images and instruments Flashcards
NG tubes adequate?
criteria for NG tube
adequate CXR
descends in the midline to the diaphragm bisecting the carina
clearly visible below the left hemi-diaphragm
>10 cm beyond the GOJ suggesting it is in the stomach
Left is inadequate as not > 10cm beyond the GOB, right image inaqueate as in the left lung
NG tube/ryles
Indication
max duration
placement
complications
indications:
discuss with SLT malnourished or risk of malnourishment, unsafe swallow in patients with intact enteral digestion
max 4 weeks
gastric decompression (SBO/LBO)
Ryles is drainage only
Placement:
-size based on nose tip, earlobe, xiphisternum
-tape securely
-confirm placement with pH test (acidic pH <5.5 but beware PPI!!! gastric secretions are around 1.5) or CXR
name
indications and use
risks
Urometer drainage bag with clearly marked volumes allowing accurate assessment of hourly urine fluid loss
Commonly placed preoperatively and used during and post operatively or fluid monitoring
Attached to a catheter and should be placed below the level of the bladder but off the floor
Risks:
above bladder placement -> retention
infection
name
indications and use
risks
urine dip stick (+ sterile universal sample pot)
used for bed side urine assessment
Commonly useful or identifying infection, nephritic/nephrotic syndromes, glucose/ketones for diabetes, microscopic haematuria from other causes
Wait allotted time before comparing each sample band to the corresponding one on the bottle
>65 or haematuria send a urine culture
Risks: not waiting long enough
sizing
materials
types
indications
complications
Sized in French (Ch). 14 french is normally good start ponts, smaller the number the larger the diameter
There are short term foleys made of latex (left)
long term indwelling made of silicone (centre)
3 way tap for flushing haematuria (larger french requird as 3 lumens) (right)
complications:
device: blockage, colonisation and infection
patient: Insertion: damage to urethra, seeding of infection (give Gent cover) In situ: Infection and urosepsis, urethral or baldder trauma if pulled
name
indication
complications
Contrindications
trucut needle used for taking histological biopsy samples from solid tumours in soft organs with minimal trauma, often breast, kidney and liver and can be done under local
complications: Bleeding, pain, site infection, damage to neighbouring structures
Contraindication:
bleeding disorders (haemophilia), obesity limiting site access, inability to control ventilation and breathing as that can be important for abdominal biopsis where organs move with breathign
name
indications
sites
risks/compication
central venous catheter, 3 lumens, placed using sterile seldinger technqiue commonly into the internal jugular, Subclavian and femoral to lie wihtin the SVC, IVC or RA
giving drugs that have profound pressing effects, drugs irritatnt to peripheral vessels (chemotherapy), TPN, measurement of RA pressure
Risks:
Insertion: damage to neighbourign structures (carotid puncgure, vagus nerve damage, pnumothorax), arrhythmia if too far in, failure
Indweling risks: Infection, trhombosis (especially if too far out), failure (blockage), close cap or risk of air embolism
when femoral over other sites for CVC
trauma -> free of other equipment, lower risk of other damage which risks life (pnenumothorax, easily compressible if bleeding)
name
indication
placement
advantages
complications
cuffed tracheostomy tube
definitive airway that also protects from aspiration. Used for long term venitlation commonly in ITU, upper airway obstruction, post laryngeal surgery
placed as open surgical tracheostomy insertion in OR or bedside with percutaneous dilational tracheostomy. Outer tube should be 1/2-2/3 tracheal diamter (10mm women and 11mm women) and the securing strap should allow a finger under it to avoid pressure sores etc
Advantages:
less deadspace
can suction thorugh it to clear the lungs
Complications:
Insertion: misplaced tube, haemorrage, sdamage to neighbouring structures
haemorrhage (which may be dealyed until a patients blood pressure normalises)
Indwelling:
-Obstruction (mucus plugs/crusts cleanse the inner cannula thoroughly and keep high humiditiy air in the system)
-compressive force of the cuff causes schaemia of the trachea
-infection -> skin and tracheitis, pneumonia
name
indications
CI
risks
TED stockings for mechanical VTE prophylaxis
used for most immobilised or limited mobility inpatients and can be used in conjunction with medical VTE prohylaxis
different sizes
CI in peripheral arterial disease (ABPI <0.6)
Risks: worsening of peripheral arterial disease, discomfort
generic procedural CI
General procedure CI:
Clotting abnormalities or significant thrombocytopaenia (not platelet)
Overlying infection
generic procedure complications
General procedure complications:
Anything with tubing can become kinked or blocked and be dislodged or misplaced
Infection
bleeding
damage to neighbouring structures
Cannula: peripheral access which comes in a variety of sizes used to deliver intravenous drugs and fluids. The smaller the gauge the more rapid the fluid administration
Yellow-> Blue (22) -> Pink -> Green -> Grey -> Orange (your best pal got grabbed oinking)
(lidocaine for pain if large)
CI: overlying infection, AV fistula, axillary node clearance
Complications:
Short: pain, bleeding, air embolism
Long: infection, extravasation
name
more generally suture types, indications,
braided absrobable 16mm suture on a reverse cuttign needle
sutures are divided by thickness, texture and asbsorbable/non-absorbable
thicker the stronger
texture: braided allows fewer throws due to increased friction but is more inflammatory while monoilament are smoother and require more throws but cause less inflammation
Absorbable do not leave behind foreign material which can cause inflammation and are useful for deep sutures
Non-absorbable are useful and cheap for superficial skin closure so that they can be removed but also for deep sutures where long lasting integrity is required in non-healing tissues (tendons/valves)
Needles used for suturing
they come in straight and curved with stright useful for precise skin sutures but curved more suitable for deeper sutures where operatve space is limited with the smaller the curve (x/8) requiring the least space
suture needles are cutting or blunt.
Blunt dilate and speparate tissue while suturing and are safer with less risk of glove or skin puncture. they are often used for abdominal closure as they have less risk of bowel perf. requires more forcea nd thus less control
sharp needles are either
-Cutting needles wihtthe shapr edge being the top of the suture cutting towards the centre of the circle you turn (can cause tissue damage and allow suture to cut into the wound).
-reverse cutting with sharp edge onthe bottom cutting away from te centre of teh tissue towards the skin protecting the sutured tisseu from more damage
-round body which can be blunt or cutting or sharp (blunt good for firable tissue as it avoids cutting damage, sharp s good for leaky tissue, cutting is good for vasucalr atherosclerosis)
CXR for CVC
the tip should be in the sVC for fluids or short term but in at the Cavo-atrial junction if long term, chemo therapy or a PICC line or even wihtin the irght atrium. tip should be vertical
the viisble landmark used is the carina (? couple cm above or below of the carina)
entry to the right atrium (cavo atrial junction) is 2 vertebral bodies below
