Images and instruments Flashcards
Central venous access complications
Immediate: Haemorrhage Pneumothorax Arterial puncture Arrythmias Cardiac tamponade Air embolism
Delayed Venous stasis THrombosis Erosion of vessel Line fracture Catheter colonisation Line related sepsis.
Triangle of safety
Lateral edge of pec major
Lateral edge of latissimus dorsi
5th intercostal space
APex of axilla
Insert above rib to avoid neurovascular bundle
Position confirmed with CXR
Chest drain complications
Insertion related
- damage to nearby structures- intercostal artery, solid organ. LT nerve damage -> winged scapula.
Subcutaneous emphysema
Pneumothorax
Position related -Obstruction -kinking -dislodged Reexpansion pul oedema.
Infection
wound
pneumonia
empyema
port a cath
For - long term chemo/abx
Centrally placed - SC port silicon.
HUBER point needle.
Low infection risk.
Epidural insertion pack
Touhy - clear depth marking for accurate
Short/long term anaesthetic
adaptor
can cause low pressure headache.
Chest drain
Indications - PTx, haemothorax, symptomatic malignant pleural effusion, empyema.
Remove when no longer swinging bubbling and CXR confirms resolution.
in forced expiration.
close wound with mattress suture.
.
Surgical drains
Indications:
Drainage of a potential space post surgery
Removal of harmful fluid e.g. blood, pus, bile
Detection of bleeding or leakage - e.g. anastomosis
Open vs closed
Open - corugated rubber connect to external env - superficial wounds - risk of infection
Closed - connect via tubing to bottle.
Active - neg presure - impreoved wound closure
Passive - gravity - abdomen - less perforation.
Complications of surgical drains
Ascending infection Foreign body reaction (fibrosis, granulation) Migration Obstruction/kinkinh Fistulation.
Breast implants
Breast augmentation, reconstruction post mastectomy, Gender reassignment.
10-15 years.
Very rare risk of anaplastic large cell lymphoma.
Rupture, infection, capsular contracture, erosion, migration.
Disposable rigid sigmoidoscope
left lateral position, knees flexed
Inspection of anus, rectum, lower sigmoid colon.
DRE before.
visual inspection.
15-20cm.
biospies e.g UC.
Proctoscope
visualise anal canal and lower rectum.
Also injecting/banding haemorrhoids.
Left lateral position, DRE, light source, lubricated.
Laporoscopic trochar
Veress needle, Hasson technique
CO2 gas - cleared by expiration, soluble in tissues, inert.
Complications; Visceral perforation
BMI
Absorbable Sutures
Vicryl, monocryl, PDS
For deep, rapid healing tissues (bowel, biliary, urinary anastomoses)
Non absorbable sutures
Steel, silk, nylon, prolene
Permanent support and slower healing tissues (vascular, tendon, fascia)
Monofilament
Superficial wound closure (less tissue reaction)
Complications of Hip prosthesis
Dislocation Osteolysis Metal sensitivity Nerve injury Chronic pain.
Oropharyngeal airway
FIrst line airway adjunct
risk of vomiting and aspiration if gag reflex is present.
Nasopharyngeal airway
Decreased Conc , intact gag reflex. horizontally inserted. pt height - Can casue ulcers, nosebleeds. Severe head or max fax trauma/basal skull fracture.
LMA
Bridge to intubation
<2h surgeries
no protection v aspiration.
Avoid if reduced chest compliance
ET Tube
Definitive airway
laryngoscope
above carina
inflate cuff - prevent gastric aspiration
check w symmetrica lexpansion, breath sounds, CXR
Tracheostomy
Below glottis
reduced deadspace, improved oral hygiene, reduced sedation.
Indication - weaning off mechanical ventilation. severe max fax trauma.
Complications of intubation
Early - cant truama bleeding cuff perforation endobronchial intubation
Delayed - tracheal necrosis/stenosis
Indications of intubation
Decreased consciousness and loss of airway reflexes (GCS <8)
Failure to oxygenate (T1RF)
Failure to ventilate (T2RF)
Failure to maintain airway patency (obstruction, angioedema, facial/upperairway trauma)
NG tube
ci if basal skull fracture
Short-med term enteral nutriion (max 4-6 w)
check position aspirate pH <4. CXR
2 ports for TPN/Drugs
Indication
- Short/med term feeding - w functional GIT
- Admin drugs/contrast in unsafe swallow.
Complications: NGT - nasal trauma, malposition , blockage
Feeding - refeeding syndrome, electrolyte imbalance, intolerance -diarrhoea.
Ryles tube
Wide bore 16-18Fr
Prevent tube collapse during aspiration
Indication: Gastric decompression (bowel obstruction, ileus, post surgical)
Complications:
Pulmonary - aspiration pneumonia, ptx
GI - malposition, obstruction, reflux oesophagitis, gastritis, visceral perforation.
Stool sample pot
Bristol 5,6,7 warrant samples. Tests - MCS - 4days Rotavirus, adenovirus, norovirus - same day GDH - Cdiff Cdiff toxin - 2 weeks Ova cysts, parasites - 4 days helicobacter antigen - 1 wk
urinary catheters
Types ;
Foley - <28days latex
Long term - silicone
3 way - haematuria- washout/irrigation.
indications
- Diagnostic: UO measure, sterile sample, renal tract imaging.
- Therapeutic - retention, immobility, bladder irrigation
Complications
- Early - create false tract, urethral rupture, paraphimosis, haematuria
Late - infection, blockage, stricture, stones.
CI -Blood at meatus -high prostate scrotal haematoma pelvic fracture
Shouldered syringe
used to inject haemorrhoids, above dentate line.
5% phenol in almond oil.
Pain, damage, bleeding
Late - prostatitis, imptotence.
Cannula colours
Orange = 14 G - blood tx, surgery, trauma
Grey = 16G rapid fluids, trauma, blood tx
Green = 18G rapid fluids, trauma, rapid blood
Pink: 20G most infusions. rapid fluids, trauma. routine blood transfusion
Blue: 22G Most infusions. paeds, older adults
routine blood transfusion
Yellow: 24G neonate, paeds, blood transfusion.
Purple 26G paeds, neonate
Complications of cannulae
Extravasation Haematoma Phlebitis Thrombosis Systemic infection
