Diagnostic and Therapeutic Procedures Flashcards by Courtney Birkett

Indications for cerumen impaction removal

EAC or TM obscured by cerumen

Hearing loss, tinnitis, vertigo or otalgia

How well did you know this?

Not at all

Perfectly

Contraindication for cerumen impaction removal

Uncooperative pt
Distorted/abnormal anatomy
Previous ear surgery
Suspected TM perf

How well did you know this?

Not at all

Perfectly

Equipment needed for cerumen impaction removal

Ear curette
Syringe
Lukewarm tap water
Towels
Ear basin
Debrox
Suction

How well did you know this?

Not at all

Perfectly

Procedure for cerumen impaction removal

Sit on table
Visualize canal and cerumen with otoscope
Place posterior traction on ear
Use curette or sunction

How well did you know this?

Not at all

Perfectly

What to use if can’t get cerumen out with straight pulling?

Irrigation (fill syringe with lukewarm tap water, tilt head to side being irrigated into basin, direct water towards occiput)

How well did you know this?

Not at all

Perfectly

Complications of cerumen impaction removal

TM perf/drainage
Otitis externa
Vertigo, n/v, tinnitus
IAC wall abrasions/bleeding

How well did you know this?

Not at all

Perfectly

Subungual hematoma

Bleeding between nail bed and finger/toenail caused by trauma

How well did you know this?

Not at all

Perfectly

Indications for subungual hematoma evacuation

Visible, painful hematoma

How well did you know this?

Not at all

Perfectly

Contraindications for subungual hematoma evacuation

Crushed or fractured nail bed

Hematomas involving >50% of nail (laceration of nail bed)

How well did you know this?

Not at all

Perfectly

Equipment for subungual hematoma evacuation

Bunsen burner
Metal paper clip
Forceps or hemostat
Cautery unit

How well did you know this?

Not at all

Perfectly

Options for subungual hematoma evacuation

Paperclip

Cautery

How well did you know this?

Not at all

Perfectly

Complications of subungual hematoma evacuation

Infection

How well did you know this?

Not at all

Perfectly

Indications for NG tube

Decompress stomach (gastric outlet obstruction, ileus)
Small bowel obstruction
Gastric lavage (med overdose, bleeding)
Enteral feeding

How well did you know this?

Not at all

Perfectly

Contraindications for NG tube

Basilar skull fracture
Facial trauma (significant)
Nasal obstruction
Esophageal disease (Strictures, diverticuli, recent surgery)

How well did you know this?

Not at all

Perfectly

Sizes of NG tubes

Smaller the number the smaller the tube

How well did you know this?

Not at all

Perfectly

Orogastric tube

Large bore, designed for gastric lavage in a more critically ill pt

How well did you know this?

Not at all

Perfectly

Feeding tube

Smaller, softer tube
Designed to being left for longer periods in time
Tend to clog (IV meds if possible)

How well did you know this?

Not at all

Perfectly

How to measure length of NG tube

Tip of nose to ear and ear to xyphoid

How well did you know this?

Not at all

Perfectly

How to help NG tube pass into esophagus

Have pt flex neck forward (when pt can feel in back of throat, have them swallow)

How well did you know this?

Not at all

Perfectly

How to verify placement of NG tube

Inject air into tube while listening over stomach with stethoscope
Should hear burp of air

How well did you know this?

Not at all

Perfectly

What to do once NG tube is in place

Secure with tape to nose

How well did you know this?

Not at all

Perfectly

Complications of NG tube

Pt discomfort
Trauma to nares at insertion/bleeding
Sinusitis on side of tube
Gastric irritation
Aspiration pneumonia (feeding tubes)

How well did you know this?

Not at all

Perfectly

How to decrease risk of aspiration pneumonia with NG tube

Keep HOB elevated

Monitor pt and start feedings slowly

How well did you know this?

Not at all

Perfectly

Contraindications of I&D

Furuncle or abscess with triangle of bridge of nose and corners of mouth
(in the triangle)

How well did you know this?

