Instruments station Flashcards by Benjamin Preston

What is it, what are they used for, what are their complications

Absorbable sutures

Are broken down by the body via enzymatic reactions or hydrolysis - clinical status affects absorption rate e.g. sepsis

Monocryl = monofilament - increased throws for stable knot (9)
Vicryl - polyfilament, less throws (3) but increased fraying and local inflammation

Are commonly used for deep tissues and tissues that heal rapidly; as a result, they may be used in small bowel anastomosis, suturing in the urinary or biliary tracts, or tying off small vessels near the skin

Infection
Early breakage/loosening
Suture hypersensitivity
Local tissue inflammation

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ABG syringe

Indications:
- To interpret oxygenation levels
- To assess for potential respiratory derangements
- To assess for potential metabolic derangements
- To monitor acid-base status
- To assess carboxyhaemoglobin in CO poisoning
- For quick assessment of lactate e.g. sepsis
- To gain preliminary results for electrolytes and Haemoglobin
- Can be conducted as a one-off sample or repeated sampling to determine response to interventions

Complications:
- Haemorrhage
- Distal ischaemia
- Nerve damage
- Pain

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Blood bottles

Indications:
- Purple = EDTA - for haematology - FBC, ESR, HbA1C
- Pink = EDTA - for haematology - Group & Save, cross match
- Blue = buffered sodium citrate - PT & aPTT, D-dimer, INR
- Yellow/gold = SST - U&E’s, CRP, LFTs, Amylase, TFTs, toxicology and drug level tests
- Grey = sodium fluoride and potassium oxalate - glucose, lactate
- Red = silica particles - hormones, toxicology, drug levels, bacterial + viral serology
- Dark green = contains sodium heparin - ammonia, renin, aldosterone, insulin
- Light green - contains lithium heparin - used for routine biochemistry but most hospitals use yellow for this
- Rust = viral immunology

Complications:
- Nerve damage
- Arterial puncture
- Pain
- Haematoma
- Fainting
- Infection

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Blood culture bottles

Blue top = aerobic (fill first if using vacutainer as butterfly may contain air)
Purple top = anaerobic

Indications:
- Infective endocarditis
- Sepsis/septic shock
- Fever of unkown origin
- Septic arthritis
- Meningitis
- Osteomyelitis

Complications:
- Nerve damage
- Arterial puncture
- Pain
- Haematoma
- Fainting
- Infection

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Blood glucose monitoring kit

To test real-time capillary blood glucose levels

Indications:
- For diabetic patient to check capillary blood glucose to help guide insulin dosing
- Diabetic crises - like DKA, non-ketotic hyperglycaemia, hypoglycaemia
- Reduced GCS as part of the ATLS protocol (Don’t ever forget about glucose)

Complications:
- Pain
- Soreness
- Sensitivities to adhesive material

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Breast implants

Are commonly made from silicone and last 10-15 years

Indications:
- Used for breast augmentation
- Breast reconstruction after mastectomy
- Gender reassignment

Complications:
- Rupture
- Degradation
- Capsular contracture
- Erosion through the skin
- Migration
- ALCL - Anaplastic Large-cell Lymphoma

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Catgut suture - is an example of natural absorbable suture made from collagen of small intestine of ruminants

Has been replaced by newer synthetic absorbable materials

Indications:
- Still used in formation of stomas and circumcisions

Complications:
- Increased frequency of post-operative adhesions
- Wound dehiscence
- Infection
- Intestinal obstruction

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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)

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Central line insertion pack

Includes a 3-5 lumen cannula, guide wire, dilator, scalpel, and introducer needle

Device that is used to obtain central IV access
* Allows administration of medical that require central access e.g. amiodarone/inotropes
* Provides IV access for patients with difficult access or who need long term IV access

Central venous catheters are placed into subclavian or internal jugular veins via ultrasound - 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

Indications:
- Parental nutrition
- Emergency venous access
- Fluid resuscitation
- Infusion of irritant drugs
- Vasopressors
- Inotropes

Complications:
- pneumothorax
- sepsis
- thrombosis
- misplacement
- Haemothorax

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Chest drain bottle

Indications:
- Chylothorax (collection of lymph fluid in pleural space)
- Haemothorax
- Pleural effusion
- Pneumothorax
- Tension pneumothorax
- Empyema

