Instruments Flashcards
What is this?
Absorbable sutures - broken down by physiological enzymatic degradation & hydrolysis
- Monocryl - monofilament, increased throws for stable knot
- Vicryl - poly-filament, less throws but increased fraying issues & local tissue inflammation
What is this?
ABG syringe
- pH – acidosis/alkalosis
- pO2 and pCO2 – identification of respiratory failure (arterial)
- Bicarbonate – renal and compensation of acidosis/alkalosis
- Lactate – poor perfusion
- Hb – anaemia
- Na+/K+ quick testing of electrolytes – handy in monitoring and treatment of hyperkalaemia.
What are these? What is the order of draw?
Blood bottles are colour coded to use for different tests
- Purple – contains EDTA. Used for haematology.
- Pink – contains EDTA. Used for group and save and crossmatch.
- Blue – contains buffered sodium citrate. Used for coagulation screening.
- Yellow/gold – known as SST. Contains silica particles and serum separating gel. Used for a variety of tests that require separated serum for analysis, including immunology, microbiology, biochemistry, endo, toxicology, oncology, U+E and liver function.
- Grey – contains sodium fluoride and potassium oxalate. Used for glucose and lactate tests.
- Red – contains silica particles. Used for sensitive tests including toxicology, drug levels, antibodies, hormones and bacterial and viral serology.
- Dark green – contains sodium heparin. Used for ammonia, renin, aldosterone and insulin tests.
- Light green – Known as PST. Contains lithium heparin and a plasma separator gel. Used for routine biochemistry.
- Rust Top- Viral Immunology.
What are these? Which do you fill first?
Blood culture bottles - one for aerobic bacteria (blue top) and one for anaerobic bacteria (purple top)
- Blood cultures are a useful investigation in a case of pyrexia or suspected systemic sepsis.
Remember, fill the aerobic bottle first if you are using a vacutainer.
What is this?
BM monitoring kit - test real-time capillary BM lvls
- Used in DM to guide insulin dosing
- Also used in DKA/HHS/hypoglycaemia and reduced GCS
- Key element to ALS & ATLS protocols (A-E)
What are these? Complications?
Breast implants - a variety of shapes & sizes to suit body habitus
- Made from silicone, last for 10-15yrs, overtime degrade/can rupture
- Used for breast augmentation, breast reconstruction after mastectomy and gender reassignment
- Complications:
- Rupture, infection, capsular contracture, erosion through skin, migration
- Rare risk of ALCL (anaplastic large-cell lymphoma)
What is this?
Catgut suture - natural absorbable suture
- Been replaced by newer synthetic absorbable materials but still used in stomas and circumcisions
What is it?
Catheter bag - includes a flexible tube used to empty the bladder and collect urine in a drainage bag
- Urethral - inserted through the tube that carries urine out of the bladder
- Suprapubic - through a small opening made in lower abdomen
What is it? Indications & complications?
Central line insertion pack
- 3-5 lumen cannula, guidewire, dilator, scalpel, and introducer needle
- Central venous catheters are placed into subclavian or internal jugular veins via USS
- Key indications include (meds that can be harmful orally/peripherally):
- Parenteral nutrition, fluid resuscitation, infusion of irritant drugs, vasopressors, inotropes
- Emergency venous access - blood tests & central venous pressures
- Complications of insertion:
- Pneumothorax
- Sepsis
- Thrombosis
- Misplacement
What is it?
Chest drain bottle
- System:
- Passive drainage – underwater seal which employs a positive expiratory pressure and gravity to drain the pleural space - passive closed drainage system
- Suction drainage - active closed drainage system
- After a chest drain is inserted –> bubbling in water as the air leaves pleural space
- Bottle can also be used to collect blood, fluid and pus from the pleural space
What is it?
CSF manometer - identification of opening pressures + represent ICP during LP
- Measured in cm H2O
- Accepted opening pressures = 10-18cm H2O if lying on side; 20-30cm H20 when sat up
What is it?
Devers retractor - used in open abdominal surgery (hold edges open to reach underlying organs
- Different sizes & types of retractors
What is this?
