Instruments Flashcards
Absorbable sutures
Broken down by physiological processes such as enzymatic degradation and hydrolysis.
Materials of absorbable sutures
- Monocryl – monofilament, increased throws for stable knot (9); ~100 days for complete absorption
- Vicryl – polyfilament, less throws (3) but has increased fraying issues and local tissue inflammation; ~42-60 days for complete absorption
- PDS takes ~200 days for complete absorption
- Tensile strength of sutures rely on diameter of thread.
Indications for absorbable sutures
Deep tissues and tissues that heal rapidly, including:
- small bowel anastomosis
- suturing in the urinary or biliary tracts
- tying off small vessels near the skin.
Arterial Blood Gas Syringe
a version of point-of-care testing (POCT) and therefore you can attain immediate results.
What can affect results of an ABG?
Note the patient’sbodytemperatureand ifthe patient is currently receivingoxygentherapy, note theoxygen delivery deviceandflow rate.
ABG position of hand
Position the patient’s hand preferably on a pillow for comfort with the wrist extended by approximately 20-30°.
How does oxygen therapy impact ABG results?
- PaO2should begreater than 10 kPawhen oxygenating on roomairin a healthy patient.
- If the patient is receivingoxygen therapytheirPaO2should be approximately10kPa less thanthe% inspired concentration FiO2(so a patient on 40% oxygen would be expected to have a PaO2of approximately 30kPa).
What are the absolute contraindications to ABG?
peripheral vascular disease in the limb, cellulitis surrounding the site or arteriovenous fistula.
What are the relative contraindications to ABG?
impaired coagulation (e.g. anticoagulation therapy, liver disease, low platelets <50)
Blood bottles
colour coded to use for different tests.
Purple blood bottle
Contains EDTA - potent anticoagulant (binds to calcium in blood).
Used for haematology.
The purple tube needsinverting about 8 timesto mix the sample with the EDTA.
NOTE: for ESR, a full bottle is needed (otherwise 1ml enough)
Pink blood bottle
Contains EDTA.
Used for group and save, crossmatch and DAT.
needsinverting about 8 timesto mix the sample with the EDTA
NOTE: patient details must be filled by hand at the bedside
Group and save (G&S) test
this simply means the patient’s blood is typed and tested for antibodies, then saved in the lab in case it is required; it DOES NOT get you blood products for transfusion. If you need blood products you have to request a crossmatch.
Crossmatch blood test
this means that the patient’s blood is typed and tested as above, then matched to specific units of blood, platelets or other products for transfusion. You need to specify on the form how many units you need, why you need them and when they are required. A full crossmatch takes about 45-60 minutes in the lab – if you have an unstable bleeding patient and think you’ll need blood products sooner than this, you still need to send a crossmatch sample, but you can ask the lab for units oftype-specificblood (which take 10-20 minutes), or in a genuine emergency you can use their stocks ofO negativeblood from the fridge.
Blue blood bottle
Contains buffered sodium citrate - disrupts the clotting cascade
Used for coagulation screening.
Bottle must be filled to the line marked around the edge.
Which clotting tests must be taken at specific times?
Some clotting tests must betaken at specific times; INRs should ideally be done in the morning, and anti-Xa assays must be taken 3-4 hours after tinzaparin is given. APTR timings are often indicated on the prescription algorithm.
Yellow/gold blood bottle
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, endocrinology, toxicology, oncology, U+E and liver function.
Grey blood bottle
contains sodium fluoride and potassium oxalate.
Used for glucose and lactate tests.
must beinverted about 8 timesto mix the sample with the fluoride and oxalate.
Red blood bottle
contains silica particles.
Used for sensitive tests including toxicology, drug levels, antibodies, hormones and bacterial and viral serology.
Dark green blood bottle
contains sodium heparin.
Used for ammonia, renin, aldosterone and insulin tests.
