catheters, drains, and dressings

Chest tube

Catheter inserted through the thorax into the chest cavity for removing air or fluid; used after chest or heart surgery or pneumothorax.

Thyroid collar (Queen Anne's collar)

Circumferential neck wrap applied to secure the dressing over a thyroid incision

Minerva jacket cast

Covers trunk area from the lower portion of the head to the hips for fractures to the cervical and upper thoracic vertebrae

Wet to dry dressing

Damp gauze dressing placed on a wound and removed after the dressing dries to the wound, providing microdebridement

Tenckhoff catheter

Dialysis catheter inserted into the abdomen in order to conduct peritoneal dialysis treatments.

Dressing sponges

Do NOT contain radiopaque markers unless it is packing material that could be retained in the body.

Tracheotomy dressing

Drain dressing is placed around a tracheotomy tube, and the tube itself is secured with wide umbilical tape that is tied around the patient's neck

Drain dressing

Gauze sponge that is manufactured (e.g., Sof-Wick drain sponge) or fashioned with a scissors (usually a slit or "Y" shape) to accommodate a wound that contains a drain

eye pad

Oval-shaped gauze applied over the eyelid to retain medication and keep the lid closed

Skin Grafts

Pieces of skin that are cut from one part of a person's body and moved to the injured area

perineal pad

Used to absorb vaginal or perineal drainage.

One layer dressing

Used to cover a small incision from which drainage is expected to be minimal. Frequently used to cover IV site. op-site bioclusive

BrovIac, Hickman, Swan-Ganz

Used to monitor central venous pressure

Active drains make use of negative pressure. Negative pressure is created by removing air from the collection device manually or mechanically.

Uses a pump. Active drains are connected to a collection devise. examples include: Chest tube water seal drainage system. Hemovac Jackson Pratt Stryker

Water seal drainage system

Water in the suction control chamber should only have bubbles when the suction is first turned on; the water level should fluctuate with breathing. Collection chamber will have gentle, continuous bubbling when suction is applied.

wet to wet dressing

Wet gauze is applied to the wound and is changed before it dries. -Removal of the dressing while still wet provides minimal wound debridement & causes the patient less pain than the wet-to-dry dressing

Hemovac drain

a closed drainage system in which a soft drain is attached to a springlike suction device

Bolster dressing / stant dressing / tie over dressing

a dressing that is sutured into position. usually used on skin grafting procedures.

bolster dressing

a dressing that is sutured into position. usually used on skin grafting procedures.

Penrose drain

a flat, thin, rubber tube inserted into a wound to allow for fluid to flow from the wound; it has an open end that drains onto a dressing

Cholangiocatheter

a plastic catheter with a small lumen and port for attaching a lure-loc crying. The syringe will contain s dye such as hypaque or renografin. The end of the catheter is inserted into the common bile duct, die is slowly injected, and intraoperative x-rays are taken to detect the perceive of calculi.

wet to dry dressing

a saturated dressing that is wrapped around a wound and left to dry. upon removal the dressing pulls away tissue debris and drainage making it a useful tool in debridement

full thickness graft

a skin graft that contains the dermis and epidermis

gastrostomy tube

a surgically placed feeding tube from the exterior of the body into the stomach

urinary catheter

a tube inserted into the bladder through the urethra to drain urine from the bladder

The intermediate (absorbant layer) is placed over the contact layer to

absorb any drainage or secretions. Thickness will vary depending on amount of drainage expected.

Passive drains

allow pathway for fluid and air to move from a high pressure area to a lower pressure area Maybe connected to a collection device or contained in the absorbent dressing.

angio-acth

an example of a vascular catheter used to provide peripheral access.

ostomy bag

an external pouch that collects fecal matter diverted from the colon or ileum through a surgical opening (colostomy or ileostomy) in the abdominal wall.

A three layer dressing is used to cover

any size incision from which drainage (light, moderate, and heavy) is expected.

tracheotomy tube

any tube inserted into the trachea to gain control of the airway

ureteral catheters

are placed in to the ureters with the assistance of a cystoscope. Used to decompress the kidney, identity and protect the ureters during pelvic procedures and introduce contrast media during retrograde pyelography. Identified by the shape of their tip. Contain radiopaque marker. -whistle tip -olive tip -and cone tip

Fogarty

ball tipped catheter. the catheter is padded beyond obstruction within the lumen of a vein, artery, or duct. The balloon is then inflated, and the catheter is withdrawn along with the obstruction (thrombus). A variation is used for irrigation of the billiard system.

