Developing an evidence-based nursing protocol on wound drain management for total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Nursing Care
• Evidence-Based Practice

Background:

• Limited evidence exists on the benefits of drains in total joint replacement.
• Practices for wound drainage management, including suction and removal timing, are inconsistent.

Purpose of the Study:

• To conduct a systematic review to develop an evidence-based nursing protocol for wound drainage management following total joint arthroplasty.

Main Methods:

• A comprehensive systematic review of literature up to 2013 was performed.
• Searches included EMBASE, Cochrane library, CINAHL, Medline, and internet engines.
• 11 relevant studies were identified from 2840 records, with 2 additional papers from reference lists.

Main Results:

• A protocol for suction drain clamping was adapted: 1 hour post-operatively, or for 1 hour if blood loss exceeds 600ml/6h (first 24h) or 800ml/8h (thereafter).
• Drainage measurement and recording every 6-8 hours is recommended.
• Wound drains should be removed within 48 hours post-total joint replacement (TJR), or sooner if blood loss is minimal ( <50ml/6h or <70ml/8h).

Conclusions:

• This paper offers guidance for nurses to develop an evidence-based protocol for wound drain management.
• Further research is needed to assess the protocol's effectiveness in improving patient care.