“MANAGEMENT OF

WOUND AND
DRAINAGE”
 MANGEMENT OF WOUND AND DRAINAGE

DEFINITION- Cleaning and irrigation are the fundamentals of wound care. Wound cleaning
and irrigation is also known as wound preparation and management.
INDICATIONS-
 To clean any disruption in skin integrity.
 To clean the skin before the suturing infusion and drainage, invasive procedures and
removal of foreign body
 To promote healing with out infection.
 To provide the best possible function and appearance for the patients.

PURPOSE-
 To protect a wound from microorganism contamination.
 Aids in Homeostasis.
 To Promote Healing by absorbing damage and debriding a wound.
 To Support or splint a wound site protect the client from seeing the wound.
 To Promote Thermal insulation of wound surface.
 To Provide a moist environment.

Injuries that require special care-

a. The eye lids- evaluate for visual acuity before suturing.
b. The neck- carefully check for child airway.
c. Spray gun injuries- extensive tissue destruction can occur.
d. Scalp- laceration may disguise skull fracture.
e. Crush of avulation injuries-extensive tissue damage can cause delayed wound healing.
f. Facial- special attention is given for cosmetic reason.
g. Associated fracture- open fracture are at high risk of infection.
h. Punctured wound- can increase the chances of infection. Evaluate carefully for the
presence foreign body.

Common cause of wound-

 Surgical Procedure
 Trauma
 Pressure Necrosis
 IV extravasation
 Prolonged contact with moisture or chemicals
  Skin excoriation

Principle of wound management-

 Use Aseptic Technique 
 Wound cleansing should not be undertaken to remove 'normal' exudate
 Cleansing should be performed in a way that minimises trauma to the wound
 Wounds are best cleansed with sterile isotonic saline or water
 The less we disturb a wound during dressing changes the lower the interference to
healing
 Fluids should be warmed to 37°C to support cellular activity
 Skin and wound cleansers should have a neutral pH and be non-toxic
 Avoid alkaline soap on intact skin as the skin pH is altered, resistance to bacteria
decreases
 Avoid agents like alcohol or acetone as tissue is degraded
 Antiseptics are not routinely recommended for cleansing and should only be used
sparingly for infected wounds

Method:

 Irrigation is the preferred method for cleansing open wounds. This may be carried out
utilising a syringe in order to produce gentle pressure - in order to loosen debris. Gauze
swabs and cotton wool should be used with caution as can cause mechanical damage to
new tissue and the shedding of fibres from gauze swabs/cotton wool delays healing.  

Choice of dressing
A wound will require different management and treatment at various stages of healing.
No dressing is suitable for all wounds; therefore frequent assessment of the wound is
required. Considerations when choosing dressing products -

 Maintain a moist environment at the wound/dressing interface

 Be able to control (remove) excess exudates. A moist wound environment is good, a wet
environment is not beneficial
 Not stick to the wound, shed fibres or cause trauma to the wound or surrounding tissue  
on removal
 Protect the wound from the outside environment - bacterial barrier
 Good adhesion to skin
 Sterile
 Aid debridement if there is necrotic or sloughy tissue in the wound (caution with
ischaemic lesions)
 Keep the wound close to normal body temperature
 Conformable to body parts and doesn't interfere with body function
 Be cost-effective
 Diabetes - choose dressings which allow frequent inspection
  Non-flammable and non-toxic

Three phases of wound healing-

1. Inflammatory phase- occurs when the wound is created and is characterized by
erythema, swelling, and warmth.
2. Proliferative phase- is characterized by granulation and tissue regeneration.
3. Maturation phase- includes contraction of the shape of the wound; scar tissues are
visible.

Care of surgical wound-

When wound occurs, a variety of effect can occurs-
1. Immediate loose of all or part of organ functioning.
2. Sympathetic stress response.
3. Bacterial contamination.
4. Hemorrhage and blood clotting.
5. Death of cells.

 Dry wound  Minimal exudate  Moderate exudate  Heavy exudate

 Non adherent island
Hydrogel   Calcium alginate  Hydrofibre
dressing
 Hydrocolloid  Hydrocolloid  Hydrofibre Foam 
Silicone
 Films semi permeable  Foams  Absorbent dressing
absorbent 
     Negative Pressure  Negative pressure wound therapy
 Hydrocolloid:
     Ostomy bags
paste/powder

Purpose of wound care and the nursing action-

S. no Purpose Nursing action

1. To prevent infection 1. Protect the wound with appropriate dressings to prevent

wound contamination.
2. Use sterile technique.
3. Clean the wound thoroughly.
4. Isolate patient with clean wounds from those with
contaminated wound.
5. Sue antiseptics on and around wounds.
6. Use systematic antibiotics.
2. To prevent further 1. Protect the wound with adequate dressings to prevent
tissue damage friction.
2. Handle injured tissues as little as possible to prevent the
destruction of new granulation tissues.
 3. Immobilize the injured part by using slings, bandages,
splint and plaster cast.
4. Use antiseptic solutions of correct strength which are
safe for the skin and mucus membranes. Using
antiseptics of high concentration can cause tissue injury.
5. Apply surgical soak when the dressings are adhered to
the wound.