Complications:
- Pain
- Incorrect placement - extrapleural, in the fissure, drainage holes outside the pleura)
- Injury to intercostal vessels
- Tension pneumothorax (if clamped whilst air is still draining)
- Re-expansion pulmonary oedema (if >1L passed in 6 hours)
- Subcutaneous emphysema
- Blocked tube
- Bleeding
- Infection
- Drain falling out
- Drowning if bottle above level of the lung

Drainage system used = passive drainage where is underwater seal - they will have a line called prime level filled with sterile water

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CSF Manometer

Used for:
Identification of opening pressures and represent Intracranial Pressure during Lumbar Puncture

Normal opening pressures are 10-18 cm H20 if lying on side or 20-30 cm H2O if sat up

Complications
- Post-lumbar headache
- Back pain
- Bleeding
- Brainstem herniation
- Infection
- Pain
- Haematoma
- Neural injury

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Devers Retractor

Type of retractor which is used in open abdominal surgery to allow the surgeon to operate
May be used to move or hold organs

Are varying shapes and sizes

Complications:
- Tissue injury
- Left in patients after closure

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Disposable rigid sigmoidoscope (there are reusable versions too)

A hollow tube to examine the anus & rectum to look for tumours/haemorrhoids etc – usually for PR bleeding or D&V/change bowel habit

Used for the inspection of the rectum and lower sigmoid colon

Indications:
- To evaluate the rectum and sigmoid colon
- To investigate rectal bleeding
- To remove foreign bodies in the rectum or sigmoid colon
- Investigate traumatic injuries
- Decompression of sigmoid volvulus
Surveillance of colon or rectal cancer
- Ulcerative colitis for biopsies (but in severe colitis a flexi sig is preserved)

Complications
* Infection/bleeding
* Pt will experience cramping/fullness due to air (normal)

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Drainage bag

Can be connected to either NG tube or ascitic drain
Relies on gravity so is example of closed passive drainage system

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Endotracheal Tube with Tape and Syringe

Is a definitive airway

Used commonly in trauma cases, surgery with general anaesthetic and in patients with a GCS <8

Tube inserted into trachea via oropharynx using laryngoscope and Eschmann Tracheal tube introducer (A bougie)
Following insertion, balloon at end of tube is inflated

Correct positioning identified by 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:
- Inappropriate placing (oesophageal)
- Injury to larynx
- Pneumothorax
- Atelectasis
- Infection
- Damage to teeth and soft tissues

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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
- Has to pass through: skin,fat,lig flavum, eopidural space (spinal then goes through dura, arachnoid, pia mater also)

Indications:
- to provide epidural anaesthesia
- to provide epidural steroid injection
- to provide epidural analgesia - such as in labour and in prolonged postoperative analgesia

Complications:
- Spinal epidural haematoma
- Pain
- Bleeding
- Infections
- Epidural abscess
- Low blood pressure
- Nerve damage
- Postdural puncture headache

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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.

Indications:
- 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

Complications:
- None really but false +ve/-ve

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Feeding NG Tube

Fine bore feeding tube with inner guidewire (for placement & then removed)

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.
- Should only be used for 4 weeks, after which use PEG tube

Sizing to estimate how far the NG tube will need to be inserted: measure from the bridge of the nose to the ear lobe and then down to 5cm below the xiphisternum

Indications:
- Inadequate or unsafe oral intake. - neurological causes, cma, following upper GI surgery
- Medication delivery
- Removal of gastric contents (bowel obstruction but would use different type of NG tube)
- Diagnostic uses - assessment of presence/volume of upper GIB (different type of NG tube)
- Administration of radiographic contrast

Complications:
- Gagging or vomiting
- Tissue trauma along nasal, oropharyngeal or upper GI tract
- Oesophageal perforation
- Incorrect placement leading to aspiration (is a never event)
- retained guidewire

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5% Dextrose

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

Indications
- dehydration
- Maintenance fluids
- hypoglycaemia

Complications:
- Hyperglycaemia
- Hypokalaemia
- Oedema (peripheral + pulmonary)

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Fluid giving set

Regularly used on wards to give IV fluids, administration of IV medications including antibiotics and blood products.

Indications
- IV Medications
- IV fluids

Complications:
- Infection
- Phlebitis
- Thrombophlebitis
- Pain
- Haematoma
- Haemorrhage
- Needlestick injuries

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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 - non-toothed forceps are also used for delicate tissues such as vessels, nerves and bowel
Grasp these forceps between thumb and fore-finger in a pincer grip

Complications:
- damage to tissues
- bleeding
- puncture damage to the tissues (toothed)
- Infection
- crush injury (delicate tissues) if excessive force is applied (non-toothed)

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Fracture plate

Is a plate used in conjunction with screws to internally fix a bone fracture

Indications:
- displaced fractures
- unstable fractures
- when is not possible to use screws for fixation

Complications:
- Under/Oversized bone plates
- Inadequate or improper screw fixation
- Malpositioning
- Pain
- Stiffness
- Implant-related fractures

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Gelofusin - is an example of 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.

