Chariker-Jeter® TechniqueChariker-Jeter® TechniqueTutorialTutorial

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

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

Step TwoStep Two

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

• Lay the Aquaphor dressing across the wound bed.Lay the Aquaphor dressing across the wound bed.

Step ThreeStep Three

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

Chariker, Jeter, 1989Chariker, Jeter, 1989

Next

Placement of the DrainPlacement of the Drain

Wrapping Technique for Wrapping Technique for DrainDrain

• Place the Jackson-Pratt suction Place the Jackson-Pratt suction catheter/drain on top of the Aquaphor catheter/drain on top of the Aquaphor dressing. dressing.

• The drain should not come into direct The drain should not come into direct contact with the wound bed. contact with the wound bed.

• Shorten the drain as necessary so that the Shorten the drain as necessary so that the flat drain is confined to the wound bed. flat drain is confined to the wound bed.

(The drain should never be placed in a fistula tract.)(The drain should never be placed in a fistula tract.)

Step FourStep Four

Placement of J-P DrainPlacement of J-P Drain

• Open the 4x4 gauze pads. Saturate with Open the 4x4 gauze pads. Saturate with normal saline. normal saline.

• Fluff into wound to completely cover the Fluff into wound to completely cover the drain and fill the defect to skin level.drain and fill the defect to skin level.

Step FiveStep Five

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

Step SixStep Six

The dressing should allow for at least 1” of intact skin beyond the wound edges.

CrimpingCrimping

Step Six Step Six continuedcontinued

Sealing the Wound Sealing the Wound DressingDressing

• Crimp or pinch the edges of the transparent Crimp or pinch the edges of the transparent film around the tubing to secure a proper seal. film around the tubing to secure a proper seal.

• You may use stoma-adhesive paste or a You may use stoma-adhesive paste or a hydrocolloid to fill any gaps caused by a skin hydrocolloid to fill any gaps caused by a skin fold to ensure appropriate seal. fold to ensure appropriate seal.

• You may also reinforce this junction with pink You may also reinforce this junction with pink waterproof tape or other adhesive tape.waterproof tape or other adhesive tape.

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

NextNext

• Insure that overflow/bacteria filter is on pump. Insure that overflow/bacteria filter is on pump.

• Use Canister with Mechanical overflow lid device. Use Canister with Mechanical overflow lid device.

• Fill with sterile water after estimating drainage to Fill with sterile water after estimating drainage to be collected. be collected.

• Be sure that filter connection tubing is Be sure that filter connection tubing is attached to the vacuum port on the canister attached to the vacuum port on the canister as this will assure proper overflowas this will assure proper overflow shutoff shutoff protection !!!protection !!!

Step Step SevenSeven

Connecting the filter and Connecting the filter and tubingtubing

Canister FillCanister 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.

Step 8Step 8continuedcontinued

• Turn pump on and adjust to upper range of low Turn pump on and adjust to upper range of low setting, (60-80 mm Hg) observe the site.setting, (60-80 mm Hg) observe the site.

• The dressing should contract noticeably. If it does The dressing should contract noticeably. If it does not you do not have a closed system and will need not you do not have a closed system and will need to find/patch the leak. to find/patch the leak.

• You may patch with a piece of transparent film. You may patch with a piece of transparent film. • Once an airtight seal is reached, adjust the pump Once an airtight seal is reached, adjust the pump

to the prescribed negative pressure. to the prescribed negative pressure.

Finished DressingFinished Dressing

Monitoring the PatientMonitoring the Patient

• Insure that protocol is present for Insure that protocol is present for Closed Suction Wound Drainage.Closed Suction Wound Drainage.

• Patients need to be monitoredPatients need to be monitored(i.e. don’t ignore patient for 3 (i.e. don’t ignore patient for 3 days)days)

Replace Chariker-Jeter dressing @ 48 hours Replace Chariker-Jeter dressing @ 48 hours initially and then every 2-3X per week as initially and then every 2-3X per week as

indicated.indicated.

Insure Good OutcomesInsure Good Outcomes

• Make sure that a protocol is present for Closed Make sure that a protocol is present for Closed Suction Wound Drainage.Suction Wound Drainage.

• Patients need to be monitoredPatients need to be monitored1.1. Check pump for proper vacuum setting.Check pump for proper vacuum setting.2.2. Document canister contents for type/color, Document canister contents for type/color,

odor and amount of exudate.odor and amount of exudate.3.3. Check for air leak using procedure below.Check for air leak using procedure below.

• Check dressing at shift change or every 8 hours Check dressing at shift change or every 8 hours by using clamp to occlude tubing. If dressing by using clamp to occlude tubing. If dressing balloons and contracts when clamp is applied balloons and contracts when clamp is applied and released; leak is present and needs to be and released; leak is present and needs to be sealed. Also have patient, nurse or caregiver sealed. Also have patient, nurse or caregiver listen for any leaks.listen for any leaks.

Dressing ChangesDressing Changes

• Frequency and extent depend on the Frequency and extent depend on the status of the patient, i.e. infection, status of the patient, i.e. infection, excessive drainage…excessive drainage…

• Initial dressing change at 48hrs and Initial dressing change at 48hrs and then as long as no leakage is then as long as no leakage is present, patient is comfortable and present, patient is comfortable and pump is effective at pulling fluid; pump is effective at pulling fluid; recommended changing 2-3X/wkrecommended changing 2-3X/wk

Patients/Wounds Not IndicatedPatients/Wounds Not Indicated

• MalignancyMalignancy

• Nutritional Compromised- < 2.0 AlbuminNutritional Compromised- < 2.0 Albumin

• Organs, blood vessels, major structures Organs, blood vessels, major structures exposedexposed

• Untreated OsteomyelitisUntreated Osteomyelitis

• Multi-system failure to thriveMulti-system failure to thrive

• Systemic steroidsSystemic steroids

• Uncooperative or unsuitable candidatesUncooperative or unsuitable candidates

Clinical Indications to D/C Wound Clinical Indications to D/C Wound SuctionSuction

• Completion of successful course of Completion of successful course of treatmenttreatment

• Pain at wound sitePain at wound site

• Wound fluid has reduced to the point Wound fluid has reduced to the point that there is a dry wound bedthat there is a dry wound bed

• Patient preferencePatient preference