Question about wound care

[blondiii]

Hi nurses,

Last Friday my brother-in-law had a colectomy (the surgeon removed @12 inches) due to scaring and stricture of his colon from radiation therapy he had about 20 years ago. He has no colostomy bag. He was ICU until Monday. Also on Monday the bandage was removed from the incision line. There was no drainage from the wound on Tuesday, when I visited him. However today there was some seepage, which dripped when he walked around the halls. He also has a tendency to touch the incision line, like a fascination with it. I am an LPN, not an RN and not much experience with wound care, other than during my clinicals. None of the staff pays much attention to the clear drainage, but don't you agree it should be covered with a bandage?

[mamason]

Maybe the doc wrote an order of some sort to leave the incision open to air?

[colleennurse, ASN, RN]

I was thinking the same thing as mamasan. But if it is draining fluid, it must not be completely closed, and if he is touching it, I would think it is a potential for infection. Maybe you could ask his nurse and tell him/her that he can't stop touching it. Maybe they can tell you why he has no dressing on it, or maybe they can put something over it to stop him from touching it.

[Antikigirl, ASN, RN]

I would call the surgeon and ask if this is what is expected. I know gravity once mobile does tend to seep...but how much is normal to the surgeons comfort level, and what about the patients comfort level? Call the surgeon and ask...you can even leave a message with their office for a call back!

Don't call the PCP...ask the surgeon directly..it is their tallent that performed the surgery and they are very picky (and rightfully so!) about the condition post op...please call and let them know! They will have advice or other information that can help feel at ease! Trust me (I work with surgeons all day and have to call them!).

[ktwlpn, LPN]

I would think a dry sterile dressing would be appropriate for infection control if he is dripping in the halls.I'm sure he is loaded up with antibiotics at this point..But I don't think it is your place to call anyone about it unless he is somehow mentally incapacitated and you are his care giver. If it continues to be a problem upon discharge he should certainly make sure he understands his discharge instructions...

[blondiii]

Thanks! I will have my sister call his surgeon.

[TazziRN, RN]

Another thought: if it needs to be open to the air, a folded 4x4 or some other padding can be taped to the skin below the incision so that the drainage drips onto that instead of everywhere else.

[mamason]

Another thought: if it needs to be open to the air, a folded 4x4 or some other padding can be taped to the skin below the incision so that the drainage drips onto that instead of everywhere else.

Yes, that would probably be beneficial. I would also be concerned about the infection risk since the pt can't leave his hands off the site. A quick call to the doc could solve the problem I think.

[Jay-Jay, RN]

Lots of experience with infected postop belly wounds...#1 indicator of infection is wound begins to seep. I think that is one reason the surgeons don't ask for dressings on them after first couple of days, because it makes it easier to observe for seepeage.

The chances of infection happeining by your brother touching it are poor to nil. Surgical wounds get infected from the INSIDE...whatever got in there during the surgery. And with pieces of bowel being removed, the potential for infection is quite high.

At this point he should have DSD on it, as the material dripping out of the incision may be loaded with bacteria, which you don't want to spread around the hallways!

[mamason]

Lots of experience with infected postop belly wounds...#1 indicator of infection is wound begins to seep. I think that is one reason the surgeons don't ask for dressings on them after first couple of days, because it makes it easier to observe for seepeage.

The chances of infection happeining by your brother touching it are poor to nil. Surgical wounds get infected from the INSIDE...whatever got in there during the surgery. And with pieces of bowel being removed, the potential for infection is quite high.

At this point he should have DSD on it, as the material dripping out of the incision may be loaded with bacteria, which you don't want to spread around the hallways!

Thanks for the clarification. I don't have much experience with post op abdominal incisions. But, your analogy makes sense.

[meownsmile, BSN, RN]

The above rational may be right IF there were NO active drainage. But with active drainage it means there is an area that the tissues have not sealed and the serrous fluids trying to net the tissue together are draining to the outside. You dont have to have a bug introduced DURING the surgery to get an infection when active drainage is present. Incisional abcesses usually dont come from the abdominal cavity out. It is usually because there was a area not healing or that hadnt sealed and the bug was introduced via someones hands. There is a reason handwashing is one of the most important ways to PREVENT spread.

That said,, he needs to at least keep a dry dressing over the incision until there is no more active drainage. Not only will it contain the drainage and exposure of anyone else to his body fluids,, it will keep him from "fingering" the incision with hands that he has also touched the toilet lever, faucet controls, hallway rails, countertops etc etc with that may be loaded with MRSA from another patient.

[Jay-Jay, RN]

Of course, if wound is open, he should not be touching it. But most surgical wounds are completely scabbed over and sealed by the time the dressing is removed, therefore little if any risk of bugs getting in.