Indications:
- Sepsis
- Hypovolaemia
- Replace/maintain intravascular colloid osmotic pressure
- Decrease oedema that can result from crystalloid use

Complications
- Volume overload
- Anaphylaxis
- Urticaria

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Hartmann/Plasmalyte Solution

Is an example of a crystalloid solution, which contains sodium, chloride, potassium, 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.

Indications:
- Daily maintenance fluids
- As a source of bicarbonate in the Tx of mild-moderate metabolic acidosis
- As method of IV drug delivery

Complications:
- Hyperkalaemia (if already at risk)
- Allergic reactions
- Volume overload
- Hypercalacaemia

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Hemiarthroplasty hip prosthesis or the femoral component in THR

Device used in THR, indications include neck of femur fractures or severe OA

Indications:
- Intracapsular fractures of neck of femur due to risk of avascular necrosis (in those not suitable for total hip arthroplasty)
- Osteoarthritis

Complications:
- Higher complication rate compared to THR
- Periprosthetic fracture
- Disloaction
- Infection
- Aseptic loosening
- Acetabular wear
- Possible bone cement implantation syndrome
- VTE’s
- General related to procedure
- Specific : nickel allergy, cement reaction, femoral fracture, dislocation

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Hickman Line (type of central line)

Is 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.

Indications:
- Long-term parental nutrition
- Long-term IV antibiotic
- Chemotherapy

Complications:
- Arrhtymia (due to insertion)
- Pneumothorax (due to insertion)
- Failure
- Infection (long-term most common)
- Occlusion due to fibrin sheath formation
- Thrombosis
- Tip migration

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Total 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.

Indications:
- Intracapsular hip fracture in well patient (due to avascular necrosis risk)
- Severe osteoarthritis
- Rheumatoid arthritis
- Septic arthritis

Complications:
- DVT’s
- Infection
- Dislocation
- Loosening
- Nerve damage
- Fracture

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Histology specimen pot

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.

Indications:
- For biopsy specimens from surgery

Complications:
- Formalin spill and leak
- Formalin exposure to staff
- Mislabelling of pots

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IM Femoral Nail

Intramedullary femoral nail which is used to internally fix femoral shaft fractures
Interlocking screws are used to fix the nail - are usually removed after 12/18 months

Indications:
- Extra-capsular proximal femur fractures
- Distal femur fractures
Metaphyseal fractures

Complications:
- Leg length discrepancy
- Rotational malalignment
- Anterior cortical perforation
- Malreduction of fracture
- Neurovascular injury
- Allergy to nails
- Toxicity to nails
- Mal and non union

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Instillagel

Instillagel is a sterile gel containing a local anaesthetic and lubricant gel.

It is used for male and female catheterisation.

Indications:
- Male and female catheterisation
- Intubation

Complications:
- Allergic reactions
- Hypotension (due to systemic absorption)
- Bradycardia (due to systemic absorption)
- Seizures (due to systemic absorption)

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IV Cannulae & Octupus

Octupus = A device that allows for multiple infusions e.g. Insulin SS and prevents backflow/siphoning due to one way valves

The newer – premade dual lumen cannula systems requires no saline preparation and allows the user to take blood samples directly post insertion.
Lumens will then need to be flushed to prevent clot formation.
Old systems may require a pre-flushed octopus as an adjunct.
Cannulae come in different sizes, 22G (Blue) and 20G (Pink) are common on wards. 16G (Grey) are common in fluid resus and trauma.

If you wish to give fluid quickly the cannula must be short and large bore.

Indications:
- IV administration of fluid.
- IV administration of medications.
- IV administration of chemotherapeutic agents.
- IV nutritional support.
- IV administration of blood or blood products
- IV administration of radiologic contrast agents for computed tomography (CT), magnetic resonance imaging (MRI), or nuclear imaging

Complications:
- infection
- phlebitis
- thrombophlebitis
- emboli
- pain
- haematoma or haemorrhage
- extravasation
- arterial cannulation
- needlestick injuries.

