Images and Instruments Flashcards
What are the complications of cannula?
Exstravasation Haematoma Phlebitis Thrombosis Systemic infection
What is a the description of the a central venous catheter (central line)?
A catheter which is inserted into either the jugular vein, subclavian vein or femoral vein
How long a central venous catheter used for?
3 days (it is short term)
What are the indications for a central venous catheter? (7)
- Central administration of medication
- Vasopressors
- Inotropes
- Total parenteral nutrition
- Chemotherapy
- Access for extracorporeal circuit - renal replacement therapy
- Monitoring central venous pressure
Describe a tunnelled central line
Catheter inserted into the subclavian through a subcutaneous tunnel
What are the other names for a tunnelled central line
Hickman line
Tesio line
What are the indications for a tunnelled central line? (6)
- IV administration of medication
- Antibiotics
- Chemotherapy
- Regular vascular access
- Renal replacement therapy
- Blood sampling
What does PICC line stand for?
Peripherally inserted central catheter
How long can a tunnelled central line be used?
Long term - months to years
Describe a peripherally inserted central catheter
inserted into the basilic or cephalic veins with the tip sitting into the superior vena cava
How long can a PICC line be used for?
Medium term - weeks to months
What are the indications for a PICC line? (4)
- IV administration of medication
- Antibiotics
- Chemotherapy
- Poor peripheral access
What are the immediate complications of central venous access? (6)
- Haemorrhage
- Pneumothorax
- Arterial puncture
- Arrhythmias
- Cardiac tamponade
- Air embolism
What are the delated complications of central venous access? (6)
- Venous stenosis
- Thrombosis
- Erosion of vessel
- Line fracture
- Catheter colonisation
- Line related sepsis
Describe a chest drain
A drain which is inserted into the triangle of safety for drainage of pleural space via a tube
How is the position of a chest drain confirmed?
CXR
What are the indications for chest drain?
- Pneumothorax
- Pleural effusion
- Traumatic haemopneumothorax - wide bore
- Post -surgical (cardiac, thoracic, oesophagus)
What are the borders of the triangle of safety
Lateral edge of pec major
Lateral edge of latissimus dorsi
5th ICS
Apex of axilla
Why do you insert it above the rib?
To avoid the neurovascular bundle
What are the complications of Chest drains?
Insertion related:
- Damage to nearby structures (intercostal artery, solid organ)
- Subcutaneous emphysema
- Pneumothorax
Position related:
- Obstruction
- Kinking
- Dislodged
- Re-expansion pulmonary oedema
Infection
- Wound infection
- Pneumonia
- Empyema
Describe chest drain bottle
Bottle filled with sterile water with drainage tube submerged
Creates an underwater seal and one-way valve
Where should a chest drain bottle be position?
Below the patient and kept upright
What does the swinging represent in the chest drain bottle? (state what up and down represents)
Movement of the water column with the respiratory cycle
Up in inspiration and down in expiration
What does the bubbling represent in the chest drain bottle?
Bubbling = air leaving the pleural cavity
Stops when all air is expelled
Describe surgical drains
Tubes inserted into the surgical field to allow decompression of fluid or air
What are the indications for surgical drains?
- Drainage of a potential space post-surgery
- Removal of harmful fluid - e.g. blood, pus, bile
- Detection of bleeding or leakage - e.g. anastomosis
Multiple uses in upper GI, orthopaedic, cardiothoracic, plastic, breast, head and neck surgery
What is the difference between open and closed surgical drains?
Open drains (e.g. corrugated or rubber) connect to the external environment Closed drains connect via tubing to a drain bottle
What are open drains used for?
Superficial wounds but increase the risk of infection
What is the difference between active and passive surgical drains?
Active drains maintained under negative pressure, improves wound closure
Passive drains use gravity
Where in the body are passive drains preferred and why?
In the abdomen because there is less risk of visceral perforation
What are the complications of surgical drains?
- Ascending infection (more common with open or passive systems)
- Foreign body reaction (fibrosis or granulation)
- Migration
- Obstruction/kinking
- Fistulation
Describe nasogastric feeding tube
A tube which goes in through the nostril, down the oesophagus into the stomach with aid of a guidewire to give stiffness to the tube
- Narrow bore nasogastric tube (<9 Fr)
How is the position of NG tube confirmed?
pH aspirate (<4.5) or CXR
What are the indications for Nasogastric feeding tube?
- Short/medium term feeding (max 4-6 weeks) in patients with a functional GI tract
- Administration of drugs/contrast in an unsafe swallow
What is a Ryles tube?
A wide bore tube (16-18 Fr) nasogastric tube - no guidewire is needed
What are the indications for a Ryles NG tube?
Gastric decompression (in bowel obstruction, ileus, post-surgical)
What is the benefit of having thicker walls in a Ryles NG tube?
Prevent tube collapse during aspiration of gastric contents
What 4 questions can you ask to make sure the position of the NG tube is correct when looking at the CXR?
- Does the tube path follow the oesophagus/avoid the contours of the bronchi?
- Does the tube clearly bisect the carina or the bronchi?
- Does it cross the diaphragm in the midline?
- Is the tip clearly visible below the left hemi-diaphragm?
What are the complications of nasogastric tubes?
Pulmonary
- Aspiration pneumonia (incorrect position)
- Pneumothorax
GI
- Malposition in the GI tract
- Obstruction/knotting/kinking
- Reflux oesophagitiis
- Gastritis
- Visceral perforation (rare)
What is post-pyloric feeding?
When the NG tube is passed through the pylorus and rests in the jejunum
How do you insert a post -pyloric tube?
Using endoscopic or fluoroscopic means
and this is also used to confirm it is in the right place
What are the indications of Post-pyloric feeding?
- Gastroparesis e.g. in critical illness, diabetes, neurological (MS, Parkinson’s)
- Gastric outlet obstruction e.g. peptic ulcer disease, malignancy
- Recurrent aspiration
- Pancreatitis (less stimulation of pancreas)
Describe urinary catheter
A catheter inserted into the urethra to the bladder into the bladder for drainage of urine
What are the 3 types of urinary catheter?
- Foleys catheter
- Long-term catheter
- Three-way catheter
What are the typical sizes of urinary catheter?
14-16 Ch
How long can Foleys be used for vs Long term?
Foleys - 28 days
Long term - more than 6 weeks