Periop nursing july2011
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Transcript of Periop nursing july2011
FUNDAMENTALS of
NURSING: special lecture on
Perioperative Nursing
Prepared by: Ronivin Garcia Pagtakhan, RN, MAN (c)
Perioperative Nursing
– a clinical specialty, refers to the role of the
nurse during the preoperative (before
surgery), intraoperative (during surgery)
and post operative (after surgery) phases
of the client’s surgical experience
What are the different types of
surgery?
- Severity/ Risk
- Urgency
- Reason
RISK
major surgery These are surgeries of the head, neck, chest, and
abdomen.
The recovery time can be lengthy and may involve a stay in intensive care or several days in the hospital.
There is a higher risk of complications after such surgeries.
Types of major surgery may include: removal of brain tumors
correction of bone malformations of the skull and face
repair of congenital heart disease, transplantation of organs, and repair of intestinal malformations
correction of spinal abnormalities and treatment of injuries sustained from major blunt trauma
correction of problems in fetal development of the lungs, intestines, diaphragm, or anus.
minor surgery
The recovery time is short and patient return to their usual activities rapidly.
These surgeries are most often done as an outpatient
Complications from these types of surgeries are rare.
Examples of the most common types of minor surgeries may include, but are not limited to, the following: placement of ear tubes
hernia repairs
correction of bone fractures
removal of skin lesions
biopsy of growths
URGENCY
ACCORDING TO DEGREE OF
URGENCY
Emergent – life-threatening – without
delay
Severe bleeding
Urgent – prompt attention – 24-30 hrs
Cholecystitis
Required – needs – weeks-months
Cataract
Elective – should be, not catastrophic
Scar repair
Optional – personal reference
cosmetic
Biopsy is the removal of a piece of tissue from an organ or other part of the body for microscopic examination to confirm or establish a diagnosis, estimate prognosis, or follow the course of a disease.
Curative surgery is the removal of the entire tumor. Even after curative surgery, you may still be given chemotherapy or radiation to kill micro-metastases. Micro-metastases are cancer cells that may still be in the body but cannot be detected by current technology.
Cryosurgery involves the use of liquid nitrogen or a very cold probe to freeze cancer cells.
Debulking surgery is when the entire cancer cannot be removed without serious damage to the body so the surgeon takes out only that portion of the tumor that can be removed safely. The rest of the tumor may be killed with radiation therapy or chemotherapy.
Electrosurgery uses an electrical current to destroy cancer cells.
Laser surgery is surgery in which a beam of light is used instead of a scalpel.
Mohs surgery is the removal of skin cancer by shaving off one layer at a time. The dermatologist (skin doctor) looks at each layer under a microscope. When the layers look normal (no cancer) the surgeon stops removing skin.
Reason
Prophylactic surgery
to prevent cancer when there is a good chance that a particular body tissue will become cancerous in the future.
Palliative surgery
does not treat the underlying disease but is done to control symptoms of cancer, such as pain.
Restorative or reconstructive surgery
commonly called plastic surgery
restores the function and appearance of an area after a previous surgery.
Staging surgery
determine the extent of the cancer, or how large it is and how much it has spread throughout the body. This is very important, as it will determine the course of treatment.
Ablative
Removal of a diseased organ
Surgery is affected by:
age
general health
nutrition
medications
mental status
Perioperative Nursing
3 PHASES OF
PERIOPERATIVE PERIOD
PREOPERATIVE PERIOD
begins with the decision to have surgery
and ends when the client is on the
operating table
Previous Medication History
Adrenal corticosteroids – do not d/c
abruptly CV collapse
Diuretics – thiazide diuretics resp
depression
Phenothiazine hypotension
Antidepressants: MAO hypotension
Tranquilizers anxiety, tension,
seizures of withdrawn suddenly
Insulin
Antibiotics – ―mycin‖ + curariform muscle
relaxant apnea
PHYSICAL PREPARATION - Preoperative
checklist
Nutrition and hydration
Consumption of clear liquids up to 2 hours
before elective surgery requiring general
anesthesia.