Octupus complications
* Infection/bleeding
* Air embolism
* Drug incompatibility

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Laprascopic port

This is a Laparoscopic post which is used during Laparoscopic procedures e.g. Laparoscopic cholecystectomy.
These ports allow the surgeon to insert a telescope and instruments in the patient.
Is a device used in laparoscopic surgery
* * Introduced via the hollow cannula into the body
* * Sharp trachar to enter body
* * Port to place devices for surgery (E.g. camera, scissors, diathermy etc)
* * Port for CO2 insufflation & surgical space/view

Indications:
- Use of laprascopic surgery
- Cyst, fibroid, stone and polyp removals
- Small tumour removals
- Tubal ligation and reversal
- Ectopic pregnancy removal
- Endometriosis surgery
- Urethral and vaginal reconstruction surgery
- Orchidopexy
- Hernia repair surgery
- Cholecystectomy
- Appendectomy
- Colectomy
- hysterectomy

Complications:
- Vascular injury - bleeding and haemorrhage
- Conversion to open procedure
- Management of haemorrhage
- GI perforation
- Bladder perforation
- Nerve injury
- Surgical site infection
- Hernia

Specific to port:
* Immediate : vascular or visceral injury, surgical emphysema (Co2 leak)
* Delayed: hearnia, infection , bleeding

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Laryngoscope

A laryngoscope is used to aid intubation, visualisation of larynx to aid diagnosis of vocal problems and strictures.

There are multiple different forms of blades – curved (Macintosh) as seen in the picture. Straight blades (Miller) are also used.

Indications
- Facilitates endotracheal intubation
- In patients with angioedema, stridor, epistaxis and/or craniofacial trauma
- Chronic cough
- Chronic throat pain
- Dysphagia
- Dysphonia
- Foreign body in throat
- Hoarseness
- Sensation of lump in throat

Complications:
- Mild soft tissue injury
- Laryngeal and pharyngeal scarring
- Ulceration
- Abscess formation

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Igel on the top and laryngeal mask on the bottom

Laryngeal mask
* Temporary airway - is a supraglottic airway devices that are used as a step prior to intubation
* Are very good for elective procedures, cardiac arrests and prehospital airway management
* Have benefits that include reduced trauma to the oropharynx (seen with intubation) and therefore can be used to reduce hospital stays in elective patients.

Indications for layngeal mask
* Apnoea, severe respiratory failure, or impending respiratory arrest in which endotracheal intubation cannot be accomplished
* Certain elective anesthesia cases
* LMAs are useful in situations where bag-valve-mask ventilation is difficult: Patients with severe facial deformity (traumatic or natural), thick beard, or other factors that interfere with the face mask seal
* ventilation during elective anaesthesia to fasted patients with low risks of regurgitation
* a rescue airway in failed intubation

Complications of laryngeal mask
* Vomiting
* Regurgitation and Aspiration
* Tongue edema due to prolonged placement or balloon overinflation
* Partial airway obstruction
* Pressure injuries and cranial nerve palsies
* Inability to acheive seal and ventilate

Igel
- is a supraglottic airway
* iGels contain a thermoplastic elastomer (styrene) that moulds to perilaryngeal framework with patient temperature - the device tip extends into the oesophageal opening, has its own gastric channel to allow the passing of NG tube into the stomach for gastric emptying
* The iGel also seals off the oropharyngeal opening from the larynx, preventing aspiration. iGel can also be used as conduit for intubation
* Insert with number facing towards you when behind the patient

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This is a leg bag which is attached to a urinary catheter.

The bag is strapped to the leg of the patient

Indications:
* 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

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Mannitol

Mannitol is 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

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Monopolar diathermy tips

Device used to stop bleeding during peri-operative procedure

Monopolar diathermy is used for coagulation and dissection of tissue during open or laparoscopic surgery

Complications
* Burns (metal)
* fires (alcohol wash
* PPM dysfunction
* environmental safety

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Nasal Cannula

Nasal cannula are commonly used mode of oxygen delivery both in hospital and in the community.

It is widely used to carry 1-3L of oxygen per minute (can be upto 5L/min). This delivers between 28-44% of oxygen.

These cannulae differ from high-flow therapy (NIV)

Indications:
* Respiratory failure
* Chronic obstructive pulmonary disease (COPD)
* Heart failure
* Sleep apnea
* Collapsed lung
* Pneumonia
* COVID-19
* Intubation
* Extubation
* General difficulty breathing

Complications:
* Nasal sores
* Epistaxis
Therefore patients are encouraged to apply water-based creams to moisturise.

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Nasal Speculum

Thudichum Nasal Speculum is designed to open and expand the nasal cavity.

