Surgical Incisions & Drain Sites
Included In This Lesson
Study Tools For Surgical Incisions & Drain Sites
Outline
Overview
- Surgical incisions
- Cut made to facilitate surgery
- Types
- Head and neck
- Wilde’s
- Postaural incision
- Mastoiditis
- Postaural incision
- Collar
- Horizontal incision
- Above collar bones
- Thyroidectomy
- Horizontal incision
- Wilde’s
- Chest
- Median sternotomy
- Vertical incision along sternum
- Cardiothoracic procedures
- Vertical incision along sternum
- Thoracotomy
- Incision between ribs
- Lobectomy
- Incision between ribs
- Inframammary
- Incision beneath breast fold
- Breast procedures
- Augmentation
- Reduction
- Mastectomy
- Breast procedures
- Incision beneath breast fold
- Infra-aerolar
- Incision around areola
- Breast procedures
- Duct resection
- Breast procedures
- Incision around areola
- Supraclavicular
- Incision above collar bone
- Lymph node excision
- Incision above collar bone
- Median sternotomy
- Abdomen and pelvis
- Vertical
- Fast entry into abdomen
- Midline
- Above umbilicus
- Straight down around umbilicus
- Exploratory laparotomy
- Above umbilicus
- Paramedian
- Lateral to the midline area
- Oblique
- Pubic tubercle to
- Anterior iliac crest
- McBurney
- Muscle-splitting incision
- Appendectomy
- Subcostal (Kocher)
- Below xiphoid process
- Extends laterally
- Right subcostal
- Gallbladder
- Biliary system
- Pancreas
- Left subcostal
- Spleen
- Below xiphoid process
- Thoracoabdominal
- Joins thoracic and abdominal cavities
- Extending midline incision
- to posterolateral direction
- Provides exposure
- Esophagus
- Liver
- Spleen
- Kidneys
- Lungs
- Right side
- Inferior vena cava
- Left side
- Superior vena cava
- Pubic tubercle to
- Transverse
- Suprapubic
- Above symphysis pubis
- Pelvic surgery
- Above symphysis pubis
- Suprapubic
- Vertical
- Laparoscopic
- Small incisions
- Multiple
- Procedures
- Laparoscopic
- Cholecystectomy
- Hernia
- Gynecololgical
- Laparoscopic
- Head and neck
Nursing Points
General
.
Assessment
- Drains
- Evacuation from operative site
- Air
- Blood
- Fluid
- Bile
- Prevent
- Deep wound infections
- Evacuation from operative site
- Inserted
- During surgery
- Choice of drain
- Depends on patient
- Activity
- Healing capability
- Surgery
- Depends on patient
- Types of drains
- Closed system
- Utilize suction
- Examples
- Jackson-Pratt
- Hemovac
- Chest tube
- Jackson-Pratt
- Open systems
- Capillary action
- Gravity
- Examples
- T-tube
- Penrose
- Closed system
- Drain materials
- Latex
- Polyvinyl Chloride (PVC)
- Silicone
- Silver coated
- Advantages
- Removal of wound collection
- Signals postop hemorrhage
- Disadvantages
- Entry and exit
- Infectious organisms
- Entry and exit
Therapeutic Management
- Documentation
- Incision and drain
- Location
- Type
- Incision and drain
- Monitor
- Drainage
- Amount
- Type
- Serous
- Serosanguineous
- Sanguineous
- Purulent
- Drainage
Nursing Concepts
- Comfort
- Infection control
- Tissue/skin integrity
Patient Education
- Teach patient
- Care for drains and incisions
- Prevent contamination
- Ask questions!
Transcript
Hi guys! Today I am going to talk to you a little about surgical incisions and drain sites!
Ok guys so a surgical incision is a cut that is made by the surgeon to provide exposure of the area that needs to be operated on. There are various types of incisions to the different areas on the body and we are going to talk about a few of those in the upcoming slides! In this picture here you can see different incisions in the head, neck, chest, and abdominal area.
Ok let’s look at a few head and neck incisions. Wilde’s incision is made in the postaural area which is basically behind the ear and is typically used to surgically treat mastoiditis. Another surgical incision is the collar incision which is used for thyroidectomies and is a horizontal incision that is typically midline in the neck area but above the collar bones.
Ok guys there are a bunch of chest incisions that are used for various procedures. In the picture you can see a median sternotomy incision which presents as a vertical incision along the sternum which is used for cardiothoracic procedures. A thoracotomy incision is between the ribs and is often used for lobectomies of the lungs. Guys an inframammary incision is going to be beneath the breast fold and we use this a lot for breast procedures like augmentations, breast reductions, and mastectomies. The infra-areolar incision is made around the areola of the breast and is also used for breast procedures like duct resections and gynecomastia.
Ok let’s take a look at common incisions of the abdomen! So abdominal incisions are completed in various ways and directions. Vertical incisions are common as they provide fast entry into the abdomen and can be midline or paramedian. Midline incisions start above the umbilicus and extend straight down but down but don’t go through the umbilicus but around it. Paramedian incisions are also vertical but they are lateral to either side of midline.
Abdominal incisions can also be oblique in nature meaning they start at the pubic tubercle and extend to the anterior iliac crest. The McBurney incision is an example of this as it is a muscle-splitting incision that is often used or open appendectomy procedures. The subcostal or Kocher incision is a little higher oblique incision as it starts below the xiphoid process and extends laterally. We would use a right subcostal incision for open gallbladder, biliary, and pancreas procedures and a left subcostal incision for procedures involving the spleen.
Ok guys so a suprapubic incision is a transverse incision that occurs above the symphysis pubis sometimes it’s called the “bikini line” incision. This incision is used often for pelvic surgeries including c-sections and you can see this here in the picture!
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!
Tiona RN
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