Fasting for 4 hours prior to surgery after
ingesting milk products
Eating a light breakfast 6 hours before the
procedure
A heavier meal 8 hours before surgery
Fasting for 8 hours prior to surgery after eating
fatty foods
Elimination Catheter insertion, Enema
Rest and Sleep
Hygiene Bath ,Remove cosmetics, Remove all hairpins and
clips, OR gown
Medication Discontinued, Preop meds
Personal valuables and prosthesis
Care of belongings, Remove all body prostheses
Special orders
NGT, insulin, etc
Special skin preparation
PREOPERATIVE TEACHING
proper timing
PAIN MANAGEMENT
PHYSICAL ACTIVITIES
DBE , Coughing exercises , Leg exercises,
Turning in bed
EMOTIONAL SUPPORT
PREOP CHECKLIST
CONSENT
HEALTH TEACHING (SPEC. POST OP
PROCEDURES)
LAB TESTS,ECG,X-RAY
SKIN PREP
BOWEL PREP
IV’S
NPO
PREOP MEDS,SEDATION AND ANTIBIOTICS
REMOVAL OF DENTURES,NAILPOLISH AND
JEWELRY
NUTRITION-TPN OR ENTERAL FEEDINGS PREOP
INFORMED CONSENT
protects the patient from unsanctioned
surgery and protects the surgeon from
claims of an unauthorized operation
nurse may ask patient to sign the form
and witness the patient’s signature
the physician provides appropriate
information:
flow of surgery
alternatives
possible risks, complications, disfigurement
what to expect early and late post op
Indications of Informed Consent
invasive procedure/ surgery
use of anesthesia
nonsurgical by there might be slight risk
involves radiation
Criteria of Informed Consent
Consent voluntarily given (without
coercion)
Competent subject
Surgery
Common surgical procedures
Appendectomy
An appendectomy is the surgical removal of the appendix, a small tube that branches off the large intestine, to treat acute appendicitis. Appendicitis is the acute inflammation of this tube due to infection.
Breast biopsy
A biopsy is a diagnostic test involving
the removal of tissue or cells for
examination under a microscope. This
procedure is also used to remove
abnormal breast tissue. A biopsy may
be performed using a hollow needle to
extract tissue (needle aspiration), or a
lump may be partially or completely
removed (lumpectomy) for examination
and/or treatment.
carotid endarterectomy
Carotid endarterectomy is a surgical procedure to remove blockage from carotid arteries, the arteries located in the neck that supply blood to the brain. Left untreated, a blocked carotid artery can lead to a stroke.
cataract surgery
Cataracts cloud the normally clear lens
of the eyes. Cataract surgery involves the removal of the cloudy contents with ultrasound waves. In some cases, the entire lens is removed.
cesarean section Cesarean section (also called a c-section) is the surgical delivery of a baby by an incision through the mother's abdomen and uterus. This procedure is performed when physicians determine it a safer alternative than a vaginal delivery for the mother, baby, or both.
cholecystectomy
A cholecystectomy is surgery to remove
the gallbladder (a pear-shaped sac near
the right lobe of the liver that holds bile).
A gallbladder may need to be removed
if the organ is prone to troublesome
gallstones, if it is infected, or becomes
cancerous.
coronary artery bypass surgery Most commonly referred to as simply "bypass surgery," this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). Bypass surgery consists of grafting veins or arteries from the aorta (a major artery that carries blood from the heart to the rest of the body) to the coronary artery, bypassing areas that are blocked. Veins are usually taken from the leg.
Craniotomy/craniectomy
debridement of wound, burn, or infection Debridement involves the surgical removal of foreign material and/or dead, damaged, or infected tissue from a wound or burn. By removing the diseased or dead tissue, healthy tissue is exposed to allow for more effective healing.
dilation and curettage (Also called D
& C.)
A D&C is a minor operation in which the
cervix is dilated (expanded) so that the
cervical canal and uterine lining can be
scraped with a curette (spoon-shaped
instrument).
free skin graft A skin graft involves detching healthy skin from one part of the body to repair areas of lost or damaged skin in another part of the body. Skin grafts are often performed as a result of burns, injury, or surgical removal of diseased skin. They are most often performed when the area is too large to be repaired by stitching or natural healing.
hemorrhoidectomy A hemorrhoidectomy is the surgical removal of hemorrhoids, distended veins in the lower rectum or anus.
hysterectomy A hysterectomy is the surgical removal of a woman's uterus. This may be performed either through an abdominal incision or vaginally.
hysteroscopy Hysteroscopy is a surgical procedure used to help diagnose and treat many uterine disorders. The hysteroscope (a viewing instrument inserted through the vagina for a visual examination of the canal of the cervix and the interior of the uterus) can transmit an image of the uterine canal and cavity to a television screen.
mastectomy A mastectomy is the removal of all or part of the breast. Mastectomies are usually performed to treat breast cancer.
