Instruments Station Flashcards
How do absorbable sutures work
They are broken down by physiological processes (e.g. enzymatic degradation, hydrolysis)
what are the two types of sutures you can have
Monofilament
Polyfilament / braided
benefits of monofilament
less friction on tissue
less risk of infection/inflammation
disadvantages of monofilament
more throws for stable knot
ABSORBABLE sutures :name a monofilament type
Monocryl
ABSORBABLE sutures :name a polyfilament type
Vicryl
Non- absorbable: name mono and polyfilament
monofilament: prolene, nylon
polyfilament: silk
what order must you fill blood bottles
Blue Yellow Purple Pink Grey
what do you get in blue bottle
Coag, INR, D ddimer
what do you get in yellow bottle
UE CRP LFT amulase
calcium phosphate maghnesium
TFT lipids trop
what do you get in purple bottle
FBC, blood film
ESR
HbbA1c
pink bbottle
GS
XM
grey bottle
glucose
lactate
what are the two smallest bore cannulas you can use
Blue (22GG)
Pink (20GG)
– colouir of babies
what are two large cannulas you cn use
Green (18GG)
Grey (16GG)
what is the biggest canula youu can use
Orange (14GG
what order must you fill culture bottles
aerobic (blue) first if using a vaccutaner
when do you use a blood glucose montioring kit
To test real time cap glucose levels
- diabetic patients (CBG) to help guide insulin / record BG
- diabbetic crisis
of in ALS, ATLS protocols
what are the two types of catheter
urethral or suprapubic (through small opening made in lower abdomen)
what are indications for inserting a central line
parenteral nutrition
emergency venous access
fluid resus
infusion of irritant drugs, vasopressors or inotropes
delivery of meds/fluids that may be harmful orally or peripherally
what can chest drain bottle be used for
to collect air or blood, pus, fluid from pleural space
collects fluid from the chest drain
example of conditions chest drain is used for
pneumothorax
pleural effusion
haemothorax
how is pssive drainage set up in a chest drain
1, fill up the chest drain bottle with sterile water up to the line (PRIME LEVEL)
2. Place tube end UNDER the sterile water
THIS CREATES A WATER SEAL
how does passive drainage of the pleural space occurs
the underwater seal in the chest drain bottle emplowys
- positive expiratory pressure
- gravity
to drain the pleural pspace
how would you use an acive drainaage system for chest drain
by attaching suction
when is a devers retractor used
in OPEN ABDOMINAL SURGERY - a hand held retractor that retracts viscera
what are breast implants made of
silicone
what different breast implants are available
in different shapes and sizes to suit different body habitus
may be rounded or anatomical (teardrop) shapes
complications of breast implants
- degradation / rupture
- infection
- erosioon through skin
- migration
- anaplastic large cell luypmpha
when is a disposable rigid sigmoidoscope used
to inspect the rectum and lower sigmoid colon
to take biopsies
to treat haemorrhoids
t decompressbvolvulus
what is the difference between a disposable and non rigid sigmoidoscope
disposable sigmoidoscope is plastic
non disposable is metal
what are CSF manometers used for
to identiify the opening pressure in the subarachnooid space
what unit do CSF manometers record in
cm H20
what are three way catheters used for
for washout and irrigation of the bladder
so indicated in:
- haematuria
- clot retention
common if post-operative e.g. post bladder / prostate surgery
explain how you would use a rigid sigmoidoscope
- bowel prep *
- introduce, explain, consent etc., position patient in left lateral
- attach light source and air pumping device
- perform DRE
- lubricate sigmoidoscope with gelly
- insert sigmoidoscope pointing towards umbilicus
- pump air into rectum to visualise rectal lumen
indications for proctoscope
- allows visualisation of rectum and anus
- so use for fresh PR bleed (haemorrhoids, tumour, polup
- polypectomy
- biopsy
- haemorrhoid treatment (injection / banding)
how are ABGs useful in pt management
useful in acute environment
- PO2, CO2 - respiratory failure
VBG as well- give quick results for:
- pH (acidosis, alkalosis)
- lactate (poor perfusion, tissue ischaemia)
- Hb (anaemai)
- quick testing of electrolytes)