Examples of specialty dressings

bolster dressing, wet to dry, wet to wet, thyroid collar, ostomy bag, drain dressing, tracheotomy dressing, eye pads and shields, and perineal pad.

3 layer dressings

can cover any size incision that drainage is expected (light moderate, heavy) 1. contact layer (inner) 2, intermediate layer (absorbant) 3. Outer layer (securing)

Rigid dressing

casts and splints

Fogarty catheter

catheter, small in diameter and is balloon-tipped, used to facilitate the removal of an embolus

Jackson-Pratt drain

drainage system that uses a compressed bulb, applies slight suction within the wound

chest tubes

evacuate air and fluid from the pleural space.

negative pressure wound therapy

for wounds that are not easily treated with conventional dressings. gauze is placed over the wound and covered with an adherent plastic film. A vacuum pump is connected, which draws out fluid.

In addition on one layer dressing, liquid collodion (A type of liquid chemical dressing) may be applied to the wound and aloud to dry

forming a seal over the incision. Often used in peds. This is flammable and may not be permitted in all hospitals.

Skin grafts are classified by

graft type

Cystotomy tube

inserted in the abdominal wall to the bladder

Oral airway

inserted through the mouth to separate the jaws and depress the tongue

Active drains

make use of negative pressure. may be connected to a battery operated pump or vacuum system connected to a collection device

A skin preparation such as tincture of benzoin or Mastisol

may be applied to the skin prior to the dressing.

Passive drains allow a pathway for fluid or air to move from an area of high pressure to one of a lower pressure.

may be connected to a gravity collection device or the drainage may be contained within an absorbent dressing. penrose drain cigarette drain T-tube Gastronomy tube cystotomy tube nephrostomy tube

The contact layer will be

non permeable semi permable permeable

Permeable (Nonocclusive) contact layer

nonadherent material. used to draw secretions from the wound (wicking action). Allows passage of air and fluid. Removal of the dressing is painless.

Biologic Dressings

-Also known as: Biosynthetic skin substitutes -Are used for temporary coverage of open wounds due to trauma, burns, or skin ulcers -Can protect wounds, can prevent wound contamination, and can reduce fluid (serum) loss. -Specific biologic dressings may also provide matrix proteins & growth factors to the wound site. This process is designed to provide an optimal wound-healing environment. -Interga -Dermagraft -Apligraft

A three layer dressing consists of

-Inner (contact) layer -immediate (absorbant) layer -outer (securing) layer

The suprapubic catheter is placed into the bladder through a surgical opening in the abdominal wall.

-foley, pezzer (mushroom), and the malecot (winged tip)

surgical dressings

-protect the wound from trauma -protect the wound from microbial contamination -absorb drainage and secretions -support the incision -provide pressure to eliminate dead space, swelling & hematoma -conceal the wound aesthetically

surgical dressings are applied to most wounds

-protect the wound from trauma -protect the wound from microbial contamination -absorb drainage and secretions -support incision -provide pressure to reduce or eliminate dead space, reduce or prevent edema, assist in maintaining homeostasis, and prevent hematoma formation. -Maintain an environment that allows for preservation of new epithelial tissue and destruction of microbes. -Conceal the wound aesthetically

Inner Contact layer of the 3 layer dressing will be one of 3 types

1. non permeable (occlusive): 2. semipermeable 3. permeable

semipermeable (semi-occlusive) contact layer

A Hydrocolloid (e.g. ExuDerm, Tegasorb) or Hydrogel (e.g. Nu-Gel, AQUA-GEL). -Semi-occlusive dressing: is used to create a mechanical surface and allow for passage of air and fluids -Hydrocolloid dressing: may be used on a chronic wound such as a burn or decubitus ulcer

composite graft

A biological graft composed of different types of tissues such as skin and muscle.

Non permable (occlusive) contact layer

A fine mesh gauze impregnanted with an emulsion (vaseline...). Creates an airtight and watertight seal. It is nonadherent and allows passage of drainage to the absorbent layer. May be placed around an exit wound for a chest tube

Aerosol adhesive spray, foams, gels, hydrocolloids, and skin closure tapes (skin closure tapes may also be used in conjunction with another dressing and uses benzoin spray to keep the tape in place.)

