03.03 Surgical Incisions & Drain Sites

Ok guys I also want you to know with laparoscopic procedures you are going to see much smaller incisions but there will be more than one!  So if you are working as a PACU RN and you know your patient just had a laparoscopic surgery it would be appropriate to ask the perioperative nurse how many incisions the patient has and where they are located because this will vary with laparoscopic surgeries! So now that we’ve talked about incisions let's talk about drains because they are very common with surgical patients!  So drains have an important purpose by helping to prevent deep wound infections by evacuating the site of things like blood, fluids, air, and bile which helps to promote the healing process.  Drains are typically inserted during surgery by the provider.

The  choice of the drain depends on the patients activity, their healing capabilities, and the actual surgery.  Guys with some surgeries no matter the patient specifics the surgeon routinely inserts a drain simply because of the type of surgery.  

So there are various drain types that exist one of those being closed systems which basically means that the drain utilizes suction.  An example of a closed suction drain is a Jackson-Pratt or JP which has a drain connected to a bulb as you see here in the picture. There are various brand names so just be aware of that!  So to “activate” the suction the empty bulb would be squeezed to remove air and then connected to the drain which has been surgically inserted into the patient.

An open system is another drain type which simply uses capillary action or gravity to drain the surgical wound.  An example of this is a penrose drain which you can see here in this picture. The penrose is inserted and then covered with a dressing so that it drains into the dressing.

So there are definitely advantages and disadvantages to drains, so I already mentioned that an advantage is the removal of substances from the wound to promote healing but it can also in the postoperative period help to signal to the PACU RN any signs of hemorrhage.  Be sure to check out the lesson on postoperative complications! But guys the disadvantage of wounds is the possibility of entry and exit of infectious organisms. So the RN’s role in drains to closely monitor the site and volume as well as teach the patient how to care for not only the drain but also the incision site to prevent contamination and infection based on the provider’s instructions! Ok guys so which nursing concepts can we apply to surgical incisions and drain sites?  Obviously as nurses one of our goals is to prevent infection as we help our patients care for their new incision and drain to also provide comfort and tissue and skin integrity!

Ok guys lets look at some key points!  A surgical incision is used to expose an area for surgery.  There are various types of incisions utilized for the best exposure.  Different types of incisions include collar for thyroid surgery, median sternotomy for cardiothoracic procedures, and thoracotomy which is an incision between the ribs, abdominal incisions can be vertical, midline or paramedian, oblique incisions like the Mcburney used for appendectomy, and the pelvis incisions like the suprapubic for pelvic surgeries. Drains promote healing by evacuate the site, they are inserted during surgery, the type is chosen by the surgeon, and the type depends on patient healing, activity, and specific to the surgery.  Drains are typically either closed system which utilizes suction or open system which utilizes capillary action and gravity. Finally the RN should document the incision location and drain type and location as well as monitor the amount and drainage appearance. Okay guys I hope you enjoyed tis lesso on surgical incisions and drain sites! Make sure you check out all the resources attached to this lesson, as well as the rest of the lessons in this course! Now, go out and be your best self today. And, as always, happy nursing!