CharikerJeter Technique Tutorial

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Chariker-Jeter TechniqueTutorial

• Step One
• Debride any necrotic tissue. Irrigate the
  wound bed thoroughly with wound cleanser or
  normal saline. Pat wound dry

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Step Two

• Apply skin sealant to all skin that will be
  covered by transparent adhesive skin dressing.
  Allow skin to dry until sticky.

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Step Three

• Open the Aquaphor dressing, cut a single layer to
  the appropriate size and shape of the wound bed.
• Lay the Aquaphor dressing across the wound bed.

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Next

• Shorten Jackson Pratt Catheter as necessary so
  that the flat drain is confined to the wound bed
  (recommend 1 shorter than wound bed). Place
  Catheter between saline moistened fluffed gauze
  (the catheter is never placed into a fistula
  tract or directly onto pink granulating tissue).
  Fill dead space with saline moistened fluffed
  gauze or roll gauze.
• Chariker, Jeter, 1989

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Placement of the Drain
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Wrapping Technique for Drain
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Step Four

• Place the Jackson-Pratt suction catheter/drain on
  top of the Aquaphor dressing.
• The drain should not come into direct contact
  with the wound bed.
• Shorten the drain as necessary so that the flat
  drain is confined to the wound bed.
• (The drain should never be placed in a fistula
  tract.)

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Placement of J-P Drain
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Step Five

• Open the 4x4 gauze pads. Saturate with normal
  saline.
• Fluff into wound to completely cover the drain
  and fill the defect to skin level.

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Step Six

• Cover the entire packed wound with the
  transparent dressing carefully moving the tubing
  to either side of the wound.

The dressing should allow for at least 1 of
intact skin beyond the wound edges.
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Crimping
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Step Six continuedSealing the Wound Dressing

• Crimp or pinch the edges of the transparent film
  around the tubing to secure a proper seal.
• You may use stoma-adhesive paste or a
  hydrocolloid to fill any gaps caused by a skin
  fold to ensure appropriate seal.
• You may also reinforce this junction with pink
  waterproof tape or other adhesive tape.

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Next

• Place the supplied tube clamp over the end of
  the drain tube and connect to canister, with
  connecting tube and supplied adapter.

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Step Seven

• Insure that overflow/bacteria filter is on pump.
• Use Canister with Mechanical overflow lid device.
  
• Fill with sterile water after estimating drainage
  to be collected.
• Be sure that filter connection tubing is attached
  to the vacuum port on the canister as this will
  assure proper overflow shutoff protection !!!

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Connecting the filter and tubing
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Canister Fill
If canister size does not match estimated
drainage, simply fill canister with sterile water
to achieve desired level i.e. pictured canister
has a volume of 800cc if we expect the wound to
drain 300cc between dressing / canister changes
we put 500 cc of sterile water in the
canister. Canister Volume Estimated Drainage
Volume of Sterile water to add.
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Step 8continued

• Turn pump on and adjust to upper range of low
  setting, (60-80 mm Hg) observe the site.
• The dressing should contract noticeably. If it
  does not you do not have a closed system and will
  need to find/patch the leak.
• You may patch with a piece of transparent film.
• Once an airtight seal is reached, adjust the pump
  to the prescribed negative pressure.

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Finished Dressing
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Monitoring the Patient

• Insure that protocol is present for Closed
  Suction Wound Drainage.
• Patients need to be monitored(i.e. dont ignore
  patient for 3 days)

• Replace Chariker-Jeter dressing _at_ 48 hours
  initially and then every 2-3X per week as
  indicated.

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Insure Good Outcomes

• Make sure that a protocol is present for Closed
  Suction Wound Drainage.
• Patients need to be monitored
• Check pump for proper vacuum setting.
• Document canister contents for type/color, odor
  and amount of exudate.
• Check for air leak using procedure below.
• Check dressing at shift change or every 8 hours
  by using clamp to occlude tubing. If dressing
  balloons and contracts when clamp is applied and
  released leak is present and needs to be sealed.
  Also have patient, nurse or caregiver listen for
  any leaks.

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Dressing Changes

• Frequency and extent depend on the status of the
  patient, i.e. infection, excessive drainage
• Initial dressing change at 48hrs and then as long
  as no leakage is present, patient is comfortable
  and pump is effective at pulling fluid
  recommended changing 2-3X/wk

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Patients/Wounds Not Indicated

• Malignancy
• Nutritional Compromised- lt 2.0 Albumin
• Organs, blood vessels, major structures exposed
• Untreated Osteomyelitis
• Multi-system failure to thrive
• Systemic steroids
• Uncooperative or unsuitable candidates

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Clinical Indications to D/C Wound Suction

• Completion of successful course of treatment
• Pain at wound site
• Wound fluid has reduced to the point that there
  is a dry wound bed
• Patient preference