**3. Nursing management**

On arrival in the ward from the recovery room, the nurse in charge of a patient post insertion of the Lautenbach irrigation system should do the following:-.

Postoperative vital data monitoring must be done as per hospital protocol. This includes checking of temperature, pulse, respiration, blood pressure, and oxygen saturation, which should be between 94 and 100% on room air. If the patient desaturates; 40% oxygen via face mask should be administered and the orthopedic surgeon on call should be informed to do arterial blood gases and also to take blood for post-operative full blood count and urea and electrolyte. As this is a major orthopedic procedure these patients bleed a lot and might need an intra-operative blood transfusion or postoperative blood transfusion depending on the condition of the patient. The patient may come back from the theatre with one, two, or even three irrigation tubes. These should be labeled, especially if there is more than one irrigation tube as follows; proximal tube, medial tube, and distal tube or tube 1, tube 2, and tube 3. The tube closest to the midline of the body of the patient would be labeled as a proximal tube and the tube that is situated further away from the body is labeled distal tube or tube 3 respectively.

The operated site should be checked as soon as possible so that the patient can be dressed with a pressure bandage to contain the bleeding. Whilst repacking the dressing; another nurse should open the red and yellow clips and let the irrigations drain regardless of time. This means for example; if the patient came back from the theater at around 16 h05 the drains should be drained from approximately 16 h10 till 18 h00, whilst monitoring the drainage. If the drainage is above 250 ml post operatively the irrigation system; (both yellow and red clips) should be closed and the orthopedic surgeon should be informed. That much drainage is concerning.

The gold standard antibiotic that is used postoperatively is gentamicin 80 mg in 50 ml of sodium chloride 0.9%. Sometimes in theater, the nursing staff will add 320 mg of gentamicin in 200 ml of sodium chloride 0.9%. This is not totally wrong but it is not ideal in a ward situation. This should be changed from 80 mg to 50 ml of sodium chloride 0.9% as soon as the patient is stabilized in the ward. Gentamicin mixed with sodium chloride will only last for two days at room temperature. So mixing 320 mg with 200 ml of saline is actually wasteful in nature and might as well prolong the patient's hospital stay because what if it is not changed at due time because 200 ml is seemingly enough to run for a few weeks.

Check for any leakage or oozing from the wound site. Do not remove dressings from the theater if oozing is noted. Dressings from the theater will only be removed on the day of removal of the irrigation system as a whole. Apply orthopedic wool and crepe bandage and monitor bleeding. In an ideal situation there should not be any bleeding at all, more often than not the report from the surgeon post operatively would be a space was left on the wound for various reasons [4], that would make exudate escape from the tubes to the dressing itself.
