4 - Procedural Skills Flashcards

1
Q

Add reasons for irradiated and CMV negative blood products

A

Irradiated blood products are cellular blood components (like red blood cells, platelets, or white blood cells) that have been treated with radiation (like X-rays or gamma rays) to inactivate lymphocytes (a type of white blood cell) and prevent a rare but potentially fatal complication called Transfusion-Associated Graft-versus-Host Disease (TA-GVHD).

Most children and adults receiving blood transfusions do not need CMV negative blood. But CMV can cause serious problems for people with weakened immune systems, such as cancer and transplant patients, adversely affecting their eyes, lungs, liver, nervous system and gastrointestinal tract. - CMV-negative blood is given to pregnant women, neonates, and those receiving granulocyte transfusions.

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2
Q

What is a bone marrow examination and how is the procedure carried out?

A
  • Bone marrow aspiration (fluid bone marrow) for cytology
  • plus Bone marrow biopsy (solid bone marrow) for histology with trephine
  • Collected from the posterior iliac crest after being given local anaesthetic
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3
Q

What are some complications with a bone marrow examination?

A
  • Excessive bleeding, particularly in people with low platelets
  • Infection
  • Long-lasting discomfort at the bone marrow exam site
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4
Q

What are some indications for a bone marrow biopsy?

A
  • Chronic microcytic anaemia
  • Diagnosis of leukaemias
  • See if lymphoma has bone marrow involvement
  • Multiple myeloma and monoclonal gammopathy of undetermined significance
  • Autoimmune thrombocytopenic purpura
  • Check if treatment is working
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5
Q

How do you take blood cultures?

A

https://geekymedics.com/wp-content/uploads/2022/04/OSCE-Checklist-Blood-Culture-Collection.pdf

Blue (aerobic) then Purple (anaerobic)

Make sure to wash the tops of the bottles with a wipe too

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6
Q

What is a thoracentesis and how is it done?

A

US guided drainage of pleural effusions for therapeutic and diagnostic purposes

Need to stop any NSAIDs and anticoagulants a few days before and check the platelets

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7
Q

What are the risks with a thoracentesis?

A
  • Collapsed lung
  • Bleeding
  • Bruising
  • Infection
  • Liver injury (rare)
  • Spleen injury (rare)
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8
Q

What tests are pleural fluid sent off for?

A
  • Cytology
  • MC+S
  • Inflammatory markers
  • Levels of glucose, protein or other chemicals

Only drain max of 0.5 L at a time (max 1.5L in 24h)

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9
Q

After a chest drain insertion what needs to be done to check it is in the right position?

A
  • CXR
  • Check the drain is swinging
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10
Q

What are some indications for chest drain insertion?

A
  • Pneumothorax
  • Pleural effusion especially if malignant
  • Peri-operative eg. thoracotomy, oesophageal surgery, cardiothoracic surgery
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11
Q

Where is the chest drain inserted?

A

The 5th intercostal space in the mid-axillary line (safety triangle)

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12
Q

What is done on a daily check for a chest drain?

A
  • Check it is swinging with respiration and no bubblingn - indicating fluid movement within the tubing with respiration, signifies a functioning drain in connection with the pleural space.
  • Daily dressing change
  • Change bottle if full
  • Check adequate analgesia as breathing with chest drain is painful
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13
Q

What is a paracentesis and how is it done?

A

Drainage of ascites

Needle and drain placed for up to 6 hours

Send fluid off for cytology

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14
Q

What are the complications with paracentesis?

A
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15
Q

What is a Hickman line and what are some indications for this?

A

Central venous catheter

Tunnelled under the skin

Indications: TPN, chemotherapy, blood transfusions, antibiotics and intravenous fluids

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16
Q

What are the complications with a Hickman line?

A
  • Infection
  • Bruising
  • VTE
  • Vein stenosis
  • Pneumothorax

Always have CXR after procedure to check in right place and no pneumothorax

17
Q

What is the care needed for a Hickman line?

A
  • Change dressing weekly and don’t get wet
  • Weekly flush with heparinised saline to keep patent
  • Keep needle free cap on at all times
  • Remove entry site stitch after 1 week and exit site stitch after 3-4 weeks
18
Q

What is a venous portocath?

A

Same as Hickman but completely tunnelled under the skin, no part out

19
Q

What are some risks with a Port a Cath and how should it be cared for?

A
  • Infection
  • Thrombosis
  • Blocked port
  • Only use Hueber needles
  • Flush every 4-6 weeks
  • Wash hands before handling
20
Q

What is a PICC line?

A

Peripheral Venous Catheter

Put into one of the large veins of the arm, above elbow joint. It is then threaded into the vein until the tip is in a large vein just above the heart.

Sometimes it divides into two or three lines which allow you to have different treatments and medications at the same time.

21
Q

What is Apheresis?

A

Removing whole blood and separating the blood into individual components so that one particular component can be removed

Used for the collection of donor blood components (such a platelets or plasma) as well as for the treatment for certain medical conditions in which a part of the blood that contains disease-provoking elements is removed

Also used for the collection of stem cells from peripheral blood

22
Q

What are some complications of aphaeresis?

A
  • Bleeding and a tendency to bleed (as clotting factors are removed)
  • Infection and a tendency toward infection (as antibodies are removed)
  • Low blood pressure (as fluids are removed),
  • Muscle cramping (as low blood calcium can occur)
23
Q

What diseases can be treated with aphaeresis?

A
24
Q

What is looked at on a blood film?

A
  • Erythrocytes
  • Leucocytes
  • Platelets
  • Cancerous cells

Looking at number of them, the morphology, any inclusions

25
Q

need to do blood transfusion

26
Q

What are the advantages of a central venous catheter?

27
Q

What are the disadvantages of a central venous catheter?

28
Q

Undergoing chemotherapy patients can become infertile, can undergo premature menopause and they should not become pregnant. How can all of these risks be managed?

A

Pre-Chemotherapy

  • If starting chemotherapy can be delayed, women can be offered oocyte or embryo collection
  • Men can be referred for sperm storage
  • Norhisterone is used in women to stop menstruation

Peri-Chemotherapy

  • Use contraception to avoid pregnancy
29
Q

What are some prophylactic medications given before chemotherapy and stem cell transplant for leukaemias?

A
  • Mouth care – chlorhexidine mouthwash
  • Prophylactic anti-fungal medication – fluconazole/posaconazole
  • Prophylactic co-trimoxazole (prevent Pneumocystis jiroveci)
  • Prophylactic antiviral – aciclovir
  • Prophylactic antibiotics
30
Q

Which cancer patients would you give LMWH for a VTE over the recommended DOACs?

A

GI malignancy due to risk of bleeding

31
Q

What are the different stages of chemotherapy induced nausea and vomiting?

32
Q

How is the severity of chemotherapy induced nausea and vomiting graded?

33
Q

How can mucositis be managed?

A

calphosol (mouthwash)
calcium
phosphate
solution

34
Q

Chemotherapy induced diarrhoea can be life threatening. How is this managed?

A
  • If capecitabine/5-FU-related: likely to need chemo withheld if ≥ grade 2, consider DPD deficiency
  • Loperamide and Codeine if not settling
  • Consider Octreotide and or Budesonide
35
Q

How is extravasation of chemotherapy managed?

36
Q

How long after treatment can immunotherapy side effects occur?

A

YEARS later

37
Q

What class of drugs are most immunotherapy agents?

A

Checkpoint inhibitors