Instruments Flashcards
Absorbable sutures
MOA
Types (2)
Absorbable sutures are broken down by physiological processes such as enzymatic degradation and hydrolysis.
Patient clinical status can affect the rate of absorption, e.g. sepsis.
- Monocryl – monofilament, increased throws for stable knot (9).
- Vicryl – polyfilament, less throws (3) but has increased fraying issues and local tissue inflammation.
Tensile strength of sutures rely on diameter of thread.
Arterial blood gas syringe
Use
Key results (6)
Arterial Blood Gas samples are a useful adjunct in the acute environment. They are a version of point-of-care testing (POCT) and therefore you can attain immediate results.
Key areas tested with the blood test include:
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.
Blood bottles
(9)
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, endocrinology, 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.
Blood culture bottles
These are two blood culture bottles, one for aerobic bacteria (blue top) and one for anaerobic bacteria (purple top). The blood is injected in a sterile manner into the bottles using a different needle from the one the blood was drawn with.
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.
Note – You need to take blood cultures via peripheral venepuncture.
Blood glucose monitoring kit
To test real-time capillary blood glucose levels.
Diabetic patients will use capillary blood glucose (CBGs) levels to help guide insulin dosing.
CBGs are also important in diabetic crises, such as DKA, non-ketotic hyperglycaemia, hypoglycaemia and reduced GCS.
CBG monitoring forms a key element to ALS and ATLS protocols. (Don’t ever forget glucose!)
Breast implants
Complications
These are breast implants. They come in many shapes and sizes to suit different body habitus. They can be round or anatomical shaped. Made from Silicone. Used for breast augmentation and breast reconstruction after mastectomy. Also in gender reassignment.
They last for about 10-15 years on average. Over time they degrade and can rupture.
There is a very rare risk of ALCL – Anaplastic Large-Cell Lymphoma – a recently described complication.
Complications: Rupture, Infection, Capsular contracture, Erosion, through the skin, Migration, ALCL.
Catgut suture
This is catgut suture, which is an example of 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
A catheter bag includes a flexible tube used to empty the bladder and collect urine in a drainage bag.
They can either be inserted through the tube that carries urine out of the bladder (urethral catheter) or through a small opening made in lower abdomen (suprapubic catheter).
Central line insertion pack
Indications
Complications (4)
Seldinger central line kits include a 3-5 lumen cannula, guide wire, dilator, scalpel, and introducer needle.
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.
Key indications include: parenteral nutrition, emergency venous access, fluid resuscitation, infusion of irritant drugs, vasopressors, inotropes.
Complications on insertion include: pneumothorax, infection/sepsis, thrombosis and misplacement/arterial puncture
Chest drain bottle
The are multiple drainage systems that can be used once a chest drain has been inserted.
Passive drainage – underwater seal which employs a positive expiratory pressure and gravity to drain the pleural space. This helps recreate a negative pressure in the pleural space. If you look carefully on these there will be a line called prime level which is filled with sterile water. The chest drain tubing is connected to a tube which is under the sterile water and therefore acts as a water seal.
After a chest drain has been inserted you can see bubbling in the water as the air leaves the pleural space. The chest drain bottle can also be used to collected blood, fluid and pus from the pleural space. The system can be driven by attaching suction to the top of the bottle making it an example of a active closed drainage system.
Pneumothorax or pleural effusion
Important to be kept below patient
CSF manometer
CSF Manometers are key in the identification of opening pressures and represent Intracranial Pressure during Lumbar Puncture.
Measurement is in cm H2O.
Current accepted opening pressures (normal) are 10-18 cm H2O if patient is lying on their side, 20-30 cm H2O when sat up.
Devers retractor
This is a type of retractor which is used in open abdominal surgery to allow the surgeon to operate.
There are different sizes and types of retractors available, you may frequently be asked to use one during you clinical training when you are assisting in theatre.
Disposable rigid sigmoidoscope
This is a disposable rigid sigmoidoscope, which is used for the inspection of the rectum and lower sigmoid colon.
e.g. haemorrhoids
After explaining to the patient what you are about to do, you must attach a light source and a air pumping device. The patient is placed in the left lateral position and a digital rectal examination is performed. The sigmoidoscope is then lubricated with jelly and inserted pointing towards the umbilicus. Air is pumped into the rectum to allow you see the direction of the rectal lumen.
Biopsies can also be taken of rectal mucosa through the sigmoidoscope e.g. in a case of ulcerative colitis
Drainage bag
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 & syringe
An endotracheal tube is a definitive airway.
Used commonly in trauma cases, surgery with general anaesthetic and in patients with a GCS <8.
The tube is inserted into the trachea via the oropharynx using a laryngoscope and Eschmann Tracheal Tube Introducer (ETTI – or otherwise known as the bougie). Usually performed by an anaesthetist.
It is connected to oxygen and ensures adequate oxygen/CO2 gaseous exchange.
After inserting the tube, a balloon at the end of the tube is inflated with air through the blue side port. Position of the tube is checked by looking for symmetrical rising of the chest on ventilation, breath sounds bilaterally and no gurgling over the epigastrium indicating oesophageal intubation
The tape secures the tube in the airway whilst balloon inflation maintains position and protects airway from aspiration.
Complications include (but not exhaustive) inappropriate placing (oesophageal), injury to larynx, pneumothorax, atelectasis and infection.
Epidural insertion pack
An epidural insertion pack contains:
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 used to identify cause of symptoms include:
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 NG tube
This is a feeding nasogastric tube (clinifeed tube) which is used to 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.
After explaining to the patient what you are about to do the tube is inserted into the nostril after it has been lubricated. These tubes come with a wire inside them to aid their introduction, you advance the tube as the patient swallows. Correct position of the tube is checked by x-raying for the wire. When you are happy with the position of the tube the wire is removed and the feed attached in a sterile manner.
5% dextrose
This is a bag of 5% dextrose, which 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.
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).
These are often known as Ramsay Forceps (dissecting forceps). They are used to grasp edges of tissue and the general rule is that toothed should only be used for Skin.
Once in 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.
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.
It can be used to provide the normal daily fluid requirement of a patient or to supplement the patient for additional loses.
Hartmann’s solution is a favourite solution of anaesthetists and is the fluid advocated to be given initially in trauma in the Advanced Trauma and Life Support (ATLS) guidelines.
Hemiarthroplasty
This is 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.
Hickman line
This is a an 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.
These are indicated for long-term parenteral nutrition, long-term intravenous antibiotic therapy and chemotherapy.
Hip replacement
A total hip replacement consists of two distinct parts:
The femoral stem with femoral head
The polyethylene acetabular cup that is inserted into the acetabulum.
Total hip replacements are often used to replace a hip joint, for instance in severe osteoarthritis.
Complications with THRs include DVTs, infection and dislocation (2%).
Histology specimen pot
Histology specimen pots are 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.
IM femoral nail
This is an intramedullary femoral nail which is used to internally fix femoral shaft fractures.
Interlocking screws are used to fix the nail. They are usually removed after 12 / 18 months.