There are several types of mastectomies, including the following:
partial (segmental) mastectomy, involves the removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer.
total (or simple) mastectomy, in which the surgeon removes the entire breast, including the nipple, the areola (the colored, circular area around the nipple), and most of the overlying skin, and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands.
modified radical mastectomy, in
which the surgeon removes the entire
breast (including the nipple, the areola,
and the overlying skin), some of the
lymph nodes under the arm, and the
lining over the chest muscles. In some
cases, part of the chest wall muscles is
also removed.
radical mastectomy, involves removal of the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, and the chest muscles.
partial colectomy A partial colectomy is the removal of part of the large intestine (colon) which may be performed to treat cancer of the colon or long-term ulcerative colitis.
prostatectomy The surgical removal of all or part of the prostate gland, the sex gland in men that surrounds the neck of the bladder and urethra - the tube that carries urine away from the bladder. This may be performed for an enlarged prostate, benign prostatic hyperplasia (BPH), or if cancerous.
Penectomy
Removal of a diseased penis
tonsillectomy The surgical removal of one or both tonsils. Tonsils are located at the back of the mouth and help fight infections.
INTRAOPERATIVE PHASE
begins with the admission of the client
to the surgical area and ends when the
client is transferred to the recovery
area.
MAINTAIN SURGICAL ASEPSIS, MONITOR CLIENT
STATUS,, APPROPRIATE GROUNDING DEVICES,
FLUID BALANCE AND SPONGE/INSTRUMENT
COUNT
SCRUB NURSE – HANDLES EQUIPMENT ,
MATERIALS TO THE SURGEON, SPONGE
AND INSTRUMENT COUNT
( STERILE)
CIRCULATING NURSE- ENSURES ADEQUACY
OF SUPPLIES, SKIN PREP ,
DOCUMENTATION , HANDLES STERILE
EQUIPMENTS BY FORCEPS
INTRA-OPERATIVE CARE
The OPERATING ROOM
free from contaminating particles, dusts,
pollutants, radiation, noise
ZONES
Unrestricted – street clothes are allowed
Semi-restricted – scrubs, shoe covers,
cap and mask
Restricted zone
SURGICAL SKIN PREPARATION
Cleaning, shaving, applying antimicrobials
POSITIONING
Performed after anesthesia is given
Provide correct position for the specific
procedure
Protect bony prominences
Avoid strain or injury to muscles, bones
and joints
Protect the skin – lift rather than pull or roll
the client into position
SPECIFIC THERAPEUTIC
POSITION HIGH FOWLERS-60-90’
FOWLER-45-60’
SEMI-FOWLERS-30-45’
LOW-FOWLERS-15-30’
SUPINE
DORSAL RECUMBENT
LITHOTOMY
SIMS LATERAL
PRONE
KNEE-CHEST
SIDE-LATERAL
ORTHOPNEIC
TRENDELENBURG
MODIFIED TRENDELENBURG
OTHER RESPONSIBILITIES
Draping
Assist in preparing and maintaining the sterile
field
Open sterile packages during surgery
Provide meds and solutions for the sterile field
Monitor and maintain sterile environment
Manage catheters, tubes, drains and
specimens
Perform sponge, instrument and sharp counts
Document care provided and client responses
Transferring of client to RR
Endorsement
THE SURGICAL EXPERIENCE ANESTHESIA
state of narcosis (severe CNS depression)
Analgesia, relaxation, reflex loss
General Anesthesia – inhaled, most
common
Volatile liquid agents – vapors
Halothane, enflurane, isoflurane, sevoflurane
Gas anesthetics – with oxygen, N2O
IV ANESTHESIA
Barbiturates, benzodiazepines, non-barbiturates
Opioids
used for induction (initiation) or mainstream
used to produce conscious sedation
Advantages
onset is pleasant
non-explosive
easy to administer
decreased nausea
and vomiting
Contraindications
children
powerful
respiratory
depressant
CONSCIOUS SEDATION
depression of LOC without impairment of
the patient’s ability to maintain a patent
airway and to respond to physical
stimulation and verbal command
Medazolam (Versed), Diazepam
first dose is given by the physician
succeeding doses – RN, Nurse-anesthetist
WOF: dysrhythmias, CNS, Respi
depression
O2, resuscitation, pulse oximetry, cont.
