Alternative Procedure and Medical Devices Review Flashcards
What are the terms used for the radiographic study of the biliary system, gallbladder and biliary ducts?
- Cholegraphy – biliary system
- Cholecystography – gallbladder
- Cholangiography – biliary ducts
***What does PTC stand for?
Percutaneous Transhepatic Cholangiography
***What does ERCP stand for?
Endoscopic Retrograde Cholangiopancreatography
PTC Procedure:
- Right side of patient is prepped with local anesthetic
- Chiba needle is inserted through right lateral intercostal space and advanced to liver hilum
- Stylet is removed and syringe with contrast is attached to needle
- After filling of ducts needle is withdrawn
PTC Procedure:
- If dilated biliary ducts are identified, a drainage catheter is placed into biliary duct
- Guidewire is passed through needle lumen & needle is removed
- Catheter is passed over guidewire and wire is removed
- Left in place for prolonged drainage
***Explain the postoperative t-tube cholangiograpm:
-Exams the biliary tract using a T-shaped or pigtail shaped catheter
-Follows a cholecystectomy
Left in common hepatic & common bile ducts for postoperative drainage
***What type of procedure is used to place a T-tube and pigtail catheter?
- T-tube is placed during a surgical procedure
- Pigtail catheter is placed during a laparoscopic biliary procedure
***What is the purpose of the postoperative T-tube cholangiogram?
- Demonstrates caliber & patency
- Status of sphincter of hepatopancreatic ampulla
- Presence of stones or other pathologic conditions such as strictures
Why is the drainage tube clamped the day before the procedure?
Allows tube to fill with bile to prevent air bubbles within the duct from mimicking stones (preventive measure)
***What is the purpose for an ERCP?
- It is used to diagnose biliary and pancreatic pathology
- It is useful when biliary ducts are not dilated and no obstruction exist @ ampulla
- Therapeutic procedure
- Removal of choleliths or small lesions
- Repair a stenosis of a duct
***ERCP Procedure:
- Endoscope is placed through mouth into duodenum
- A small cannula is passed into the hepatopancreatic ampulla
- Contrast is then injected into common bile duct (retrograde injection)
- Contrast drains from ducts within 5 minutes of injection
What is another name for a chest tube?
Thoracostomy or intrapleural tube
Where is a chest tube inserted?
- Fluid accumulates near lung base
- 5th to 6th intercostal space @ midaxillary
- Air rises to upper pleural space
- 2nd to 3rd intercostal @ midclavicle
***A chest tube is inserted to reestablish intrapleural pressure that may be caused by what various conditions?
- Pneumothorax
- Hemothorax
- Pleural effusion
- Empyema
What is the purpose of an endotracheal tube (ETT)?
- Patient has need for mechanical ventilation or oxygen delivery
- Patient has upper airway obstruction
- Possibility of gastric acid reflux or aspiration
***Where is the proper placement of the endotracheal tube?
5 to 7 cm superior to tracheal bifurcation (halfway between clavicles and carina {T5-T7}
***Malpositioning of the endotracheal tube:
- If tube is inserted too far – enters the right bronchus causing a collapse of left lung or atelectasis
- If tube is too high – air enters the stomach and regurgitation leads to aspiration pneumonia
***What is the name of the catheter that is inserted into a large vein and has a variety of uses?
- Central venous catheter
- Venous access device
- Hickman/Groshong (developer)
What are some of the uses for the catheter mentioned in the previous question?
- Administer chemotherapeutic and other drugs
- Parenteral nutrition
- Manage fluid volume
- Blood analysis and transfusion
- Monitor cardiac pressure
***Where is the preferred location for a central venous line?
SVC approximately 2 to 3 cm above the right atrial junction
***What are some of the common insertion sites for central venous lines?
- Subclavian vein
- Internal jugular vein
- Femoral vein
- Antecubital area (PICC lines)
- Basilic vein
- Cephalic vein
***What type of line is a Swan-Ganz catheter?
Pulmonary arterial or PA line
What is a pulmonary arterial line?
- Single or multilumen CV line that contains a small electrode at distal end which is used to monitor pulmonary arterial pressure
- It enters through right internal jugular and ends in the right pulmonary artery
***Who performs the insertion of a PICC line?
Radiologist
Nurse
Specially trained technologist
***What are some of the uses of a PICC line?
- Prolonged antibiotic treatment
- Home health care for extended treatment
- Chemotherapy
- Nutrition
What is an implanted access device?
- A device surgically implanted under patient’s skin in the chest wall or patient’s arm.
- Tip lies in SVC
- Used for drawing blood or administering medications/contrast
***What type of needle is used to access an implanted access device (port)?
Huber needle
What are the primary uses for a nasogastric tube?
- Administration of medications
- Gastric decompression
- Removal of fluids from stomach after obstruction or trauma
What is the most common NG tube?
Levin tube
-Single lumen with several holes near its tip
What are some uses for the nasoenteric feeding tube?
- Feeding and hydration of patient
- Contrast administration
- Nasoenteric feeding tubes are thinner and more flexible than NG tubes.
- NE tubes can stay in for a longer period of time
- NE tubes are positioned @ the level of 3rd portion of duodenum
What is a PEG tube?
-Gastric feeding tube
-Percutaneous Endoscopic Gastrostomy
– most common type
-Inserted through a small incision into stomach/jejunum using surgery or endoscopy
-Used for long term nutrition