A one layer dressing

walking cast

A short- or long-leg cast reinforced for strength

nephrostomy tube

A tube inserted through the abdominal wall into the kidneys to drain urine

Bulky dressing

A type of three-layer dressing to which additional material is added to the intermediate layer. -Used to immobilize an area, provide additional support to the wound, and absorb excessive drainage

Arterial catheters may be inserted temporarily to draw arterial blood for lab study

or may be indwelling. used to perform diagnostic studies and carious procedures such as a coronary artery angioplasty.

autologous

originating within an individual

Packing material is used to assist with hemostasis, provide pressure, support a wound, and/or eliminate dead space.

packing material is typically a long strip of gauze

Cigarette drain

passive drain; penrose drain with gauze inside encourages fluid to move out of the wound into the dressing by wicking action

endotracheal tube

polyvinyl-chloride airway that is inserted through the nose or the mouth into the trachea, using a laryngoscope as a guide

spica cast

secured to the torso to support the hip or shoulder in the desired position

Intravascular catheters are used to infuse fluids (including nutrients and medications), obtain a diagnosis, monster body functions, and remove thrombi.

sized according to gauge or the french method and may contain a single or double lumen. Inserted percutaneously or via small incision referred to as cut-down. Venous access in the subclavian or jugular vein.

Swan-Ganz catheter

soft, flexible catheter that is inserted through a vein into pulmonary artery with the help of a fluoroscopy. used to provide continuous measurements of pulm artery pressure. can exercise with device but patient should avoid activities that increase pressure on injection site

Dressing changes are also considered a

sterile procedure. The first scrub ST should remove the outer soiled sterile gloves before handeling the dressing material by passing to the surgeon or placing on the patient.

Dressing sponges are not opened on the sterile field until

the final count is complete and the body cavity is closed.

Xenografts

tissue taken from a different animal species

T-tube

tube placed in the bile duct for drainage into a small pouch (bile bag) on the outside of the body

stryker drain

typically used following orthopedic procedures. Effective in reducing dead space due to the strength of the battery operated evacuation pump .

Wet to wet dressing

used on clean open wounds; dressing saturated with solution; dressing is kept moist; removed before it dries. thick exudates are more easily removed

Gastrointestinal tubes

used to aspirate air and fluids from the gastrointestinal tract. May have the sump design (dual lumen tube in which one lumen is used for evacuation of fluid and the second allows air to flow to enter for equalizing the pressure within the structure, reducing risk of damage to delicate tissue.

one layer dressings

used to cover a small incision which drainage is expected to be minimal. -transparent film -aerosol adhesive sprays, soaps, gels, or tapes (stern strips) -liquid skin.

self retaining or indwelling urethral catheters are called foley catheters. They are used to measure urinary output

uses a balloon to stay in bladder

eye shield

Rigid oval shield applied over the eye pad to protect the eye from pressure or trauma

Dermabond

Skin "glue" used to repair simple lacerations that are not very deep.

The three way foley has an additional port that allows for instillation of irrigation fluid of medications into the bladder.

Some foley catheters contain a thermometer in the tip that is used to measure the patients core temperature.

Robinson catheter

Multiple openings at the tip to facilitate intermittent drainage. It may also be used to provide irrigation fluid with in a duct or threaded through the nasal cavity in to the oral cavity and is used to retract the uvula when a tonsillectomy is performed.

split thickness graft

All epidermis and some dermis

nasal airway

An airway adjunct that is inserted into the nostril of a patient who is not able to maintain a natural airway. It is also called a nasopharyngeal airway.

Body jacket cast

Applied to trunk of body to immbolize the spine.

nonretaining catheters

Are temporarily inserted through the urethra into the bladder to obtain a urine specimen, decompress the bladder, or maneuver around an obstruction. These do Not require a drainage bag. Examples include: Robinson and the Coude catheter

The outer (securing layer) is used to secure the contact and absorbent layers in place.

Tape, Wrap (elastic bandage), Stockinette, Tube gauze, Montgomery straps

Tubes are uses to remove hit and fluids from the body for the purpose of decompression.

They are also used to maintain patency of a lumen and for the administration of oxygen, anesthesia gases, medications, and fluids including nutrition supplements.

Pressure dressing is a type of 3 layer dressing to which additional material is added to the intermediate layer or one that is tightly secured to cause compression of the surgical wound.

Tissue compression may promote wound healing. However, to tight will inter fear with that. -immobilization of an area -support -absorption of excess drainage -even pressure distribution -Elimination of dead space -reduced edema -reduced hematoma formation

homografts

Tissue from disease free cadavers