what are two key types of forceps
TOOTH vs NON TOOTH
when do you use tooth forceps
for SKIN (good grasp of tissue, but may cause damage on viscera)
when do you use non tooth forceps
for VISCERA
explain NG tube insertion
- explain, consent etc
measure from tip of nose to halfway between xiphoid and umbilicus
- lubricate tube, insert into nostril
- get patient to swallow watr as you advance tube with chin to chhest (to minimise risk of inserting into bronchi)
- check position by X raying for the wire/ aspirating for pH
once happy remove wire > attach feed in sterile manner
NGT contraindications
base of skull fractures
nasal ingury
UGI stricturw
what are the two types of NG tube and what are their indications
Wide bore: RYLE’S - for decomplression and aspiration
Narrow bore: feeding parenterally
x ray criteria for appropriate NG tube location
- descendingsa midline
- bisects carina
- crosses diaphragm in midline
- tip sits below diaphragm
what is a catgut suture
a natural monofilament absorbable suture
used for circumcision / formation of stomas
what is a self retaining retractor
used to hold wounds open e.g. during hernia repair, appendicectomy
what does a faaecal sample tell you
Identification of pathogens:
- MCS (microscopy for ova)
- C diff toxin
- H pylori antigen
- viral (adenovirus, rotavirus, norovirus)
Occult Blood (FIT test)
Inflamm (faecal calprotectin)
pancreatic damage (chronic pancreatitis - faecal elastase)
what are the different types of central venous lines
- central venous catheter (CVC)
- peripherally inserted central catheter (PICC)
- Hickmann line
- Tesio
- Vascath
- Portacath
where is the CVC inserted
in the superior vena cava
via subclavian or internal jugular
what are the two types of CVC
single lumen triple lumen (to run multiple inifusions via same site)
what are iindicationos for CVC insertion
- measure CENTRAL VENOUS PRESSURE
- Drug insertion e.g. amiodarone, dopamine, chemo
where is a PICC LINE (peripherally inserted central catheter) inserted
via the antecubital fossa
where does tip of PICC line sit
in the superior vena cava
how do you recognise a PICC line from CVC
PICC line is really long!!
what is a Hickmann line
central line that is tunnelled (partially buried) to reduce infection risk)
what is a tesio line like
2 separate tunneled catheters
what is a vascath like
similar to tesio line
but two catheters are formed into one
complicatioons of CVS
Short term (at inserton):
- pneumothorax
- haemorrhage
Long term
- infection
- thrombosis
- venous irritation
broad indications of CVL
- long term IV therapy (chemo, haemodialisis, abx, coma)
- TPN
- emergency access needed (NOT Hickmann)
when do you need to use a face mask with nebuliser
when nebulised drugs are required e.g. COPD, asthma exacerbation
what is the Seldinger technique
insert TROCAR hollow needle to puncture vessel
pass in a guide line through the TROCAR and advance into lumen
confirm position via US
hold guidewire in place while trocar is removed
pass cannula over guidewire into cavity
leave cannula in situ and remove guide wire
when is seldinger technique used
- insert CVC incl tesio
- chest drain
- PEG tibe
- digital subtraction angiography
- insertion of pacemaker / ICD
indications do you use a laryngoscope
VISUALISE LARYNX FOR
- aid intubation
- diagnose vocal problems
- visualise strictures
what are the two typeps of blades of a laryngoscope
curved: Macintosh
straight: Miller
when are histology specimen pots usd
routinely used in surgery for biopsy (tumour resections) > placed here and set in formalin
what is a total hip replacement made up of
- Femoral stem with femoral head
- acetabular cap (polyethylene) that is inserted into acetabululm
what are the 3 types of airway you many get
oropharyngeal
laryngeal mask airway (LMA)
Endotracheal
What is another name for oropharyngeal airway
Guedel
indications for guedel arway
as airway adjunct - maintains airway patency
what is a type of LMA
iGel
when are LMAs used
they are NOT definitive airways - so just a step prior to intubation
Used in:
- elective procedures
- cardiac arrests
- prehospital airway management
list two downsides to LMAs
do not elimiinnate aspiration riksk
