Paediatrics: Post-operative care: drains and wounds

Post-operative care: drains and wounds

Chest drain removal

An adult can be asked to suspend respiration in full inspiration before removal of a chest drain. Children will not co-operate with this.

• The best strategy is to remove the drain quickly. Then cover the site with an air-tight transparent dressing (e.g. Tegaderm™).

• The dressing should remain undisturbed for 48hr after which time the wound can be left open.

• Purse-string sutures are painful and not necessary.

• It is not necessary to take a chest radiograph immediately after the drain has been removed provided the child is clinically well.

Wound care

Routine closure of skin wounds in children is by subcuticular suture. The suture runs along below the surface of the wound and provides a neat and water-tight closure. Invariably an absorbable suture is used (e.g. Vicrylâ„¢ or PDSâ„¢).

• Dressings are a matter for individual preference. If dressings are used it is wise to keep the wound dry until the dressing is removed.

• If no dressing is used, then keep the wound dry for 24–48hr.

• The appearance of clean surgical wounds should improve progressively each day after surgery.

• Parents should be asked to report increasing redness or tenderness so that the wound can be reviewed.

Advice after discharge from hospital

Parents should be given clear simple advice before discharge from hospi-tal regarding analgesia, wound care, and post-operative follow-up. Ideally, written information should also be provided.

• Following minor day case: children will generally be back to normal within 24hr. They should be kept off school for 2–3 days and be excused sports activities for 14 days. Routine follow-up of children has now been abandoned by most surgeons. This is, however, a matter of personal preference.

Convalescence following major surgery: specific advice relating to return to school and resumption of sporting activity depends on the operation.