Indications:
* Anterior rhinoscopy
* Septal surgeries
* Removal of foreign bodies
* Polyp removal

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Is a nasopharyngeal airway which is inserted into the nose using a rotational action.

An airway adjunct to enable airway oxygenation/ventilation
Sizing – tragus of the ear to incisors of teeth

The diameter tube should be sized against the patients own little finger distal phalanx. A safety pin is placed in the end of the tube to prevent it being inhaled.

The appropriate airway size can be determined by measuring from the tip of the patient’s nose to the tragus of the ear (i.e. soft airway = measure ‘soft to soft’). The diameter of the airway should not exceed that of the patient’s little finger.

Indications:
* Used to bypass obstructions in the mouth, nose, nasopharynx or base of the tongue.
* Are typically better tolerated (and less likely to trigger the gag reflex) in patients who are partly or fully conscious compared to oropharyngeal airways.

Nasopharyngeal airways should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of the NPA entering the cranial vault.

Complications
* Epistaxis
* Nasal trauma and bleeding
* Brain herniation in basal skull fractures
* Detoriation requiring intubation

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Neubilser mask and chamber

Device used to turns liquid medication into a fine mist - The medicated mist is inhaled

Nebuliser mask and chamber can be used to administer all commonly prescribed bronchodilators for respiratory conditions
Aerosol drug effectiveness depends on the quality of its delivery to the lungs

Indications
- management of exacerbations and long-term treatment of chronic obstructive pulmonary disease (COPD),cystic fibrosis, bronchiectasis, HIV/AIDS and symptomatic relief in palliative care

Complications
* Most of the side effects due to nebulizer use correspond to the drug being taken
* Eye irritation may occur with the use of a face mask if not worn correctly
* The risk of bacterial infection increases (S. aureus and P. aeruginosa) if the device is not cleaned correctly
* From nebulised medication e.g. salbutamol – tachycardia

What it is, what are they used for, what are their complications

Needle Holders

These are special forceps designed to hold the needle to allow the surgeon to suture accurately.

What it is, what are they used for, what are their complications

Tuning forks

128 Hz = Vibration
256 Hz = Weber’s and Rinne’s test

Causes of loss of vibration:
* Demyelinating lesions - MS, B12 deficiency, late syphilis
* Brainstem lesions involving the medial lemniscus
* Dorsal spinal artery occlusion (unilateral impairment)
* Diabetic neuropathy

What it is, what are they used for, what are their complications

Non-Absorbable Sutures

Indications
Non-absorbable sutures are used in longer-term tissue approximation:
* Percutaneous wound closure (more appealing cosmetic result)
* Bowel anastomosis (Prolene)
* Vascular anastomosis (Prolene)

Complications
* Irritation from the cut ends

What it is, what are they used for, what are their complications

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.
Both ethilon and prolene have high tensile strength and low-reactivity. However, ethilon knots are more likely to loosen over time. Therefore usually limited to percutaneous closure.
Advantages = inert, low coeficcient of friction, hold strength for 300 days or longer
Non-absorbable suture thought to have better tensile strength and so keep edges opposed better for better wound healing
* Absorbable = pt doesn’t have to return (absorbs in 1-8weeks) e.g. Vicryl/monocryl is absorbable

Complications
* Irritation from the cut ends
* Wound infection
* Sutures break

What it is, what are they used for, what are their complications

Non-rebreather mask

Device that delivers high flow oxygen (60-90%)
Breathe in from reservoir and exhale via side vents**

A non-rebreather mask (NRB) is used to assist in the delivery of oxygen therapy. It requires that the patient can breathe unassisted.

The non-rebreather mask covers both the nose and mouth of the patient and attaches with the use of an elastic cord around the patient’s head. 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.

Indications:
* Acutely ill patients with hypoxia

Complications
* Occur if no oxygen being delivered to the mask (can cause suffocation)

What it is, what are they used for, what are their complications

Normal (0.9%) Saline

Normal saline is an 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.