ECG, VS
Adjunctive Agents : Neuromuscular
blockers – purified curare
REGIONAL ANESTHESIA
form of local anesthesia
anesthetic agent is injected around nerves
so that the area supplied is anesthetized
SPINAL ANESTHESIA
extensive conduction nerve block
local anesthetic agent into subarachnoid
space at the lumbar level (L4, L5)
lower extremities, perineum, lower
abdomen
knee-chest position, place supine after
injection
if high level block, head and shoulders are
lowered
anesthesia and paralysis of toes, perineum
then legs and abdomen
may also reach upper thoracic and cervical
spine resp paralysis
CONDUCTION BLOCKS
Epidural anesthesia
injection of local anesthetic into the spinal
canal in the space around the dura mater
higher dose than spinal
no headache
disadvantage: epidural space vs.
subarachnoid space
Brachial plexus
arm
Paravertebral anesthesia
chest, abdominal wall, extremities
Transsacral (caudal)
perineum, lower abdomen
Local Infiltration Anesthesia
Advantages – simple, economical,
nonexplosive, minimal equipment, postop
recovery is shortened, no GA side effects,
short superficial surgical procedures
TAKE NOTE: Anesthesia
Halothane-respiratory and cardiovascular depression-monitor VS, open IV site-ABC’s prevent aspiration
Nitrous Oxide- Hypotension and nausea and vomiting- adequate O2
IV thiopental Na- decreased BP , respiratory depression, laryngospasm- ABC
spinal and saddle – hypotension and HA- increased OFI
conduction block/epidural block- hypotension and respiratory depression-HA not experienced
local – excitability and hypersensitivity;no epinephrine on fingers
STAGES OF ANESTHESIA
STAGE 1. BEGINNING ANESTHESIA,
analgesia, sedation and relaxation
warmth, dizziness, feeling of
detachment
ringing, roaring, buzzing in ears
aware of being unable to move the
extremities noises are exaggerated
STAGE 2. EXCITEMENT, DELIRIUM
struggling, shouting, talking, singing,
laughing, crying – decreased if
anesthesia is given quickly and
smoothly
pupil dilates but constricts if with light
PR rapid, RR irregular
Vomiting
Restraining
STAGE 3. SURGICAL ANESTHESIA,
OPERATIVE ANESTHESIA
unconscious
pupils – small but reactive
RR irregular, PR normal
Skin – pink, flushed
No hearing
STAGE 4. MEDULLARY
DEPRESSION, DANGER
if anesthesia is too much
RR shallow
Pulse weak, thready
Pupils – widely dilated, non reactive
Cyanosis death
SPINAL SET
NITROUS OXIDE TANK
OR gowns and surgical
equipment
Suture
medical device use to hold skin, internal
organs, blood vessels and all other
tissues of the human body together
after they have been severed by injury,
incision or surgery.
Assessment of the suture line:
Stitched too tight or too loose
Too many or too few stitches
Suture holes not equidistant for the edges so
that the bite is not uneven, or uneven spacing
between sutures
Inversion or eversion of tissue edges
Edges of tissue overlapping and heaped on
each other.
Types of stitch:
Simple interrupted suture
Inserted singly through each side of the
wound and tied with a surgeon’s knot. Several
of these may be used at short intervals ( 4—
8mm apart) to close large wounds and share
tension. Easy to keep clean, can be replaced
singly and will evert edges of the flap.
Horizontal mattress suture
Evert the mucosal or skin margins,
thereby bringing greater areas of raw
tissue into contact. Useful for closing
wounds over bony deficiencies such as
oro-antral fistulae or cyst cavities.
Vertical mattress suture
Specially designed for use in the skin.
Pass through at two levels:
(i) Deep—provides
support and adduction of wound surface
(ii) Superficial—draw
edges together and evert them
Vertical Mattress is a suture technique
most commonly used in anatomic
locations which tend to invert, such as
the posterior aspect of the neck or the
palm of the hand.
