How to manage a dislodged medical device post C-section?

Management of a Dislodged Bellovac Drain After C-Section

When a Bellovac drain becomes dislodged after a C-section, immediate assessment and management are required to prevent complications such as infection, bleeding, or fluid collection. Apply direct pressure to the drain site for at least 5 minutes, then cover with an occlusive dressing after bleeding has stopped. 1

Immediate Management

• Position the patient flat with the exit site below heart level to reduce risk of air embolism 1
• Apply firm digital pressure at the exit site for at least 5 minutes to control bleeding 1
• Once bleeding has stopped, apply an occlusive sterile dressing over the site 1
• Monitor vital signs including temperature, pulse, blood pressure, and respiratory rate every 4 hours 1
• Assess the wound for signs of infection, hematoma formation, or dehiscence 2

Assessment for Complications

Air Embolism

• Monitor for respiratory distress, chest pain, hypotension, altered mental status, and neurological changes 1, 3
• If symptoms of air embolism are present, place patient in left lateral decubitus position with head down (Trendelenburg) and administer oxygen 1
• Air embolism is a rare but serious complication with an incidence of approximately 0.5% during central line procedures 3

Bleeding and Hematoma

• Evaluate for persistent bleeding from the exit site 1
• Hematoma within the wound has been identified as a risk factor for surgical site infection 2
• If hematoma forms, evacuation should only be performed when there is increased tension on the skin 2
• Needle aspiration should be avoided because of the risk of introducing skin flora into the wound 2

Infection

• Monitor for signs of infection at the exit site (redness, swelling, purulent discharge) 1, 4
• If exudate is present, obtain a swab for culture and Gram staining 1
• Monitor for systemic signs of infection (fever, chills, hypotension) 1
• Surgical site infections after C-section can occur at rates of up to 13.5% 5

Wound Management Options

Standard Dressing Care

• Use either sterile gauze or sterile, transparent, semi-permeable dressing to cover the site 6
• Replace gauze dressings every 2 days and transparent dressings at least every 7 days 6
• Any dressing should be replaced immediately if it becomes damp, loosened, or visibly soiled 6
• Use 2% chlorhexidine solution in 70% isopropyl alcohol for skin antisepsis during dressing changes 6

Advanced Wound Management

• For complex or infected wounds, vacuum-assisted closure (VAC) therapy may be considered 7, 8
• VAC therapy has been shown to be effective in treating complex postoperative wounds by:
  • Promoting granulation tissue formation 8
  • Reducing wound size significantly after 1 week of treatment 8
  • Facilitating wound healing in an average of 17 days 8
• However, VAC therapy carries risks including bleeding complications, which should be carefully monitored 7

Evaluation of Need for Drain Replacement

• Determine if continued drainage is still required based on:
  • Amount of expected ongoing drainage 2
  • Presence of fluid collection on imaging 2
  • Risk of infection or hematoma formation 2
• If drain replacement is necessary, consider:
  • Using ultrasound guidance for placement 1
  • Ensuring proper sterile technique 6
  • Securing the drain properly to prevent future dislodgement 1

Prevention of Future Complications

• Ensure proper education of patient regarding wound and drain care 2
• Implement a surgical site infection prevention bundle including:
  • Preoperative skin preparation 4
  • Proper wound care education 4
  • Regular wound assessment 6
• Such prevention bundles have been shown to reduce post-C-section surgical site infection rates from 13.3% to 4.5% 4

Common Pitfalls to Avoid

• Never attempt to reinsert a dislodged drain 1
• Do not delay assessment for potential complications such as air embolism or bleeding 1
• Avoid needle aspiration of hematomas due to risk of introducing infection 2
• Do not submerge the wound site in water until complete healing 6
• Avoid excessive manipulation of the wound which may disrupt healing 6