3. To promote healing. 1. To closing large wounds with stiches

2. Change the dressing of wound before moisten the
surface of dressing.
3. Manage the chronic medical conditions such as
Diabetes.
4. Give and instruct high protein rich diet
4. Wound dressing 1. Wound dressing should sterile.
2. Apply dry dressing after application of prescribed
medications.
3. Dressing should be change before soiled.
5. Pharmacological 1. Give antimicrobial treatment on time as prescribed by
management doctor.
2. Give tetanus injection and tetanus immunoglobulin.
3. Give antibiotic depending upon age of wound, presence
of soiled infection.
6. Patient education 1. Inform patient that pain should be subside within 24
hours.
2. Acetaminophen or prescribed analgesic to be given for
first 24 hours.
3. High protein diet should be advise to fast healing of
wound.
4. Tell patient to come to meet doctor if any problem occur
at home setting related to wound.

WOUND DRAINAGE-
A drain is inserted into or close to a surgical wound, where large amount of drainage is expected
and when keeping wound layers closed is especially important. Accumulation of fluid under
tissue prevents closing of wound edges.
The drains are inserted and sutured through the incision line or inserted through stab wounds, a
few inches away from the incision lin. The letter site allows incision line. The latter site allows
incision to be kept dry. Drains vary in length and width. Sometime a rubber tubing is required
length and width with 2-3 holes on one end is used as a drain. In order to facilitate healing and
drainage of tissues from inside to outside or from the bottom to the top, the drains are to be
pulled out or shortened from day to day until it falls out on its own.

Common types of drains-

Corrugated drains- used after incision and drainage of an abcess.
Rubber tubes- used after chest surgery. A water seal drainage system is attached to this type of
drain.
T Tube- used in case of cholecystectomy.
Pediatric feeding tubes- used after mastectomy or thyroidectomy where a continuous
transudate is expected. These drains are installed with a continuous suction.
Gauze wick- used to keep the sinus open, so that healing can take place from the base of the
wound.

Character of wound drainage-

The amount, color and consistency of the drainage must be observed daily and documented. The
amount of drainage depends on the location and extends of the wound. The type of drainage
include following-
- Serous- clear watery plasma
- Sanguineous- bright red in color and indicates fresh bleeding.
- Sero sanguineous- pale, watery drainage.
- Purulent- thick yellow, green or brown drainage.

If the drain has pungent or strong odor, an infection must be suspected.

Care of the drain-

The drain site is considered as the most contaminated. Therefore it is cleansed after the wound
has been cleansed from the cleanest area to most contaminated area. The skin around the drain is
cleaned from the drain site outward.

Shortening and removal of drain-

The physician often places a pin or clip through the drain to prevent it from slipping further into
the wound. The nurse must assess and record following-
1. Placement of drain, character of drainage, condition of collecting apparatus.
2. Observe the security of the drain and location with respect to the wound.
3. Is there is a collecting device, measure volume of drainage.
4. Observe the drainage flow through the microscope to ascertain its patency.
 5. If the drain is connected to suction site, may sure that the pressure ordered is been
exerted. If the evacuation device is not able to maintain a vacuum on its own, a second
vacuum system may be connected by surgeon. If the fluid is allowed to accumulate under
the tissues, infection may occur and delayed healing may result.

The shortening of the drain is done conjunction with the change of dressing. The preparation of
the patient and equipment’s is the same as for a dressing change. A straight scissors is needed to
cut the sutures fixes the drain to the site. A sterile safety will hold the drain in place above the
skin. To cleaning the incision and drain site , cut the sutures to release the drain. Hold the drain
with artery forceps and pull out the drain gently and firmly until one or two inches of the drain
gently or firmly until one or two inches of the drain comes out. Using an artery forceps, insert
sterile safety pins through the drain as close as to the skin as possible and fasten the safety pin.
Close the excess drain. Complete the procedure as with sterile dressing.
Drainage seeks a low level. Therefore the bulk of the dressing should be at the lower edge of the
wound. Dressing over the drains need to be changed frequently.

BIBLIOGRAPHY-
- Dutta parul, pediatric nursing 9as per INC syllabus), 3rd edition, page no- 256-58.
- Ghai O.P, paul, k, Vinod, bagga Arvind, Ghai essential Pediatric, 7th edition, page no-
827-829.
- William S Linda, hopper D paula, understanding medical surgical nursing, 7th edition,
page no- 876-878.
- Nettina M Sandra, Lippincott manual of Nursing Practice, 8th edition, page no-213-14