What are the post-operative wound care instructions for a patient after right hip pinning?

Post-Operative Wound Care Instructions for Right Hip Pinning

After hip pinning surgery, proper wound care is essential to prevent infection, promote healing, and ensure optimal recovery. The wound should be kept clean and dry with minimal dressing changes for the first 48 hours, followed by regular monitoring for signs of infection.

Immediate Post-Operative Care (First 48 Hours)

• Keep the surgical dressing intact for the first 48 hours unless there is excessive bleeding or drainage 1
• Maintain supplemental oxygen for at least 24 hours post-operatively to prevent hypoxia 1
• Monitor the wound for signs of infection (redness, swelling, increased pain, warmth, drainage)
• Ensure adequate pain management with regular paracetamol, supplemented by carefully prescribed opioids as needed 1
  • Avoid non-steroidal anti-inflammatory drugs in patients with renal dysfunction
  • Use opioids with caution in renal dysfunction patients (reduce dose and frequency)

Dressing Management

• After 48 hours, the surgical dressing may be removed as early dressing removal appears to have no detrimental effect on outcomes 2
• If dressing change is required due to saturation or contamination:
  • Use clean technique when changing dressings
  • Consider using a transparent, occlusive dressing like Mepilex Border Post-Op which has shown good exudate management and reduced surgical site infections 3
• Avoid excessive dressing changes as they may increase the risk of contamination 1

Wound Cleansing and Bathing

• Keep the wound clean and dry
• Early post-operative bathing or showering should consider:
  • The quality of water
  • The type of wound closure (primary/secondary) 1
• If showering is permitted, gently pat the wound dry afterward - do not rub

Thromboprophylaxis Management

• Continue prescribed thromboprophylaxis as directed
• For hip fracture patients, low molecular weight heparin is recommended for up to 35 days post-surgery 4
• Typical dosing for LMWH:
  • Enoxaparin 30 mg subcutaneously twice daily or 40 mg once daily 4
  • Start 12-24 hours after surgery and continue for at least 10-14 days 4

Mobilization and Activity

• Follow the physical therapist's instructions for weight-bearing and mobility restrictions
• Early mobilization helps improve respiratory function and reduces the risk of thromboembolism 1
• Use assistive devices (walker, crutches) as instructed

Signs of Complications to Monitor

• Wound infection: Increasing pain, redness, swelling, warmth, purulent drainage
• Deep vein thrombosis: Calf pain, swelling, warmth
• Pulmonary embolism: Shortness of breath, chest pain, rapid heart rate
• Bone cement implantation syndrome: Hypoxia, hypotension, or loss of consciousness (rare but serious) 1

Follow-up Care

• Attend all scheduled follow-up appointments
• Report any concerns about the wound immediately
• Continue nutritional support as malnutrition can impair wound healing 1

Special Considerations

• For patients with external fixation pins, implement general strategies to reduce cross-infection at pin sites 1
• Remove urinary catheters as soon as possible to reduce the risk of urinary tract infection 1
• Monitor for postoperative cognitive dysfunction, which is common (25%) in hip fracture patients 1

By following these instructions carefully, you can help ensure proper healing of your surgical wound and reduce the risk of complications following hip pinning surgery.