Instruments Flashcards
What is it?
How much of the active ingredient is in 1 litre of water?
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.
What is it?
What does it measure and what does this indicate?
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.
What is it?
What are the different materials they can be made of, and what effect does this have on its use?
Absorbable Sutures
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.
What is it?
What is its benefit?
How much oxygen can it deliver? (in % and L/min)
Self inflating 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.
What is it?
What are each of the colours used for?
Blood Bottles
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, 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.
What is it?
What is the difference between the two?
How are they filled?
What should be remembered if using both and a vacutainer?
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.
What is it?
When is it used?
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!)
What is it?
How long do they last?
What is a rare risk of their use?
What are the complications of thier use?
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.
What is it?
What are its parts?
How is it inserted?
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).
What is it?
What are its contents?
Where are they commonly placed and how?
What are they used for?
What are the key indications for its use?
What are the complications of insertion?
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, sepsis, thrombosis and misplacement.
What is it?
How does it work?
How would you ensure it is correctly located?
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.
What is it?
What does it measure, and in what units?
What is the normal range for this value?
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.
What is it?
When is it used?
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.
What is it?
What is it used for?
How is it used?
What else does it allow you to do?
This is a disposable rigid sigmoidoscope, which is used for the inspection of the rectum and lower sigmoid colon.
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.
What is it?
What can it be connected to?
How does it work, hence how is the deviced classified?
This is a drainage bag which can be connected to 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.
What is it?
What are its contents?
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
What is it?
How is it used?
When is it used?
What are the complications of its use?
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.
What is it?
What is it used for?
What is it made of and why?
How is it inserted?
How should you check it has been correctly inserted?
This is a feeding nasogastric tube which is used for 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.
What is it?
Female three way catheter
What is it?
When is it used?
Fluid Giving Set
Regularly used on wards to give IV fluids, administration of IV medications including antibiotics and blood products.
What is it?
What are the two common types and when should they each be used?
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.
What is it?
When is it used and with what?
Fracture Plate
This is a plate that is used in conjunction with screws to internally fix a bone fracture.
What is it?
When is it commonly used?
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.
What is it?
When is it used?
WHat is a common complication of its use?
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.
What is it?
What is it an example of?
Where is it inserted?
When is it indicated?
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.
What is it?
What chemical is used with it?
At what part of the WHO surgical safety checklist is it prompted?
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.