Instruments Flashcards

1
Q

What is this?

A

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
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2
Q

What is this?

A

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.
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3
Q

What are these? What is the order of draw?

A

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.
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4
Q

What are these? Which do you fill first?

A

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.

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5
Q

What is this?

A

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)
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6
Q

What are these? Complications?

A

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)
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7
Q

What is this?

A

Catgut suture - natural absorbable suture

  • Been replaced by newer synthetic absorbable materials but still used in stomas and circumcisions
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8
Q

What is it?

A

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
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9
Q

What is it? Indications & complications?

A

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
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10
Q

What is it?

A

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
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11
Q

What is it?

A

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
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12
Q

What is it?

A

Deaver retractor - used in open abdominal surgery (hold edges open to reach underlying organs

  • Different sizes & types of retractors
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13
Q

What is this?

A

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
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14
Q

What is this?

A

Drainage bag - connected to NG tube or a drain coming out of the abdomen

  • Drainage relies on gravity = closed passive drainage system
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15
Q

What is it? Indications? Process of insertion? How to check placement? Complications?

A

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
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16
Q

What is it?

A

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
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17
Q

What is it?

A

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
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18
Q

What is it?

A

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
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19
Q

What is it?

A

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.
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20
Q

What is it?

A

Fluid giving set - used to give IV fluids, IV fluid meds incl. abx & blood products

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21
Q

What are they?

A

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
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22
Q

What is it?

A

Fracture plate used with screws to internally fix a bone fracture

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23
Q

What is it?

A

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
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24
Q

What is it?

A

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.
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25
Q

What is it? Indication? Complication?

A

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
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26
Q

What is it? Indications?

A

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
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27
Q

What is it? Indications? Complications?

A

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%)
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28
Q

What is it?

A

Histology specimen pot - routinely used for surgery

  • Biopsies, resected tumours –> placed here + set in formalin
  • Part of WHO surgical safety checklist
29
Q

What is it? Indication?

A

Intramedullary femoral nail - used to internally fix femoral shaft fractures

  • Interlocking screws fix nail –> removed after 12/18 months
30
Q

What is it? Indication?

A

Instillagel

  • Sterile gel containing LA & lubricant
  • Indication: male & female catheterisation
31
Q

What is it? What are the different colours & sizes (x3)?

A

IV cannular & octopus giving set

  • Multiple different cannula systems are available:
    • New premade dual lumen cannula need no saline prep –> lumens flushed after blood taken to prevent clot formation
    • Old systems need pre-flushed octopus as an adjunct
  • Cannulae come in different sizes:
    • 22G (Blue) - blue is MAN’s fave colour –> adult men
    • 20G (Pink) - pink is WOMAN’s fave colour –> adult women
    • 16G (Grey) - fluid resus & trauma = large-bore cannula
32
Q

What is it?

A

Laparoscopic port - used in laparoscopic surgical procedures e.g. laparoscopic cholecystectomy

  • These ports allow the surgeon to insert a telescope and instruments in the patient
33
Q

What is it? Benefit? Types?

A

Laryngeal mask airways (LMAs) & airway adjuncts (iGels)

  • Supraglottic airway devices - step prior to intubation –> good for elective procedures, cardiac arrests, prehospital airway Mx
  • Benefit - reduced trauma to oropharynx (vs intubation) –> reduce hospital stay in elective patients
  • Types:
    • iGels contain thermoplastic elastomer that moulds to perilaryngeal framework with patient temp
      • Device tip extends into the oesophageal opening - has gastric channel to allow passing of NG tube into stomach
      • Also seals off oropharyngeal opening from larynx preventing aspiration
      • Can be used as conduit to intubation
    • Laryngeal mask airways (LMAs) do not eliminate the aspiration risk, device inflation can also cause pressure lesions & nerve palsies
34
Q

What is it? Indications? Complications?

A

Laryngoscope used to aid intubation, visualisation of the larynx to aid Dx of vocal problems & strictures

Blades:

  • Curved (macintosh)
  • Straight (miller)

Complications if inexperienced:

  • Mild soft tissue injury
  • Laryngeal/pharyngeal scarring
  • Ulceration, abscess formation
35
Q

What is it? Indication?

A

Leg bag - attached to urinary catheter

  • Indicated for mobile patients with indwelling urinary catheter e.g. man with incontinence following sphincter damage after multiple TURPs
36
Q

What is it? Indication?

A

Mannitol is an osmotic diuretic –> lower raised ICP or drive the urine output in a patient with obstructive jaundice to prevent hepatorenal syndrome.

37
Q

What is it? Indication?

A

Monopolar diathermy handle - used for coagulation & dissection of tissue during open/laparoscopic surgery

38
Q

What is it? Complications?

