Key Takeaways
- Alginate dressings are best for heavily draining wounds; hydrogel for dry wounds
- Maximum suction time is 10-15 seconds; apply suction only on withdrawal
- Venturi mask provides precise FiO2, ideal for COPD patients
- Use sterile technique for urinary catheterization and tracheostomy suctioning
- Apply heat or cold for maximum 20-30 minutes; check skin frequently
Last updated: January 2026
Therapeutic Procedures
LPN/VNs perform various therapeutic procedures to support patient treatment and recovery. Understanding proper technique, patient preparation, and monitoring ensures safe and effective care.
Wound Care
Types of Wound Healing:
| Type | Description | Example |
|---|---|---|
| Primary Intention | Edges approximated, minimal scarring | Surgical incision |
| Secondary Intention | Heals from bottom up, granulation tissue | Pressure ulcer, abscess |
| Tertiary Intention | Delayed closure after infection controlled | Contaminated wound |
Phases of Wound Healing:
- Hemostasis (Minutes): Blood clotting
- Inflammatory (1-4 days): Redness, swelling, warmth
- Proliferative (4-21 days): Granulation, re-epithelialization
- Remodeling (21 days-2 years): Scar maturation
Wound Assessment:
- Location and size (length × width × depth)
- Appearance of wound bed (pink/red, yellow/slough, black/eschar)
- Drainage (type, amount, odor)
- Surrounding skin condition
- Pain level
- Signs of infection
Wound Dressing Types:
| Dressing | Use For | Characteristics |
|---|---|---|
| Gauze | Most wound types, packing | Absorbent, may dry wound |
| Transparent Film | Minimal drainage, IV sites | Maintains moisture, allows visualization |
| Hydrocolloid | Partial-thickness wounds | Creates moist environment, 3-7 day wear |
| Hydrogel | Dry wounds, necrotic tissue | Adds moisture, promotes debridement |
| Alginate | Heavy drainage, deep wounds | Highly absorbent, forms gel |
| Foam | Moderate drainage | Absorbent, cushioning |
| Negative Pressure (VAC) | Complex wounds | Promotes granulation, removes drainage |
Suction and Drainage
Types of Drainage Devices:
| Device | Mechanism | Nursing Care |
|---|---|---|
| Jackson-Pratt (JP) | Closed, bulb suction | Empty when half full, squeeze to re-activate |
| Hemovac | Closed, reservoir suction | Empty per policy, maintain vacuum |
| Penrose | Open, passive drainage | Dressings absorb drainage |
| Nasogastric (NG) Tube | Low continuous or intermittent suction | Verify placement, monitor output |
NG Tube Management:
- Verify placement before use (pH < 5.5, X-ray)
- Secure to nose without pressure
- Irrigate with 30 mL NS per facility policy
- Monitor for electrolyte imbalances (especially K+)
- Measure and document output
Suctioning:
- Oropharyngeal: No need for sterile technique, comfort measure
- Nasopharyngeal: Clean technique, suction on withdrawal only
- Endotracheal/Tracheostomy: Sterile technique required
Suctioning Guidelines:
- Hyperoxygenate before suctioning
- Maximum suction time: 10-15 seconds
- Suction only on withdrawal
- Allow rest between passes
- Reassess breath sounds after
Oxygen Therapy
| Device | O2 Flow | FiO2 Delivered | Indications |
|---|---|---|---|
| Nasal Cannula | 1-6 L/min | 24-44% | Mild hypoxemia, long-term use |
| Simple Mask | 5-8 L/min | 40-60% | Moderate hypoxemia |
| Partial Rebreather | 6-10 L/min | 60-75% | Moderate-severe hypoxemia |
| Non-Rebreather | 10-15 L/min | 80-100% | Severe hypoxemia, emergency |
| Venturi Mask | Varies | Precise (24-50%) | COPD, need precise FiO2 |
| High-Flow Nasal Cannula | 20-60 L/min | 21-100% | Severe hypoxemia, comfort |
Oxygen Safety:
- Post "Oxygen in Use" signs
- No open flames, smoking, or sparks near oxygen
- Check equipment for proper function
- Humidify if flow > 4 L/min
- Monitor for complications (drying of mucosa, skin breakdown at device site)
Heat and Cold Therapy
| Therapy | Effects | Indications | Precautions |
|---|---|---|---|
| Heat | Vasodilation, relaxation, pain relief | Muscle spasms, chronic pain, arthritis | Max 20-30 min, check skin frequently |
| Cold | Vasoconstriction, decreased swelling, numbing | Acute injury (first 24-48 hr), fever, bleeding | Max 20 min, protect skin |
Contraindications to Heat:
- Acute injury (first 24-48 hours)
- Active bleeding
- Decreased sensation
- Impaired circulation
Contraindications to Cold:
- Raynaud's disease
- Peripheral vascular disease
- Open wounds
- Decreased sensation
Urinary Catheterization
Indications:
- Acute urinary retention
- Accurate I&O measurement
- Perioperative
- Wound care protection (incontinence)
- End-of-life comfort
Catheter Sizes:
- Adults: 14-16 Fr female; 16-18 Fr male
- Children: 8-10 Fr
- Infants: 5-6 Fr
Insertion Technique:
- Explain procedure, provide privacy
- Position patient (female: lithotomy; male: supine)
- Use sterile technique throughout
- Cleanse meatus properly
- Insert until urine flows, then advance 1-2 inches more
- Inflate balloon with sterile water
- Secure catheter to thigh
Specimen Collection
| Specimen | Collection Method | Nursing Considerations |
|---|---|---|
| Clean-Catch Urine | Midstream after cleansing | Teach proper technique |
| Catheterized Urine | Aspirate from port with syringe | Never open closed system |
| 24-Hour Urine | All urine for 24 hours | Keep on ice, proper storage |
| Stool for Occult Blood | Small sample on card | Avoid red meat, vitamin C, NSAIDs before |
| Sputum | Early morning, deep cough | Collect before eating/oral care |
| Blood Glucose | Fingerstick, glucometer | Clean site, adequate drop size |
Specimen Handling
- Label specimens at bedside immediately
- Include patient ID, date, time, specimen type
- Transport to lab promptly
- Follow chain of custody for legal specimens
- Note any special handling requirements (ice, protect from light)
Test Your Knowledge
Which wound dressing is most appropriate for a wound with heavy drainage?
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Test Your Knowledge
When suctioning a tracheostomy, what is the maximum duration for each suction pass?
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D
Test Your Knowledge
Which oxygen delivery device provides the most precise FiO2 for a patient with COPD?
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B
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D