inflation of the end device can cause pressure lesins / nerve palsies
benefits of iGel
they have a thhermoplastic elastomer that moulds to the perilaryngeal framework with patient temperature
seal off oropharyngeal opening from larynx, prevening aspiration
can be used as conduit for intubation
what is the only definitive airway
ENDOTRACHEAL TUBE
explain how an endotracheal tube works
the tube is inserted into the trachea
the end of the tube is inflated > this prevents it from dislodging and creates a safe airway
explain difference between old and new cannula types
old cannulas - required pre-flushed octopus
new cannulas - have a premade dual lumen system, allow blood to be taken diectly on insertion, lumens need to be flushed with each use
indications of breast implants
breast augmentation
reconstruction post mastectomy
gender ressignment
two types of spinal needles
traumatic
atraumatic
explain traumatic needles
these are CUTTING needles
carry higher risk of post-LP haeaaches
needle of choice for epidural
explain atraumatic spinal needles
blunt-tipped
for blunt diissection of the anatomu
needle of choice for LP
what are the uses of synthetic absorbable suturs
bowel anastamosis
tying fof vessels
what is mannitol used for
to lower raised ICP
prevent hepatorenal syndrome in partients with obstructive jaundice
what are specimen swabs routinely used for
MRSA screenign
how is OPA e.g. guedel sized
HARD to HARD
from incisor to angle of mandible
how is OPA inserted
insert into mouth upside down then rotated within cavity
but inserted the correct way up in children
how is NPA sized
SOFT TO SOFT
earlobe to nose
diameter sized using patients little fingr
how iis NPA inserted
insert into nose using rotatonal action
what is the flow rate of a non rebreather mask
10 to 15 L
delivers <90% oxygen concentration
what venturi mask do you start in for COPD
BLUE (24%)
complications of endotracheal tube insertion
- inappropriate placing
- injury to larynx
- pneumothorax
- atelectasis
- infection
when do you see an endotracheal tube being used
- trauma cases
- surgery with GA
- patients with GCS <8
what are benefits of a trachi over intubation
patient can speak (using spaking valve)
easier to weane patients off
reduced discomfort
reduced risk of glottis trauma
complications of nasal cannulae
nasal sores
epistaxis
cx of tracheoostomy
immediate: haemorrhagae, local structure damage
Early: tracheal erosion, block/displacement, surgical emphysema, aspiration pneumonia
late: trachemoalacia, tracheo-oesopahegal fisrtuala, tracheal stenosis
where is a tracheostomy inserted
1 to 2 cm inferior to cricoid cartilage
at 3/4th tracheal ring
whow does GCS determine which airway adjunct to use
GCS8, intubate
GCS >8 = OPA, NPA
GCS<=8 = ET tube
how do you confirm appropriate endotracheal tube location
clincial: breath sounds bilaterally, moisture in the tube, direct visualisation of vocal cords, no gurgling over epigastrium
summarise incremental flow rates of oxygen for each equioment type
nasal cannula <5L
facemask 5-10 L
Non rebreather / Hudson 10-15
Venturi: specific percentage (can go from 2L to 15L, from 24% to60%)
how do you differentiate a swan-ganz catheter from central venous line
SGC: lots of wires
it is used to measure pressures in the heart
common if pt is in ITU / cardiogenic shock
what is the sizing unit for catheters
French (Ch)
the higher the Ch, the wider diameter the catheter
what are common cateter sizes
14, 16, 18
when is a nasopharyngeal airway used
when
- cannot insert OPA (e.g. oral trauma, spasm of muscles of mastication)
- to facilitate bag mask valve ventilation (oxygenation has remained liow)
what is the function of a haemostat
haemostatic clamp
used in surgery to clamp small blood vessels for haemorrhage control
what is a shouldered sysringe used for
to inject haemorrhoids with 5%phenol in almond oil
the injection is performed with a proctoscope above the dentate line (as it is insensitive)
what is a trucut needle used for
to take histological specimens from lesions e.g. breast lump or liver
can be done under local anaesthetic s
indications for tracheostomy
- prolonged requirement for invasive ventilation (e.g. covid ITU)
- upper airway obstruction
- after laryngeal surgery