A

Nasal cannula are commonly used mode of oxygen delivery both in hospital and in the community.

  • It is widely used to carry 1-4L of oxygen per minute (can be up to 5L/min). This delivers between 28-44% of oxygen.
  • These cannulae differ from high-flow therapy (NIV).

Complications: nasal sores, epistaxis –> apply water-based creams to moisturise

39
Q

What is it?

A

Nasal Speculum is designed to open and expand the nasal cavity

40
Q

What is it? When is it used?

A

Nasopharyngeal airway - inserted into the nose using rotational action

  • Provide an airway in people with decreased GCS/decreased gag reflex
  • The diameter tube should be sized against the patient’s little finger distal phalanx
  • A safety pin is placed in the end of the tube to prevent it being inhaled.
41
Q

What is it? Indication?

A

Nebuliser mask & chamber

  • Used to administer all commonly prescribed bronchodilators for respiratory conditions
  • Aerosol drug effectiveness depends on the quality of its delivery to the lungs.
42
Q

What is it?

A

Needle holders - special forceps designed to hold the needle to allow the surgeon to suture accurately

43
Q

What is it?

A

Neurology exam kit:

  • 128Hz tuning fork (larger, vibration sense) - let’s vibrate
  • 512Hz tuning fork (smaller, Weber’s & Rinne’s) - I hear you
  • Neurotips - blunt/sharp sensation in sensory exam (spinothalamic)
  • Orange stick - babinski reflexes (plantar) - hold like a pen (thumb & middle finger)
  • Tendon hammer - reflexes
  • Other: snellen chart, opthalmoscope, tongue depressor
44
Q

What is it? Indications?

A

Non-absorbable sutures

  • Ethilon (nylon) is monofilament – therefore requires multiple throws to maintain a strong knot over time - limited to percutaneous closure
    • Prolene is another example of non-absorbable suture - less likely to loosen over time
  • Non-absorbable sutures are used in longer-term tissue approximation:
    • Percutaneous wound closure
    • Bowel anastomosis (Prolene)
    • Vascular anastomosis (Prolene)
45
Q

What is it?

A

Non-rebreather mask

  • Used to assist in O2 delivery, requires the patient to breathe unassisted
  • Covers nose & mouth, has attached reservoir bag that connects to external O2 tank/bulk O2 supply system
  • Flow rate 10-15L/min - delivers up to 90% O2 conc
46
Q

What is it? Indication?

A

Normal 0.9% saline - crystalloid solution containing 153mmol NaCl

  • Used to provide normal daily fluid requirements for patient or to replace additional losses e.g. D&V
47
Q

What is it?

A

Oropharyngeal airway - airway for patient when impaired consciousness

  • Sized measuring angle of mouth to angle of jaw
  • Inserted into mouth upside down and rotated in oral cavity (correct way up in children)
48
Q

What is it? Indications?

A

PICC line (peripheral IV central catheter) - commonly used IV access option

  • Has features of both central & peripheral venous access - suitable for long-term vascular access for:
    • Blood sampling
    • Chemotherapy administration
    • Infusion of hyperosmolar solutions e.g. for total parenteral nutrition
49
Q

What is it? Indications?

A

Proctoscope - used to visualise anal canal & lower rectum and when injecting/banding haemorrhoids

  • Placed in LLP & PR exam done –> proctoscope then attached to light source & lubricated before insertion
50
Q

What is it? Indication? Procedure?

A

Ryles NG tube - used for decompression (drip & suck) in bowel obstruction but can also be used to give drugs/contrast into GI tract

  • Require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe, a drainage bag and pH dipstick.
  • Correct position of tube checked by aspirating gastric contents & checking for acidity on pH dipstick –> CXR to identify tube
  • Once in correct position –> bag attached & taped to patient face
51
Q

What is it?

A

Types: disposable (on top) and non-disposable (below, blade must be changed).

  • Blades vary by size & shape
  • Used for cutting tissue during surgical procedures
52
Q

What is it? Indications?

A

Seldinger chest drain insertion pack - used on wards/outpatients to insert chest drains

  • Indications include:
    • Pneumothorax (in ventilated patient, tension pneumothorax after needle aspiration, persistent pneumothorax or large spontaneous pneumothorax)
    • Symptomatic malignant pleural effusions
    • Empyema
    • Traumatic haemothorax
53
Q

What is it?

A

Self-retaining retractor to hold wounds open e.g. during hernia repair or appendicectomy

54
Q

What is it?

A

Self-inflatable bag valve mask

  • Indication: cardiopulmonary resus
  • Very useful to deliver high O2 lvls even at low-flow rates
  • Can deliver 100% O2 with flows above 10L/min
55
Q

What is it? Indication?