Disposable rigid sigmoidoscope - for inspection of rectum & lower sigmoid colon
- Explain procedure –> must attach light source + air pumping device, patient put in LLP & PR performed –> lubricated with jelly and device inserted pointing towards umbilicus
- Air pumped in to allow you to see direction of rectal lumen
- Biopsies can be taken of rectal mucosa through sigmoidoscope (e.g. in UC
What is this?
Drainage bag - connected to NG tube or a drain coming out of the abdomen
- Drainage relies on gravity = closed passive drainage system
What is it? Indications? Process of insertion? How to check placement? Complications?
Endotracheal tube with tape & syringe
- Definitive airway
- Used in trauma cases/surgery with GA & GCS <8
- Process:
- Anaesthetist inserts into trachea via oropharynx with laryngoscope & bougie
- Connected to O2 for adequate O2/CO2 gas exchange
- Balloon at the end of tube is inflated with air via blue side port - maintains position and protects airway from aspiration
- How to check appropriate placement:
- Symmetrical chest rising on ventilation
- Breath sounds bilaterally
- No gurgling over epigastrium (oesophageal intubation)
- Complications:
- Oesophageal placement
- Laryngeal injury
- Pneumothorax
- Atelectasis
- Infection
What is it?
Epidural insertion pack:
- Epidural needle (touhy-type) - clear depth marking for accurate insertion depth reading
- Epidural catheter - designed for short-term/long-term anaesthesia & pain-relief
- Epidural catheter adapter - safe & secure attachment to catheter
What is it?
Faeces sample pot - enable identification of pathogens that are infecting the gut
- Ideally Bristol stool chart 5/6/7 warrant samples
- Possible tests:
- Rotavirus/adenovirus/norovirus - same day
- MC&S - 4 days
- Microscopy for OCP (ova, cysts, parasites) - 4 days
- H. pylori testing - 1wk
- C. diff testing
What is it?
Feeding NG tube - long-term enteral nutrition
- Tube inserted into nostil after lubrication
- Advance tube after patient swallows
- Correct positioning checked with CXR (for the wire) –> wire removed once happy with positioning
What is it?
A bag of 5% dextrose - can be used in conjunction with normal saline to provide the normal daily fluid requirement for a patient.
- One litre of 5% dextrose contains 50g of dextrose in 1 litre of water.
- It should be remembered that because the sugar in this fluid is metabolised to carbon dioxide and water you are essentially giving them water.
What is it?
Fluid giving set - used to give IV fluids, IV fluid meds incl. abx & blood products
What are they?
Forceps = non-toothed (top) & toothed (bottom).
- Used to grasp edges of tissue and the general rule is that toothed should only be used for skin
- Once in the peritoneal cavity, the general rule is that only non-toothed should be used.
- Grasp these forceps between thumb and fore-finger in a pincer grip
What is it?
Fracture plate used with screws to internally fix a bone fracture
What is it?
500ml of gelofusin = artificial colloid solution
- Colloid solutions raise plasma oncotic pressure –> expand intravascular compartment e.g. in shock (sepsis, hypovolemia)
- Other examples include albumin and blood
What is it?
Hartmann/Plasmalyte solution
- Crystalloid solution containing Na, Cl, Bicarb, lactate
- Similar composition to extracellular fluid –> normal daily fluid requirements/supplement additional loses
- Favourite solution of anaesthetists, normally used in trauma & Advanced Trauma and Life Support (ATLS) guidelines.
What is it? Indication? Complication?
Hemiarthoplasty hip prosthesis
- It is used in cases of intracapsular fractures of the neck of femur
- Avascular necrosis of the femoral head is a common complication
What is it? Indications?
Hickman line - long-term central venous line, inserted in similar way to central line (subclavian)
- Remnant of line tunneled subcutaneously –> decreases line infection
- Indications: long-term parenteral nutrition/IV abx therapy/chemo
What is it? Indications? Complications?
Total hip replacement: consists of femoral stem with femoral head, acetabular cup (inserted into acetabulum)
- Indications: replace hip joint e.g. severe osteoarthritis
- Complications: DVTs, inf, dislocation (2%)