Instruments and images Flashcards
Central venous catheter Indications
- Central venous pressure measurement - Administration of drugs: amiodarone - TPN
How is a central venous catheter used
Inserted using the seldinger technique under US guidance Sterile procedure Under LA Order CXR afterwards Common sites: int jugular vein, subclavian vein
Central venous catheter: complications
Immediate: pneumothorax, arrhythmia, malposition Early: infection, haematoma, occlusion Late: thrombosis, Phrenic nerve damage, sympathetic chain damage (corners)
Indication for central venous catheter vs PICC line vs Hickman line
CVC = short term use Hickman + PICC line = long term central access
Hickman line:
Tunneled under skin to enter IJV, and tip lies in the SVC
Tesio catheter: indication and features
Indication = haemodialysis Features = tunnelled subcutaneously Cuffs promote a tissue reaction –> creates a better seal Red limb: takes blood TO the machine Blue limb: takes dialysed blood BACK to patient
Tesio catheter: method
Sterile insertion under X-ray guidance
Tesio catheter: complications
Early: Pneumothorax Arrhythmia Bleeding Late: Infection Catheter occlusion Thrombosis
Blood bottles: Purple Yellow Grey - use? what does it contain?
Purple - contains EDTA to prevent clotting. use = FBC, X-match Yellow - contains activated gel. SERUM chemistry Grey - contains fluoride to inhibit glycolysis. Use = glucose
Endotracheal tube: indications
Definitive airway - long surgery: eg abdominal surgery - head injury –> reduced GCS
Endotracheal tube: features
Cuffed = prevents aspiration Long enough to sit below the vocal cords = definitive Blue line = radio-opaque
Endotracheal tube: method
- Anaesthetist - Pt sedated and muscle relaxant may be used - Laryngoscope aids direct vision - Tube is secured using tape Check position: symmetrical chest movements + auscultate for BS, CXR
ET tube: complications
Early: misplacement into oesophagus/bronchus TRAUMA - oropharyngeal/laryngeal Late: sore throat, tracheal stenosis
Guedel airway: indications
Non-definitive airway Used in its with lowered GCS to maintain a patient airway .e.g. during extubation
Guedell airway: method
Measure size: incisors –> angle of mandible Insert upside down, rotate once inside oral cavity
Guedell airway: complications
- Oropharyngeal trauma - Gagging –> vomiting –> aspiration
Ryles tube: indications
Draining the stomach, and NOT for feeding Drip + suck in obstruction
Ryles tube: features
Wider + stiffer than a feeding NGT Radio-opaque line –> to visualise on CXR
Ryles tube: insertion method
Sizing: tip of patient’s nose, down to epigastrium, going around the ear Lubricate the tip w gel Insert tube + ask pt to swallow sips of water when they feel is at back of throat Secure with tape Checking location: - Aspirate gastric contents + check pH<4 - CXR
Ryles tube: complciations
Nasal trauma Malposition Blockage
Feeding NG tube: indications?
Provides enteral nutrition: Reduced GCS/ITU Malnutrition Catabolic state: sepsis, burns, major surgery Dysphagia: stricture, stroke
Feeding NG tube: features and insertion?
Soft silicone + guide wire to aid insertion Sizing: tip of nose to epigastrium, going round the ear Lubricate tip w gel Insert via nostril + ask pt to sip water when they feel it at back of throat. Remove guide wire + secure with dressing Check location: CXR + aspiration of gastric contents <4
Foley urinary catheter: indications
- Urinary retention - BPH, neuropathic bladder - Monitor urine output in acutely unwell pt - Immobile
Foley catheter: features
2 ports: one for drainage of bladder, one for inflating balloon which keeps catheter in place Usually latex