The green bottle needs to beinverted about 8 timesto mix the sample with the heparin. This bottle cannot be reliably used to assess sodium levels.
Light green blood bottle
Known as PST.
Contains lithium heparin and a plasma separator gel - acts to separate the plasma layer.
Used for routine biochemistry.
needsinverting about 8 times
NOTE: This bottle cannot be reliably used to assess lithium levels.
Rust Top blood bottle
Viral Immunology
Blood culture bottles
one for aerobic bacteria (blue top) and one for anaerobic bacteria (purple top).
Remember,fill the aerobic bottle first if you are using a vacutainer.
Blood glucose monitoring kit
CBGs are also important in diabetic crises, such as DKA, non-ketotic hyperglycaemia, hypoglycaemia and reduced GCS.
Breast implants - Used for breast augmentation and breast reconstruction after mastectomy
Made from silicone
They last for about 10-15 years on average. Over time they degrade and can rupture.
Complications of breast implants
- Rupture
- Infection
- Capsular contracture
- Erosion, through the skin
- Migration
- ALCL (there is a very rare risk of ALCL – Anaplastic Large-Cell Lymphoma – a recently described complication)
Catgut suture
A natural absorbable suture - Catgut as been replaced my many of the newer synthetic absorbable materials, however you will still see it being used in the formation of stomas and circumcisions.
Catheter Bag
includes a flexible tube used to empty the bladder and collect urine in a drainage bag.
Seldinger central line (insertion) kits
Includes a 3-5 lumen cannula, guide wire, dilator, scalpel, and introducer needle.
Indications for central line
Central venous catheters are placed often into the subclavian or internal jugular veins via ultrasound. They are useful in the delivery of medications/fluids that may be harmful orally or peripherally. Blood tests and central venous pressures can also be obtained.
- parenteral nutrition
- emergency venous access
- fluid resuscitation
- infusion of irritant drugs
- vasopressors, inotropes.
Complications of central line
Immediate: pneumothorax, bleeding, damage, misplacement
Early: skin infection, nosocomial infection, dislodged or blocked, sepsis
Late: thrombosis (central vein with scarring)
Chest drain bottle
Passive drainage –underwater sealwhich employs a positive expiratory pressure and gravity to drain the pleural space.
Borders of triangle of safety
- Pectoralis major
- Latissimus dorsi
- 5thintercostal space (roughly at the level of the nipple)
- Also: base of axilla
CSF manometer
For identification of opening pressures and represent Intracranial Pressure during Lumbar Puncture.
Measurement is in cm H2O
What are normal CSF opening pressures?
Current accepted opening pressures (normal) are 10-18 cm H2O if patient is lying on their side, 20-30 cm H2O when sat up.
Dacron graft
Devers Retractor
used in open abdominal surgery to allow the surgeon to operate.
Disposable Rigid Sigmoidoscope
used for the inspection of the rectum and lower sigmoid colon.
attached to a light source and a air pumping device.
This is a drainage bag which can be connected top either a nasogastric tube or a drain coming out of the abdomen.
Drainage relies on gravity so this is an example of a closed passive drainage system.
Endotracheal Tube with Tape and Syringe
Used commonly in trauma cases, surgery with general anaesthetic and in patients with a GCS <8.
What is used to insert an Endotracheal Tube with Tape and Syringe?
a laryngoscope and Eschmann Tracheal Tube Introducer (ETTI – or otherwise known as thebougie)
Epidural Insertion Pack
What is included in an epidural insertion pack?
- Touhy/Epidural needle – Touhy type needle is provided with clear depth marking for accurate insertion depth reading.
- Epidural catheter- It is specially designed for short term and long term anaesthesia and pain relief.
- Epidural catheter adapter – This catheter adapter is for safe and secure attachment to the catheter for convenience of the procedure
Faeces Sample Pot
Stool samples enable the identification of pathogens that are infecting the gut. Ideally, Bristol stool chart 5,6 and 7 warrant samples.