Not at all

Perfectly

Complications of I&D

Pain Recurrence Scar Worsening infection (fistula formation, osteomyelitis)

Indications for arthrocentesis

Evaluate synovial fluid | Relieve pain by either removing fluid or injecting lidocaine and/or corticosteroids

Contraindications for arthrocentesis

``` Cellulitis or broken skin over joint Coagulopathy Infected bursa (for injection) Bacteremia (unless joint is cause) Joint prosthesis ```

Complications of arthrocentesis

``` Bleeding Infection Nerve trauma Adverse drug rxn Cartilage or tendon damage ```

Indications for CT guided biopsy

Mass (lymph node, lung, liver, kidney, bone) | Fluid collection

Contraindications for CT guided biopsy

Coagulopathy Skin infection at site Uncooperative patient

Complications of GT guided biopsy

``` Allergy to contrast Renal failure from contrast Pain Bleeding Others based on site (pneumo or hemothorax) ```

Indications for US guided biopsy

Mass (lymph node, liver, kidney, thyroid, prostate, NOT lung) Fluid collection

Contraindications of US guided biopsy

Coagulopathy Skin infection at site Uncooperative pt

Complications of US guided biopsy

Pain Bleeding Others bases on site (pneumo or hemothorax)

What should you not use arterial line insertion?

Not for med administration

Indications for arterial line insertion

Invasive arterial blood monitoring | Recurrent ABGs

Contraindications for arterial line insertion

Coagulopathy Skin infection at site Uncooperative pt

Complications of arterial line insertion

``` Pain Swelling Bleeding Damage to adjacent structures Infection Vascular complications (vasospasm, thromboembolism, dissection, pseudoaneurysm, arteriovenous fistula) ```

How to collect arterial blood gas

Usually from radial (can be brachial or femoral) | Collected with anticoagulant, placed on ice and taken to lab)

Indication for central venous catheters (central line)

``` Hemodynamic/CV pressure monitoring Med administration TPN Lack of peripheral sites Emergent need for vascular access Hemodialysis To avoid repetitive blood draws Administer abx in home setting ```

Contraindications of central venous catheter

Distortion of anatomy/landmarks Coagulopathy Infection over insertion site Pneumo or hemothorax on CONTRALATERAL side

Is a central venous catheter sterile?

YES

Where can you put a central venous catheter?

Internal or external jugular, subclavian, femoral or brachial veins

How to insert central venous catheter into internal jugular?

Anterior or posterior to SCM or between sternal and clavicular heads of SCM Aim 30 degrees to xyphoid

How to insert central venous catheter into supraclavicular?

1 cm above mid point of clavicle | Direct 30 degrees to opposite nipple

Subclavian approach for central venous catheter

There are good landmarks | 2 cm below mid point of clavicle (direct needle to manubrium and maintain 15 degree angle)

High risk of what with subclavian approach to central venous catheter approach

Pneumothorax

Complication of central venous catheter

Hemorrhage, hematoma Pneumo or hemothorax Arrhythmias Infection

What to do for follow up with central venous catheter?

CXR- to verify line position (want to see tip of catheter in SVC near right atrium)

Indications for chest tube insertion

Pneumo or hemothorax Recurrent pleural effusion Empyema Penetrating chest trauma or flail chest

Contraindications for chest tube insertion

Coagulopathy Loculated pleural effusion Previous chest tube insertion (preventing re-insertion)

Types of chest tubes

``` #16-24 for air #34-40 for fluid or blood ```

Where is the positioning for fluid or air evacuation?

4th or 5th ICS in anterior axillary line or MCL

Complications of chest tube insertion

Injury to heart, vessels, lung, diaphragm Pneumothorax Hemorrhage Localized infection

Indications for bone marrow aspiration and biopsy

``` Unexplained anemia, leukopenia, thrombocytopenia Abnormal peripheral smear Unexplained splenomegaly Fever of unknown origin Dx and staging leukemia and lymphoma Bone marrow transplant ```

Contraindications of bone marrow aspiration and biopsy

Bleeding disorders Skin infection at site Uncooperative pt

What is the only site to perform both bone marrow aspiration and biopsy in adults?

Iliac crest (options are posterior superior iliac crest, anterior iliac crest or sternum)

How to palpate anatomical landmarks for iliac crest

Three finger widths from the midline and 2 finger widths inferior to iliac crest

Aspiration and biopsy needles

They are different-do aspiration first and then biopsy from cortical bone

Complications of bone marrow aspiration and biopsy

Bleeding (at biopsy site or retroperitoneal hemorrhage) Infection Pain Perforation of sternal plate *pressure at biopsy site for 1 hr after procedure