Common Procedures In Anaesthetics Flashcards
What is an endotracheal tube?
A flexible plastic tube with an inflatable cuff + connector at either end
What feature does an ET tube have that allows for air flow if the main tube becomes blocked?
Murphy’s eye
What is a bougie?
- A device which helps with intubation
- it is inserted into the trachea
- slide ET tube along the bought to the correct place
- bougie is removed
What is a stylet?
- a device that helps with intubation
- a metal wire that is inserted into the ET tube before intubation
- allows for the ET tube to be bent into a specific space
What is awake fibre optic intubation?
- A procedure where the ET tube is inserted when the patient is awake under guidance of endoscope (camera)
- ET tube is inserted over the top of the endoscope tube to the correct position
When is awake fibre optic intubation done?
Restricted mouth opening e.g. trismus
Difficult anatomy
What is trismus?
Refers to pain and restriction when opening the jaw
What is first line option if intubation fails in a difficult airway scenario?
Supraglottic airway device
Where do supraglottic airways devices sit?
- tip of the SAD at the top of the oesophagus
- cuff around the opening of the larynx
What is an I-gel?
A non inflatable supraglottic airways device
What are options for maintaining an airway?
- Oropharyngeal
- Nasopharyngeal
- Supraglottic airways devices I-gel
- Endotracheal tube
How do you measure the correct size for an oropharyngeal tube?
Centre of the mouth to the angle of the jaw
How do you measure the correct size of a nasopharyngeal tube?
Edge of the nostril to the tragus of the ear
When are oropharyngeal tubes used?
When ventilating a patient via a face mask + bag prior to inserting SAD or ETT
When are nasopharyngeal tubes used?
In emergency scenarios e.g. in A&E or cardiac arrests
What is a contraindication for nasopharyngeal tube?
Base of skull fracture
Indications for tracheostomy
- resp failure where long term ventilation is required
- prolonged weaning from mechanical ventilation
- upper airway obstruction
- management of respiratory secretions e.g. pt with paralysis
- reducing risk of aspiration
What is the 4 step plan for difficult airways?
- A: laryngoscope with tracheal intubation
- B: Supraglottic airways device
- C: face mask ventilation + wake pt up
- D: cricothryoidotomy
Where could a central line/central venous catheter be inserted into?
- internal jugular vein
- subclavian vein
- femoral vein
What is a Hickman line?
- A type of tunnelled central venous catheter
- travels through SC tissue then enters subclavian or jugular vein
- sits in superior vena cava
- long term
Why are Hickman lines appropriate for long term used?
- A cuff surrounds the catheter near the skin insertion
- This promotes adhesion of tissue to the cuff
- Barrier to bacterial infection
What are pulmonary artery/Swan-Ganz catheters?
What are they used for?
- inserted into IVJ > RA > RA > pulmonary artery
- balloon on the edge which can be inflated into a wedge
- pressure distal to wedge gives pulmonary artery wedge pressure
- indicates pressure in left atrium
What is a portacath?
- a type of central venous catheter
- there is a port under the skin at the top of the chest
- this connects to a catheter which sits in superior vena cava or RA
Why is a portacath appropriate for long term use?
- skin remains intact when nothing is attached to port
- fully internalised under skin
- reduced chance of infection