Indications
* Hydration - replace fluids lost and for maintenace fluids
* Irrigation - to irrigate wounds, body cavities, and other tissues to clean them of debris and to prevent infection
* Blood volume expansion - to expand blood volume in cases of hypovolemia (low blood volume) or to maintain blood pressure during certain medical procedures.
* Electrolyte replacement - to replace sodium and chloride ions in the body, which are important for maintaining the balance of fluids and electrolytes in the body.
* Medication administration - as a diluent or solvent for some medications, particularly those given intravenously (into a vein)

Complications
* Fluid overload - especially if kidney failure or HF
* Electrolyte imbalances
* Infusion reactions - including itching, rash, hives, or difficulty breathing.
* Infection - contaminated with microorganisms during preparation or administration, which can result in infection.
* Hypercholraemic Metabolic alkalosis

What it is, what are they used for, what are their complications

Oropharyngeal Airway

An airway adjunct to enable airway oxygenation/ventilation
Sizing – angle of mandible to angle of mouth

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.

Indications
* Unconscious patients - to prevent the tongue from obstructing the airway and to maintain a patent airway
* Snoring or sleep apnea - to prevent airway obstruction and to maintain a patent airway during sleep
* Comatose patients - maintain a patent airway and to prevent airway obstruction, particularly if they are at risk of regurgitation or vomiting
* Conscious patients with upper airway obstruction - to maintain a patent airway and to prevent airway obstruction.
* Respiratory distress - such as those with bronchospasm or bronchitis, to maintain a patent airway and to prevent airway obstruction.

Complications:
* Mucosal trauma & bleeding
* Elicit gag reflex/laryngospasm
* Teeth damage especially if used in epileptics (don’t use in seizures)
* Displacement
* Aspiration
* Gagging

What it is, what are they used for, what are their complications

Paediatric oxygen mask

Indications:
* Croup
* Acute epiglottis (whilst waiting intubation)
* Asthma
* Bronchiolitis

What it is, what are they used for, what are their complications

PICC Line (Peripheral IV Central Catheter)

A commonly used IV access option that is inserted into a peripheral vein and advanced into a larger vein nearer the heart
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.

Indications:
* Long-term IV therapy - like antibiotics, nutrition, or hydration, in patients who require frequent or extended IV access.
* Chemotherapy
* Infusions: like pain killers of HF medications
* Blood draws in patietnes requiring frequent monitoring of blood tests, such as those with chronic medical conditions.
* Central venous pressure monitoring - procedure that measures the pressure in the large veins near the heart

Complications
* Infection
* Thrombosis
* Phlebitis
* Bleeding
* Blockage
* Catheter-related bloodstream infection

What it is, what are they used for, what are their complications

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

Indications
* Hemorrhoids - diagnosis and Tx of them
* Anal fissures - diagnose and treat anal fissures
* Polyps - to detect and remove polyps
* IBD - to diagnose and monitor the progression of IBD (UC starts at the rectum)
* Rectal bleeding - to diagnose the cause of rectal bleeding
* Rectal prolapse - to diagnose and treat rectal prolapse
* Constipation - may be used to diagnose the cause of chronic constipation (e.g. due to rectal stenosis)

Complications
* Pain/discomfort
* Bleeding
* Infection
* Allergic reactions to LA used in procedure
* Perforation

What it is, what are they used for, what are their complications

Scalpel

A blade used in surgery or procedures using sutures (operative theatre, minor ops areas etc.)

There are two types of scalpels: disposable (on l;eft) and non-disposable (right)
The blade of the non-disposable scalpel must be changed.

Surgical blades, or scalpels, are used for cutting skin and tissue during surgical procedures. There are different types of blades specific to the type of procedure. Surgical blades vary by size and shape. The number of the blade indicates the blade size and shape e.g. 10, 11, 12, 15, 22.

Indications:
* Surgical incisions
* Mole removal
* Cataract surgery

Complications
* Sharps injuries
* Infection
* Bleeding
* Nerve damage
* Scaring

What is it, what are they used for, what are their complications

Seldinger Chest Drain Insertion Pack

Chest drain seldinger can come in a variety of forms, (Rocket, Portex etc)

These can be used on the wards and in outpatients to insert chest drains.

Indications include:
* Pneumothorax (in ventilated patient, tension pneumothorax after needle relief, persistent pneumothorax or large spontaneous pneumothorax)
* symptomatic malignant pleural effusions
* empyema
* traumatic haemothorax

Complications
* Infection
* Pain
* Misplacement
* Bleeding
* Pleural effusion
* Pneumothorax
* Tissue damage
* Drain blockage

What is it, what are they used for, what are their complications

Specimen Swabs

Sterile specimen swabs are used routinely in MRSA screening (nasopharyngeal and rectal).
Bluetop Transwab Amies are to recover aerobes, anaerobes and fastidious organisms.
These swabs are excellent to aid gram stains.
They are also used to take specimens from wounds, skin, urogenitalia and throat.