Tests that can be done on a stool sample (7)
- MCS – takes up to 4 days for result.
- Rotavirus/Adenovirus/Norovirus – same day result
- Glutamine Dehydrogenase (GDH) (C.diff)
- C.Diff Toxin test only performed if GDH is positive
- C.Difficile ribotyping results take up to 2 weeks
- Microscopy for Ova, Cysts and parasites – 4 days
- Helicobacter antigen testing – up to a week
Feeding nasogastric (NG) tube
used to give long term enteral nutrition in patients.
It is thin bore and soft making it more comfortable for patients, it is also made of silastic which blocks less often.
5% dextrose fluid
can be used in conjunction with normal saline to provide the normal daily fluid requirement for a patient.
How much dextrose is found in 1L of 5% dextrose
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.
Fluid giving set
Regularly used on wards to give IV fluids, administration of IV medications including antibiotics and blood products.
Forceps
Two common types of forceps include non-toothed (top) and toothed (bottom).
Which type of forceps should be used for the skin?
Toothed forceps (should only be used for skin).
Which type of forceps should be used once in the peritoneal cavity?
Once in peritoneal cavity, the general rule is that only non-toothed should be used.
Fracture plate
This is a plate that is used in conjunction with screws to internally fix a bone fracture.
Gelofusin
This is 500ml of gelofusin which is an example of an artificial colloid solution.
Colloid solutions raise the plasma oncotic pressure and hence expand the intravascular compartment. There are other colloids and some available are natural e.g. albumin and blood. Colloids are useful in cases of shock e.g. due to sepsis or hypovolaemia.
Hartmann/Plasmalyte Solution
This is an example of a crystalloid solution, which contains sodium, chloride, bicarbonate and lactate.
It has a similar composition to the extracellular fluid.
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.
Hickman line
example of a long term central venous line which is inserted in a similar way to a central line (usually subclavian).
The remnant of the line is tunnelled subcutaneously, which decreases the incidence of line infection.
A total hip replacement consists of two distinct parts:
1. The femoral stem with femoral head
2. The polyethylene acetabular cup that is inserted into the acetabulum.
Histology specimen pots
Routinely used in surgery - Biopsies, resected tumours etc can be placed here and set in formalin.
They form a part of the WHO Surgical Safety Checklist. There is a distinct prompt in the “Sign Out” section to make sure histology specimens are correctly labelled.
Intramedullary femoral nail
Used to internally fix femoral shaft fractures.
Interlocking screws are used to fix the nail. They are usually removed after 12 / 18 months
Instillagel
Sterile gel containing a local anaesthetic and lubricant gel.
Intravenous Cannula & Octopus
Cannulae come in different sizes, 22G (Blue) and 20G (Pink) are common on wards. 16G (Grey) are common in fluid resus and trauma.
laparoscopic port
These ports allow the surgeon to insert a telescope and instruments in the patient.
laryngeal mask airway (LMA)
iGel - supraglottic airway device that is used as a step prior to intubation.
Laryngoscope
used to aid intubation, visualisation of larynx to aid diagnosis of vocal problems and strictures.
What types of blades can be used on a laryngoscope?
Curved (Macintosh)
Straight blades (Miller)
**Leg bag **
The bag (attached to a urinary catheter) is strapped to the leg of the patient and is indicated for patients who are mobile and have either a short or long term indwelling urinary catheter.
A man who suffers with incontinence following sphincter damage after multiple TURPs.
Mannitol
an osmotic diuretic which can be used to lower raised intracranial pressure or drive the urine output in a patient with obstructive jaundice to prevent hepato renal syndrome.
Monopolar diathermy
Used for coagulation and dissection of tissuex during open or laparoscopic surgery.
Nasal cannula
It is widely used to carry 1-3L of oxygen per minute (can be upto 5L/min). This delivers between 28-44% of oxygen.
