Editor’s note:Medical students who are new to the clinic must have no knowledge of dressing changes and draining Unfamiliar, but why do you want to drain and how to choose the method of drainage? Today’s one-page manual will lead you to review the big mystery hidden in the small drainage tube!
I. What is Drainage
Definition of Drainage
Drainage of fluids in interstitial spaces, body cavities, joints, organs, The gas is drawn out of place or excreted
Purpose of drainage
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Prevent the accumulation of fluid and gas
Reduce necrotic cells, inflammatory factors, Local accumulation of possible pathogenic bacteria leading to inflammation and infection
formation of artificially controlled fistulas
Reduce the pressure in the lacunar space
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Figure 1 Different drainage methods[1]
strong>2. Things you need to know before drainage
01
Complications
Improper drainage is prone to bleeding and tissue inflammation;
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The hematoma formed after vascular anastomosis cannot be drained to prevent hypovolemia.
02
Indications
Therapeutic drainage: tension pneumothorax, pleural effusion, abscess, acute urinary block, acute Septic Arthritis
Conservative Drainage: Hydrocephalus
Diagnostic Drainage: Biliary Fistula, Common Bile Duct Stone T-tube angiography
Prophylactic drainage: organ resection
Monitoring drainage: gastrointestinal bleeding, catheterization
03
Basic Requirements
The specific drainage method is determined according to the requirements of different diseases, surgical conditions, and the basic condition of the patient;
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The materials used need to support drainage, with little pressure on surrounding tissues, and not easy to adhere to granulation tissue;
Drainage should be placed in a suitable The drainage site is located at the bottom of the wound or close to the site that needs drainage, to ensure that the drainage is sufficient and no dead space remains.
The drainage needs to be properly fixed to prevent the drainage from falling out and falling in
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Avoid suturing the drainage tube together when closing the deep wound, which will make it difficult to remove it eventually;
Try to ensure drainage The smoothness of the tube to avoid bending and clogging.
Fig 2. Appendiceal abscess drainage[2] p>
III. Principle and mechanism of drainage
01
Passive Drainage
Adsorption: Drainage through capillary attraction of gauze
Figure 3. Adsorption of tampons (just a chestnut…)
Drainage effect: Use the relative pressure difference between the drainage gap and the atmosphere to drain through the catheter
Siphon effect: Under the condition that the drainage gap is equal to the pressure of the drainage bottle, the gravitational potential energy is used to drain the effusion at a higher position to a higher position. Low drainage bottle.
02
Active drainage< /strong>
Using negative pressure drainage;
VSD (Vaccum Scaling Drainage): biological semipermeable membrane and polyvinyl alcohol hydrated seaweed salt foam (VSD dressing) ) to drain the wound exudate through the micropores and drainage tube of the VSD dressing
Figure 4. VSD wound drainage (Eryuan County People’s Hospital)
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03
Open drainage
and air traffic, easy to generate Exogenous contamination;
Including suction drainage and catheter drainage;
It can be applied to gauze drainage after breast abscess incision.
05
Closed Drain strong>
Without air traffic, it may be beneficial to the growth of some specific anaerobic bacteria;
Closed chest drainage:
Using semi-recumbent position to achieve The role of sequential drainage, the principle of negative pressure suction and the pressure difference during breathing drain the gas or liquid in the chest cavity to the outside of the body.
Indications: spontaneous pneumothorax (pulmonary compression greater than 50%), traumatic hemopneumothorax, massive pleural effusion or continuous pleural effusion drainage, early complete drainage of empyema, postoperative drainage after thoracotomy< /p>
Contraindications: tuberculous empyema
Figure 5. Chest drainage
After reading this one-page manual,
Have you gained a more comprehensive understanding of drainage?
References
[1] Surgical Drains: What the Resident Needs To Know: Makama J G, Ameh E A
[2] Use of drains in surgery: a review
Author:An unknown chicken
Review:< /strong>Xu Yuan, Attending Physician, Department of Thoracic Surgery, Peking Union Medical College Hospital
Editor:Left-clamping the appendix is Hong< /p>
Daily Insights
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Selected Daily Questions
The signs shown in the picture below are:
Swipe down for answers
Answer:BrudZinski sign positive
Analysis: the patient lies supine with the pillow removed , lower limbs Straighten, the examiner supports the patient’s back occiput with one hand and presses the other hand on the chest. When the head is passively lifted up and the neck is flexed forward, both hips and knee joints are involuntary at the same time
Buckling is positive.
It is one of the manifestations of meningeal irritation sign, and a positive meningeal irritation sign generally indicates meningitis or neurological diseases such as subarachnoid hemorrhage
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Topic source: past real questions of the clinical practitioner qualification examination
Editor in this issue: Tugua King Gantang Pear