Indications
* MRSA Testing
* Wound infections
* Respiratory infections
* Skin infections

Complications
* Introduction of new infection/spreading of exisiting one
* Pain/discomfort
* False negatives/positives due to contamination

What is it, what are they used for, what are their complications

Spinal Needles

There are two types of spinal needle
* Traumatic needles are cutting needles (top picture) - are related with higher risk of post-LP headaches (35%), severe headaches that may require blood patching to help treat the symptoms and additional hospital visits for pain.
* Pencil-point (atraumatic) needles are blunt tipped, allowing for blunt dissection of the anatomy rather than cutting. 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

Indications
* Spinal anaesthesia
* CSF collection
* Pain management - potentially for back pain/sciatica

Complications
* Infection
* Nerve injury
* Bleeding
* Headache
* Allergic reactions
* Back pain

What is it, what are they used for, what are their complications

Stoma Bags
(closed, other type is drainable)

Device attached to the skin around stoma to collect faeces

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
* Colorectal cancer resection
* IBD post resection
* Rectal prolapse
* Bowel obstruction (Hartmann’s)
* Faecal incontinece

Complications
* Poorly sited = local skin inflammation & infection risk/psychological impact
* Specific to stoma= parastomal hernia, necrosis, pyoderma gangrenosum

What is it, what are they used for, what are their complications

Surgical Chest Drain

Surgical Chest Drains (thoracostomy) are 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.

Indications:
* Pneumothorax
* Malignant Pleural Effusion
* Empyema
* Traumatic pneumothorax or haemothorax
* Peri-operative

Reasons why may need surgical chest drain over seldinger chest drain = if is airway obstruction that prevents normal chest drain insertion, Need for larger drain, absence of subcutaenous tissue layer, patient anatomy, failed attempts of a Seldinger chest drain insertion

Complications
* Infection
* Bleeding
* Pain
* Pneumothorax
* Drain dislodgement
* Air leak
* Emphysema

What is it, what are they used for, what are their complications

Ryles NG Tool

This is a Ryles nasogastric tube which is primarily used for decompression (drip and suck) in bowel obstruction, but can also be used to insert drugs or contrast into the GI tract.

After explaining what you are about to do to the patient, you will require a NG tube which has been in the fridge as it is stiffer, some lubricant, a bladder syringe, a drainage bag and pH dipstick.

The correct position of the tube is checked by aspirating gastric contents and checking for acidity on pH dipstick, if this is unavailable then air can be inserted to the tube and the epigastrium auscultated for bubbling. Finally, an x-ray can be taken to identify the tube.

Once the tube is in the correct position a bag is attached and it is taped to the patients face.

Indications
* Bowel obstruction (drip and suck)
* Gastric suction
* Diagnostic purposes - to measure stomach acid

Complications
* Nose and throat irritation
* Sinusitus
* Pneumothorax
* GI Bleeding
* Aspiration
* Tube dislodgement
* Tube blockage

What is it, what are they used for, what are their complications

Self-Inflatable Bag-Valve-Mask

Is a mannual resucitation device that is easy to use
Very useful in delivering high levels of oxygen even at low-flow rates. Can deliver 100% oxygen with flows above 10L/min.

Indications:
* Cardiac arrest - to provide artificial ventilation during a cardiac arrest, which can help to maintain oxygenation and circulation
* Respiratory arrest - To provide artificial ventilation in cases of respiratory arrest, which can help to maintain oxygenation and prevent brain damage
* Chemical or drug overdose - To provide artificial ventilation in cases of chemical or drug overdose, which can help to maintain oxygenation and prevent brain damage
* Trauma -To provide artificial ventilation in cases of severe trauma, such as head injury or spinal cord injury, which can help to maintain oxygenation and prevent brain damage.
* Anesthesia - to provide artificial ventilation during anesthesia, which can help to maintain oxygenation and prevent brain damage
* Asthma - to provide artificial ventilation in severe cases of asthma, which can help to maintain oxygenation and prevent brain damage

Complications
* Airway trauma
* Ventilation of stomach contents - if not positioned properly, may venitlate stomach leading to regurgitation and aspiration
* Over-ventilation - leading to barotrauma (injury to the lungs and airways due to high pressure), pneumothorax (collapsed lung))
* Inadequate ventilation - if not used properl y

What is it, what are they used for, what are their complications

Self Retaining Retractor

This is a type of retractor used to hold wounds open e.g. during a hernia repair or an appendicectomy

