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?

[Altra, BSN, RN]

It was definitely a saline bag, I could tell

By the lettering. A surgeon came and removed the staples and the bag and the patient was discharged several days later. The attending at the time did not seem half as alarmed as I was which made me think there had to be a reason for it.

I suppose the pt could have done it himself but I have no idea where he could have gotten the supplies. He also seemed like a pretty 'normal' person for lack of a better word. Very grateful, compliant and realistic.

I hope to never see something like that again. Looked careless, painful and inhumane

Did you ask the not-alarmed attending what the rationale was? Or are you content to just conclude that it's "inhumane" without getting any additional contextual information?

[mmc51264, BSN, MSN, RN]

They regularly stable adaptic and xeroform to graft sites for flap donor sites. Doesn't seem out of the realm of possibility. I'd be kinda weird to see the lettering LOL

[cardiacfreak, ADN]

I've seen this done for surgical wounds as well as for weeping edema (without the staples). It works particularly well for weeping edema since the tubing port can used as a drain port.

I work on a Progressive Care Unit and see quite a bit of weeping edema, can you elaborate on this, it seems better than just changing pads and sheets all night long.

[Wile E Coyote, ASN, RN]

When they have to stop a CABG surgery and bring the patient back to the ICU with the chest still open to be stabilized they come with cup open bags of saline covering their open chests. Is a common practice.

x2...forgot about seeing it used in this instance as well.

[MunoRN, RN]

I work on a Progressive Care Unit and see quite a bit of weeping edema, can you elaborate on this, it seems better than just changing pads and sheets all night long.

It's basically the same idea as using a ostomy wafer/bag or external flexiseal to catch weeping drainage, but it can be used on a larger area. If the weeping edema isn't more concentrated in one particular area, none of these will work, but in cases where it's mainly draining from a specific part of the lower leg you can capture the drainage.

With an NS bag, what I've seen is that they cut off half the bag, except they leave the very bottom as two sided to create a pocket, then use the tubing port attach a drain. They used duoderm where the edges would be taped to protect against the cut edges of the bag, then taped the bag. They do leak eventually, but it's better than uncontrolled drainage, such as patients who saturate a couple diapers on each leg every half an hour.

[cardiorn2687]

Did you ask the not-alarmed attending what the rationale was? Or are you content to just conclude that it's "inhumane" without getting any additional contextual information?

I did and he had no answer either

[UnbrokenRN09, BSN]

The inside is sterile, and it would seem to me that it more or less makes a wet to dry dressing to keep the graft moist and keep anything from getting stuck to it since it's not a porous/absorbant material. The staples seem a bit harsh, perhaps maybe a few sutures in key places would have worked along with some tape of some sort. I do cardiac, so I'm out of the loop on skin grafts, but these are just my thoughts. I do know that people who have abdominal surgeries sometimes have so much swelling that their internal organs can not fit back inside the abdominal cavity well enough to close the incision without causing compartment syndrome, so they use saline bags as "skin" extensions to form a barrier until the swelling goes down enough for the incision to be closed. I'm sure whoever did this probably had the same concept in mind.....whether this is "best practice" or not can't really say....

[Esme12, ASN, BSN, RN]

The inside is sterile, and it would seem to me that it more or less makes a wet to dry dressing to keep the graft moist and keep anything from getting stuck to it since it's not a porous/absorbant material. The staples seem a bit harsh, perhaps maybe a few sutures in key places would have worked along with some tape of some sort. I do cardiac, so I'm out of the loop on skin grafts, but these are just my thoughts. I do know that people who have abdominal surgeries sometimes have so much swelling that their internal organs can not fit back inside the abdominal cavity well enough to close the incision without causing compartment syndrome, so they use saline bags as "skin" extensions to form a barrier until the swelling goes down enough for the incision to be closed. I'm sure whoever did this probably had the same concept in mind.....whether this is "best practice" or not can't really say....

Wow....

IN 35 years of nursing I have seen open chests and abdominal wounds covered with "mesh" and big tegaderm like drsgs.....I have never seen saline bags.

[UnbrokenRN09, BSN]

Medscape: Medscape Access

It's called the IV bag technique. In this case the big 3L irrigation bags are used.

[LadyFree28, BSN, LPN, RN]

Medscape: Medscape Access It's called the IV bag technique. In this case the big 3L irrigation bags are used.

Wow; great information...you NEVER stop learning in this business.

[lamazeteacher]

Hopefully the ICN was informed and able to do the investigative work necessary to explain this. She/he has the time and incentive to call the former physician and find out his/her rationale. A teaching conference might be arranged that explains what that is, so medical and nursing staff have information from the source of the concern. This would be a great opportunity for interfacing with IC and developing a coordinated plan of care.

[AMN74]

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.