A

Shouldered syringe - used to inj haemorrhoids w/ 5% phenol in almond oil

  • Injection done via proctoscope - carried out above dentate line as insensitive
56
Q

What is it? Types depending on indication?

A

Urinary catheter - sizes measured in french (Ch). 14Ch is normal starting point (large Ch is larger diameter)

Types:

  • Foleys catheter (centre) - short-term up to 28 days (latex)
  • Long-term catheter (left) - up to 3 months (silicone)
  • Three-way catheter (right) - in cases of haematuria for bladder washout & irrigation (larger Ch needed as 3 lumens)
57
Q

What is it?

A

Single lumen CVP cannula - inserted in the superior vena cava (via internal jugular/subclavian veins)

  • Can be single/triple lumen lines, mainly used to measure central venous pressure but can be used for drugs e.g. amiodarone, dopamine, chemo
58
Q

What is it? Indications?

A

Specimen swabs

  • Indications:
    • Used routinely in MRSA screening (nasopharyngeal/rectal)
    • Bluetop transwab amies - recover aerobes, anaerobes & fastidious organisms
    • Excellent to aid gram stains
    • Take specimens from wounds, skin, urogenitalia, throat
59
Q

What are they?

A

Spinal needles

  • Types:
    • Traumatic needles = cutting needles (top picture)
      • Increased risk of post-LP headaches, severe headaches that may require blood patching to help Tx Sx and additional hospital visits for pain
    • Pencil-point (atraumatic) needles (bottom pic) = blunt-tipped, allowing for blunt dissection of anatomy rather than cutting
      • Needle of choice for LP (not for epidural) –> much lower risk of post-LP headaches and backache.
60
Q

What is it? Indication?

A

Stiff neck cervical collar

  • Used to stabilise the cervical spine in a trauma patient when used in conjunction with 2 sand bags and tape (Triple Immobilisation).
  • They are sized by measuring number of fingers from the clavicle to the angle of the mandible, compared to the measuring peg on the stiff neck collar.
61
Q

What is it? Indications?

A

Stoma bag

  • Prosthetic medical device for collection of waste from surgically diverted bowel
  • Pouching systems are most commonly associated with colostomies, ileal conduits and ileostomies.
62
Q

What is it? Indications?

A

Surgical Chest Drains (thoracostomy) are used as an emergency procedure

  • Differ from seldinger chest drains which can be inserted by trained physicians
  • Sizing is measured in French (Ch) – smaller calibre drains used for pneumothorax, larger calibres needed for haemothorax, effusion and empyema.
  • Indications include: Pneumothorax, Malignant Pleural Effusion, Empyema, Traumatic pneumothorax or haemothorax, peri-operative.
  • ATLS guidelines should be followed in emergencies.
63
Q

What is it? Indications?

A

Swan-ganz catheter

  • Used to measure pressures in heart, pul wedge artery pressure, cardiac output
  • Used in intensive care & typically inserted into central vein
64
Q

What are they? Indications?

A

Thromboembolic deterrent stockings - for all patients undergoing surgery + those immobile to help prevent DVT

  • Available in different sizes + used with LMWH
  • C/I if arterial disease of lower limb
65
Q

What is it? Indications?

A

Tracheostomy = definitive airway (protects patient’s lungs from aspiration)

  • Indications:
    • Most commonly used on patient being ventilated on ICU
    • Allows more efficient ventilation of patient with decreased dead space + allows more effective suctioning of the airways
    • Upper airway obstruction/after laryngeal surgery.
66
Q

What is it? Indication?

A

Trucut biopsy needle - used to take histological specimens from lesions, e.g. breast lumps or liver.

  • Can be done under LA
67
Q

What is it? Indications?

A

Urine dip + universal sterile container

  • Very useful in acute clinical environment & primary care
  • Assesses blood (haematuria), protein (renal disease), nitritis/leukocytes (inf), glucose (DM), ketones (DKA), bilirubin/urobilinogen (haemolysis & liver pathology)
  • +ve nitrites & leukocytes –> urine MC&S
  • Positive blood & protein –> urine protein: creatinine ratio (PCR)
68
Q

What is it? When to use?

A

Urometer drainage bag - allows monitoring of urine collection as has clear graduation scheme

  • Reflects accurate UO/hr
  • Used in surgery, post-op & monitor fluid status
69
Q

What are they? Indications? Types?

A

Venturi mask - used in T2RF (COPD), when don’t want to over oxygenate

  • Deliver 24-60% O2, flow rate depends on colour:
    • Blue - 2-4L/min 24%
    • White - 4-6L/min 28%
    • Yellow - 8-10L/min 35%
    • Red - 10-12L/min 40%
    • Green - 12-15L/min 60%