This type of suture is good for deep
lacerations, instead of combining two
layers of deep and superficial sutures.
Continuous suture
Disadvantaged that if they cut out at
one point the whole suture will slacken.
Advantage—only two knots present.
¨ Simple continuous— applies pull on
the wound obliquely
¨ Continuous blanket stitch—more firm
and stable. Gives traction on the wound
edges at right angles to the wound
¨ Purse string suture—useful as a deep
suture for wounds of the skin of the
face.
Suture sizes:
defined by the United States
Pharmacopeia (U.S.P.).
Sutures were originally manufactured
ranging in size from #1 to #6, with #1
being the smallest.
Modern sutures range from #5 (heavy
braided suture for orthopedics) to #11-0
(fine monofilament suture for
ophthalmics).
Types of Suture Material
Plain catgut
Absorbable biological suture material.
taken from bovine intestines.
absorbed by enzymatic degradation.
Chromic
Absorbable biological suture material.
taken from bovine intestines.
offers roughly twice the stitch-holding time of
plain catgut.
absorbed by enzymatic degradation.
Note – catgut is no longer used in the UK for
human surgery.
Polyglycolic acid (P.G.A.)
Synthetic absorbable suture material.
thread extremely smooth, soft and knot safe.
Polydioxanone (PDS)
Synthetic absorbable suture material.
Indication
Plain catgut Chromic Polyglycolic
acid (P.G.A.)
Polydioxanone
(PDS)
-all surgical
procedures
- for tissues
regenerating
faster are
involved.
- General
closure,
ophthalmic,
orthopedics,
obstetrics/gyne
, GI
-all surgical
procedures
- for
tissues that
regenerate
faster.
Subcutaneou
s,
intracutaneo
us closures,
abdominal
and thoracic
surgeries
- combination of
an absorbable
suture
- extended
wound support
is desirable,
pediatric
cardiovascular
surgery,
ophthalmic
surgery
Removal of Sutures
facial wounds 3–5 days
scalp wound 7–10 days
trunk of the body 7–10 days.
limbs 10–14 days
joints 14 days
Others…. Tissue adhesives
topical cyanoacrylate adhesives ("liquid
stitches"), combination or alternative to, sutures
in wound closure.
adhesive is liquid exposed to water/water-
containing substances/tissue cures
(polymerizes) forms a flexible film that bonds
to the underlying surface.
act as a barrier to microbial penetration as long
as the adhesive film remains intact.
Contraindications: near eyes and a mild
learning curve on correct usage.
Antimicrobial sutures
sutures coated with antimicrobial
substances to reduce the chances of wound
infection.
INTRAOP COMPLICATIONS
Nausea and Vomiting
Hypoxia, respiratory complications
Hypothermia (below 36.6)
d/t room temperature, cold fluids, cold
gases, open body, wound, cavities, dec.
muscle activity, age, drugs
Check: core temp, u/o, ECG, BP, ABC,
electrolytes
Malignant Hyperthermia
d/t anesthetic agents, muscle relaxants,
syphatomimetics, theo/aminophylline,
anticholinergic, cardiac glycosides
Risks: bulky, strong muscles, muscle cramps,
weakness
CM: tachycardia, SNS stimulation
(vent.dysrhythmias, hypotension, dec CO, oliguria,
cardiac arrest, tetany-like movements, increased
temperature 1 degree every 15 minutes
Mgt: critical assessment 10-20 mins post induction
or 24 hrs postop; stop anesthesia, surgery; 100%
oxygen; DANTROLENE Na – muscle relaxant,
NaHCO3
POSTOPERATIVE PHASE
begins with the admission of the client
to the PACU and ends when healing is
complete
PHASE I – Immediate postoperative care,
intensive nursing care
