauze tampons and rubber graduates are used quite rarely to treat purulent cavities. For example, the last device does not have any suction properties at all. It is clogged with detritus and pus, covered with mucus, thereby causing inflammation in surrounding tissues.
Thus, in order to conduct a correct drainage of purulent wounds, specialists began to use special tubular devices. They can be single and multiple, double, complex, etc.
Drainage after surgery (surgical wounds) involves the use of tubes of silicone. Due to their elastic-elastic properties, transparency and hardness, they occupy an intermediate position between polyvinyl chloride and latex devices. Moreover, they significantly exceed them in terms of biological inertness. This fact makes it possible to increase the length of stay of drains in postoperative wounds. It should also be noted that they can be repeatedly sterilized by hot air and autoclaving.
Requirements for drainage
This process should be carried out in compliance with all the prescribed rules, namely:
- Careful compliance with the rules of asepsis. This includes the replacement or removal of drainage, especially if inflammation changes around the wound. It should be specially noted that the possibility of penetration of the infection into the cavity decreases exactly twice, if during the day the used agent is replaced with a sterile one.
- Drainage of cavities and purulent wounds should ensure the outflow of fluid during the entire period of therapy. After all, the loss of the used remedies can lead to the appearance of serious complications, which weigh down the outcome of the operation. Prevention of this situation is achieved by carefully fixing the drainage bandage, the outer cover, silk suture, leykoplastom or rubber sleeve, which is put on the drainage tube.
- The drainage system must never be bent or squashed. And the drainage should be located optimally. In other words, the outflow of fluid should not be carried out only by giving the patient a certain position in the bed.
- The drainage should not be the cause of any complications (damage to large vessels and tissues, pain, etc.).
After drainage - the consequences
Drainage, or drainage in medicineIs a special therapeutic method, the purpose of which is to remove the contents of # 8212; purulent formations, exudate, various fluids from the wound or cavity. For this procedure, special tubules, rubber and gauze bands are used for gauze tampons. With their help, unhindered removal from the body of pathological formations and liquids.
Drainage, or drainage can lead to irreparable consequences and complications. For example, the so-called remote catheter syndrome is a very frequent complication after the end of drainage in the treatment of biliary tract disease. This syndrome is observed in one-fifth of patients with external drainage.
The syndrome manifests itself in a rise in temperature. the occurrence of stress in the right hypochondrium and persistent pain syndrome after removal of the catheter - a special drainage rubber tube. Such inflammatory phenomena usually pass by themselves in about four to five days from the onset of conservative treatment. Moreover, there is a regularity: the earlier the catheter is removed, the more opportunities arise and the development of the syndrome of the remote catheter. Therefore, the most optimal time for removal of the catheter is two to three weeks after drainage.
To drainage does not end with complications and undesirable consequences, a number of requirements are put forward to it.
- The patient should not take any special position when draining.
- Throughout the entire period of treatment and wound healing, drainage should pass unchecked.
- The tube used during drainage should not be bent along its entire length, squeezed, press on the skin - this is very important.
- Drainage systems should be installed so that they can not transmit nerves and blood vessels, otherwise it will lead to longer recovery and healing.
- The drainage pipe should be well-reinforced - so that it can not fall out. If the tube still fell out, it should be brought back immediately (moreover, it can only be done by a doctor).
- If the amount of detachable sharply increased, his character changed, the nurse should immediately inform the doctor.
- Pumping the contents of the cavities through the drainage is exclusively and only medical manipulation.
When fixing the drainage system, it should be understood that there should not be much resistance from the water valve. To do this, he must immerse himself in the antiseptic solution to a depth of no more than two to three centimeters. If this is not done, the contents will accumulate in the cavity instead of going through the drainage.
However, the flow of air into the drainage tube with a valve unloaded into the antiseptic solution will immediately lead to pneumothorax with the ensuing consequences.
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Sources: http://meduniver.com/Medical/Xirurgia/183.html, http://fb.ru/article/147501/drenaj-v-meditsine-chto-eto-takoe-kak-i-dlya-chego-ispolzuetsya, http://nmedicine.net/posle-drenazha-posledstviya/
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