Therapeutic rationale for saline bag stapled to pt's leg?!?

[cardiorn2687]

A few weeks ago I had a young patient admitted for an infected upper thigh wound which occurred after the patient had jumped over a fence and cut himself. The injury was quite serious and required a skin graft that was placed at an outside hospital. After the graft was placed, the physician cut up a saline bag (just like the ones we used to administer a regular old 1 L bag of 0.9NS)and stapled it to the patients leg! No other dressing, just the stapled plastic bag. The patient later left AMA and came to our facility for further management. There must have been some therapeutic reason for stapling the bag to the patient's leg (Maybe for the wound to retain moisture to heal?) but it looked inhumane and like some crazy hackjob! Any thoughts fellow nurses?

[PMFB-RN, RN]

As an old home health nurse, I had a patient that had an abdominal wound dehiss right in front of my eyes. She was sitting in her chair and went to stand up and her wound opened, blood pouring and insides falling out. She had an IV dripping and I quickly cut the bag placed it over the wound and then got saran wrap and covered over it. I wanted something sterile touching the wound. Then I called her MD and had 911 on the way. Sometimes you have to do what you have to do.

*** NICE! Good work.

[Anna Flaxis, BSN, RN]

Bogota bag

[Esme12, ASN, BSN, RN]

Bogota bag

Well I'll be.....learn something every day!.......

A Bogota bag is a sterile plastic bag used for closure of abdominal wounds^. It is generally a sterilized, 3 litre genitourinary irrigation bag that is sewn to the skin or fascia of the anterior abdominal wall. Its use was first described by Oswaldo Borraez while a resident in Bogota, Colombia.

Temporary abdominal closure techniques are used to postpone definite closure until predisposing factors causing pathologic elevation of intra abdominal pressure are resolved. These techniques include the Bogota bag, absorbable mesh, vacuum pack dressings, the Wittmann patch or velcro burr and the KCI VAC or Abthera dressings.

These temporary abdominal closure techniques are most commonly used in cases of abdominal compartment syndrome in which decompressive laparotomy is necessary to reduce intra abdominal pressure to restore system perfusion.

Regardless of the technique used, they are characterized by a tension free closure. In addition, the Bogota bag acts as a hermetic barrier that avoids evisceration and loss of fluids. Another advantage to the Bogota bag, is that the abdominal contents can be visually inspected which is particularly useful in cases of ischemic bowel.

The bogota bag can be used in cases of 'burst abdomen' following laparotomies, especially those using a midline horizontal incision. Burst abdomen is usually characterized by a serosanguinous pink discharge from the wound, 6–8 days after surgery

One alternative to the Bogota bag temporarily abdominal closure is the artificial burr temporary abdominal closure (a.k.a. Wittmann Patch). The artificial burr closure adds continuous tension on the fascial edges as a benefit to those of the Bogota bag.

An alternative is to apply sterile towels over the silo and to secure them with a Montgomery abdominal wound binder, being careful not to create increased abdominal pressure while securing the dressing. The wound is inspected and the dressing is changed every 24 hours (or as needed). Intravenous (IV)/cystoscopy bag silos may be replaced in the ICU setting using standard sterile surgical technique and equipment. This technique is a variation of the silon (silo) closure used for the repair of gastroschisis and omphalocele. In hospitals in Colombia, South America, IV bag closure (also known as the Bogotá Bag) has been used extensively and successfully. See the images below.

Presterilized (gas), 3-L, cystoscopy irrigation bag.

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