PHASE II – Ongoing postoperative care
Step down, Sit up or Progressive Care Unit
– 4-6 hours
NURSING RESPONSIBILITIES
ASSESSMENT
Respiratory Status
Airway patency, O2 sat, Effectiveness of ventilation
Cardiovascular Status
BP, All pulses, Color, skin temp, edema , Urine
output
CNS
LOC, Orientation, Reflexes, Ability to move
extremities
Fluid Status
IVF, Urine output, Wound drainage, Drainage from
catheters, tubes and drains, Skin turgor, edema, VS
Status of wound
Dressing and drainage
Pain
Nausea and Vomiting
Keep all lines patent
Assure that monitors and equipments are
functioning
Positioning
Help arouse and orient the client
Facilitate oxygenation
Treat hypotension
Provide for safety AND comfort
Readiness for Discharge from PACU
uncompromised pulmonary function
pulse oximetry ok
stable VS
oriented
U/O > 30cc/hr
N/V under control
Minimal pain
SURGICAL WARD
postop bed
1st hours
Assess and manage ventilation
Hypoventilation
Atelectasis
Pneumonia
PE : IPPA
Breathing, coughing (except intracranial
surgery. IOP, plastic surgery)
CPT
Incentive spirometry
Assess and Manage Hemodynamic
stability
Shock and hemorrhage
WOF dec BP 90 mmHg, dec, 5 mmHg q
15mins
IVF
FVE
I&O
Venous stasis – d/t dehydration,
immobility, pressure on legs DVT
(Homan’s sign, pain swelling on calf, fever,
chills, diaphoresis) = leg exercises,
antiembolism stocking, early ambulation,
low dose heparin
Assess and Manage the Surgical Site
WOF bleeding, dressing, drains
Hematoma
Infection after 5 days, wound dehiscence
and evisceration
Assess and Manage Pain
Maintain body temperature
Assess Mental status and NVS
LOC, speech, orientation
Assess GI function
N/V, hiccups, NGT, Antiemetics,
phenothiazine
Liquid - clear liquid soft solid food
Assess and manage voluntary voiding
Urinary retention
Void within 8 hours post surgery non
catheter interventions catheter
Encourage Activity
Early ambulation
Bed exercises
Maintain safe environment
Provide emotional support to the patient
and family
POST-OPERATIVE COMPLICATIONS
SHOCK
PARALYTIC ILEUS
ATELECTASIS AND PNEUMONIA - 2ND DAY
EMBOLISM- 2ND DAY
WOUND INFECTION-3-5D
DEHISCENCE AND EVISCERATION-5-6D
PSYCHOSIS
CARDIOVASCULAR COMPROMISE
URINARY RETENTION-8-12H
URINARY INFECTION -5-8 D
DVT-6-14 DAYS-1 YEAR
POST-OPERATIVE CARE
POST OP- MONITOR VS
Q15X4;Q30X2;Q1HX2 THEN PRN
MONITOR I AND O , K LEVEL , CVP, BOWEL SOUNDS, BREATH SOUNDS AND LOC
RESPIRATORY PHYSIOTHERAPY,TCBD
INCENTIVE SPIROMETRY-20 SECS INHALATION
ENCOURAGE AMBULATION
REFER IF UNABLE TO VOID IN 8 HOURS
APPLY TED HOSE AND PNEUMATIC COMPRESSION DEVICE,CHECK FOR HOMAN’S SIGN
Wound Care
DRESSINGS
PROTECT FROM INJURY , BACTERIAL CONTAMINATION
PROVIDE HUMIDITY
INSULATION
ABSORB DRAINAGE
DEBRIDE THE WOUND
PREVENT HEMORRHAGE
SPLINT / IMMOBILIZE
COMFORT
GUAZE, SYNTHETIC , SECURING, TEGADERM
TYPES OF DRESSINGS
DRY TO DRY – TRAP NECROTIC DEBRIS AND EXUDATE
WET TO DRY ( SALINE AND ANTI MICROBIAL SOLUTION – SOFTEN DEBRIS AS IT DRIES, DILUTE EXUDATE
WET TO DAMP – WOUND DEBRIDED IF GAUZE REMOVED( VARIATION @ DRYING)
WET TO WET – KEEP MOIST – WOUND BATHED – MOISTURE DILUTES VISCIOUS EXUDATE
pressure ulcer dressings
dry gauze stage II-IV
tegaderm film/ hydrocolloid – SI - SII
Absorptive Dressing III
Hydrogel – II - III
SURGICAL DRAINS
PENROSE – OPEN ENDS
CLOSED WOUND DRAINAGE ( SUCTION) –
DECREASE ENTRY OF MICROBES-
HEMOVAC / JACK PRATT TO RESERVOIR
D/C 3-7 DAYS POST – OP
penrose
hemovac
Jackson prat
Thank you very much!
God Bless!