**Thudichum Nasal Speculum **
Designed to open and expand the nasal cavity.
Nasopharyngeal airway
Inserted into the nose using a rotational action.
It is used to provide an airway in people with a decreased level of consciousness or decreased gag reflex.
A safety pin is placed in the end of the tube to prevent it being inhaled.
**Nebuliser mask and chamber **
Used to administer all commonly prescribed bronchodilators for respiratory conditions.
Aerosol drug effectiveness depends on the quality of its delivery to the lungs.
Needle holders
These are special forceps designed to hold the needle to allow the surgeon to suture accurately.
Neurology kit
- 1x 128Hz tuning fork (vibration for joints)
- 1x 512Hx tuning fork (Weber’s and Rinne’s)
- Neurotips for blunt/sharp sensation in sensory examination
- Orange stick – to test Babinski reflexes (plantar reflex)
- Tendon hammer – reflexes.
- Other aids may include: Snellen chert, ophthalmoscope and tongue depressor.
Non-absorbable sutures
Ethilon (nylon) is monofilament – therefore requires 9 throws to maintain a strong knot over time.
Prolene is another example of non-absorbable suture.
Indications for non-absorbable sutures
- Percutaneous wound closure
- Bowel anastomosis (Prolene)
- Vascular anastomosis (Prolene)
Non-rebreather mask (NRB)
used to assist in the delivery of oxygen therapy. It requires that the patient can breathe unassisted.
The NRB has an attached reservoir bag, that connects to an external oxygen tank or Bulk Oxygen Supply system.
The flow rate is 10-15 litres/minute and it can deliver up to 90% oxygen concentration.
Normal (0.9%) Saline
- Example of a crystalloid solution which contains 153mmol of NaCl.
- It can be used to provide the normal daily fluid requirement for a patient or to replace additional losses e.g. vomit or diarrhoea.
Nylon suture
This an example of a synthetic non absorbable monofilament suture.
This suture can be used to close skin wounds.
Oropharyngeal Airway (Guedel)
- This is used to provide an airway for a patient where there is an impaired level of consciousness.
- It is sized by measuring the distance from the angle of the mouth to the angle of the jaw. It is inserted into the mouth upside down and rotated within the oral cavity. It is inserted the correct way up in children.
Peripheral IV central catheter, or PICC line
Shares features of both central and peripheral venous access.
PICC lines are suitable for long-term vascular access for blood sampling, chemotherapy administration, and infusion of hyperosmolar solutions such as those used for total parenteral nutrition.
A PICC line is composed of a thin tube of biocompatible material and an attachment hub that is inserted percutaneously into peripheral veins and advanced into a large central vein.
Proctoscope
This is a proctoscope, it is used to visualise the anal canal and lower rectum, it is also used when injecting or banding haemorrhoids.
After explaining the procedure to the patient, the patient is placed in the left lateral position and a digital rectal examination is performed.
The proctoscope is then attached to a light source and lubricated prior to its insertion into the rectum.
Redivac
Ryles nasogastric tube
primarily used for decompression (drip and suck) in bowel obstruction, but can also be used to insert drugs or contrast into the GI tract.
Scalpel - either disposable (on top) and non-disposable (below)
Seldinger Chest Drain Insertion Pack
Self Retaining Retractor
This is a type of retractor used to hold wounds open e.g. during a hernia repair or an appendicectomy.
Self-Inflatable Bag-Valve-Mask
- Very useful in delivering high levels of oxygen even at low-flow rates.
- Can deliver 100% oxygen with flows above 10L/min.
Shouldered Syringe
This a syringe used for the injection of haemorrhoids with 5% phenol in almond oil.
The injection is performed in conjunction with a proctoscope. The injection is performed above the dentate line as it is insensitive.
Drainage type silastic Foley urinary catheter
Silastic catheters are made of silicone and are more appropriate than latex one for long term catheterization.
