Authors (including presenting author) :
HO CW (1), Lam YH (1), Aboo Gloria (2), Chan KH Sharon (1), Lai CH Eric (1)
Affiliation :
(1) Department of Surgery, Pamela Youde Nethersole Eastern Hospital (2) Quality and Safety Office, HKEC
Introduction :
Soft tissue injury with retained foreign body is common in wound clinic. This paper describes the foreign body removal by ultrasound and rethink the nursing quality and risk in wound care procedure.
Objectives :
1. To reform the nursing quality and risk in wound care after the incident of retained foreign body in wound 2. To establish clinical application of ultrasound in advanced wound care
Methodology :
A man left an unhealed perianal draining wound for complex fistula-in-ano. It was a 3mm pin-hole sized opening with a long-angled tunnel. Patient went to the casualty on 3 November 2021 for the cotton buds retained in wound after dressing at home. Medical officer tried to remove by otoscope and crocodile tweezer. But it could not be successfully removed after several attempts. Then, the patient came back to our nurse clinic next morning. For the pinhole opening and multiple attempt removals in casualty before. There may be a high risk of foreign body migration if we blindly removed the foreign body. Then, we used the 18MHz linear probe and GE Venue-40 in the ultrasound diagnostics. The probe was put on the longitudinal axis to the wound. The findings were a 0.77cm long hyperechoic image which lied along the wound track, and 1.3cm down below from skin. For the perineum has a limited space, foreign body removal under real-time ultrasound guided may be really difficult. We marked an arrow on skin which was parallel to the longitudinal axis of wound. Followed wound exploration accordingly to the marked arrow; cotton buds were removed successfully by mosquito curved forceps. Nature of removed cotton buds was correctly correlated to the finding of ultrasound imaging. Wound reassessed by ultrasound after procedure, confirmed the retained cotton buds has been completely removed.
Result & Outcome :
Retained cotton buds in wound was extremely rare, it allowed us rethink the nursing quality and risk in wound. A comprehensive wound assessment, skilful wound dressing technique plus instrument handling, specific wound drainage procedures and personalised patient education is crucial in preventing the incident recurrence.