Single Lumen CVP
Central venous cannulas are inserted in the superior vena can usually via either the internal jugular or subclavian veins.
They can be single or triple lumen lines. They are primarily used to measure the central venous pressure. They can also be used for the insertion of drugs e.g. amiodarone, dopamine or chemotherapy.
Sterile specimen swabs
Used routinely in MRSA screening (nasopharyngeal and rectal).
Bluetop Transwab Amies are to recover aerobes, anaerobes and fastidious organisms.
Spinal needle
Two types: traumatic and pencil-point (atraumatic)
Pencil-point spinal needle: It is now the needle of choice for LP (not for epidural) as they have significantly the incidence of post-LP headaches reduced (relative risk of 0.4 compared to traumatic) and backache.
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 the number of fingers from the clavicle to the angle of the mandible, and this is then compared to the measuring peg on the stiff neck collar.
Stoma bag
A stoma bag is a prosthetic medical device that provides a means for the collection of waste from a surgically diverted bowel.
Pouching systems are most commonly associated with colostomies, ileal conduits and ileostomies.
Indications for a stoma bag
- Birth defect e g, an imperforate anus
- Serious infection, such as diverticulitis
- Inflammatory bowel disease
- Injury to the colon or rectum
- Partial or complete intestinal or bowel blockage
- Rectal or colon cancer
- Wounds or fistulas in the perineum.
Surgical Chest Drains (thoracostomy)
Used as an emergency procedure; They 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.
Swan Ganz catheter
Used to measure the pressures in the heart, the pulmonary artery wedge pressure and can also be used to measure the cardiac output.
These are used in the intensive care setting and are typically inserted into a central vein.
One end has balloon other end 3 ports.
Thromboembolic deterrent stocking (TEDS)
Used in all patients undergoing surgery and those who are immobile to help prevent deep vein thromboses.
Tracheostomy
It is an example of a definitive airway as it protects the patients lungs from aspiration.
A tracheostomy allows more efficient ventilation of the patient with a decreased dead space and also allows more effective suctioning of the airways.
Tracheostomy can also be used in patients with upper airway obstruction or after laryngeal surgery.
Triple Lumen CVP
- Central venous cannulas are inserted in the superior vena can usually via either the internal jugular or subclavian veins.
- They can be single or triple lumen lines. They are primarily used to measure the central venous pressure. They can also be used for the insertion of drugs e.g. amiodarone, dopamine or chemotherapy.
Trucut biopsy needle
Used to take histological specimens from lesions, e.g. breast lumps or liver.
The procedure can be performed under local anaesthetic.
3 common types of urinary catheters
- Foleys Catheter (centre) – short term up to 28 days catheter. Made usually of latex
- Long-term Catheter (left) – up to 3 months made usually of silicone
- Three-way catheter (right) – used in cases of haematuria for bladder washout and irrigation. Larger Ch required due to containing 3 lumens.
Urinary catheter
Urine Dip + Universal Sterile Container
Positive tests for Nitrites and Leukocytes should be sent for urine MCS
Positive blood and protein should be sent for Urine Protein:Creatinine Ratio.
Urometer Drainage Bag
allows monitoring of urine collection as it is designed with a clear graduation scheme.
Venturi mask
Venturi mask: blue
2-4L/min = 24% O2
Venturi mask: white
4-6L/min = 28% O2
Venturi mask: yellow
8-10L/min = 35% O2
Venturi mask: red
10-12L/min = 40% O2
Venturi mask: green
12-15L/min = 60% O2
Central venous line
Endotracheal tube (uncuffed)
Fogarty embolectomy catheter
Nasopharyngeal airway
Suprapubic catheter
Swan Ganz catheter
Tesio line (dual central line)
Port-a-cath
Bladder US scanner
Order of blood draw
Tesio line
central line, two lumens - one sits in SVC and one above right atrium, tunneled under skin to lateral chest. Also for haemodialysis.