Indications
* Abdominal surgery - hernia repairs, appendectomies, cholecystectomies
* Orthopaedic surgeries - to hold back and stabilize tissue and provide exposure to the surgical site
* Gynaecological surgeries

Complications
* Tissue damage
* Pressure ulcers - if prolonged use
* Infections
* Bleeding
* Organ injury
* Post-operative pain
* Scarring

What is it, what are they used for, what are their complications

Shouldered Syringe

This is 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

Indications
* Aspiration procedures - removal of fluid or air from the body
* Injection procedures
* Sampling procedures - for collecting samples of body fluids, such as blood or synovial fluid, for laboratory analysis
* Irrigation procedures - such as the washing out of wounds or body cavities
* Intramuscular injections - the raised shoulder provides a stable platform for needle insertion

Complications
* Infection
* Needle-stick injuries
* Air embolism
* Medication errors
* Haematoma formation
* Pain

What is it, what are they used for, what are their complications

Silastic Urinary Catheter

This is a drainage type silastic Foley urinary catheter.

Silastic catheters are made of silicone and are more appropriate than latex one for long term catheterization.

Indications
* Urinary incontience
* Urinary retention
* Neurogenic bladder
* Prostate surgery
* Spinal cord injury/pelvic surgery/injury
* Multiple sclerosis, parkinson’s
* Palliative care

Complications
* UTI
* Catheter blockage
* Urethral irritation/damage
* Bladder spasms
* Bloodstream infections
* Catheter association sepsis
* Dislodgmeent
* Decreased mobility

What is it, what are they used for, what are their complications

Single Lumen Central Venous cannula

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.

Device that is used to obtain central IV access
Allows administration of medical that require central access e.g. amiodarone/inotropes
Provides IV access for patients with difficult access or who need long term IV access

Complications:
* Haemothorax
* Pneumothorax
* Haematoma

What is it, what are they used for, what are their complications

Stiff Neck Cervical Collar

This is a stiff neck collar which is 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

Indications
* Immobilization and support of the neck and cervical spine in case of suspected spinal cord injury, neck pain, neck strain, or whiplash
* As a precautionary measure during neck and spinal procedures, to prevent movement and potential further injury

Complications
* Pressure sores
* Respiratory distress
* Decreased mobility
* Psychological distress - are uncomfortable

What is it, what are they used for, what are their complications

Swan Ganz catheter - is a pulmonary artery catheter

This is a Swan Ganz catheter which is 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

Indications
* Acute heart failure - To monitor heart function, especially when there is a sudden onset of symptoms such as shortness of breath or chest pain.
* Shock - To diagnose and monitor the treatment of different types of shock, such as septic shock or cardiogenic shock.
* Pulmonary hypertension - To measure the pressure in the pulmonary artery to diagnose and monitor pulmonary hypertension.
* Cardiac output measurement - to measure the blood flow through the heart, which helps to determine the severity of heart failure or other cardiac conditions.
* Monitoring during surgery - to monitor heart and lung function during major surgeries, such as open heart surgery or lung transplant.

Complications
* Arrhythmias
* Infection
* Blood clots
* Haemorrhage
* Pulmonary artery rupture
* Cardiac tamponade
* Air embolism
* Pneumothorax

What is it, what are they used for, what are their complications

Synthetic Absorbale Suture

This is an example of a synthetic absorbable suture which can be used for bowel anastomosis or tying off vessels.

What is it, what are they used for, what are their complications

TEDS Stocking

This is a thromboembolic deterrent stocking which should be used in all patients undergoing surgery and those who are immobile to help prevent deep vein thromboses.

They are available in different sizes and are used in conjunction with low dose subcutaneous heparin. They are contraindicated in patients with arterial disease of the lower limb.

Indications:
* Deep vein thrombosis (DVT) prophylaxis
* Post-operative immobility
* Varicose veins
* Post-thrombotic syndrome
* Chronic venous insufficiency
* Lymphedema
* Pulmonary embolism (PE) prevention

Complications
* Skin irritation or pressure ulcers
* Improper fit
* Allergic reactions
* Interference with wound healing
* Overheating

What is it, what are they used for, what are their complications

Tracheostomy kit

This is a temporary tracheostomy; it is an example of a definitive airway as it protects the patients lungs from aspiration.

One of the most common occasions you will see a tracheostomy is on a patient being ventilated on the intensive care unit.

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.

What is it:
* A definitive airway used for complex airways e.g. Maxillofacial/ENT OR long term ITU patients/ventilation

Indications
* Obstruction of the upper airway
* Respiratory failure - may make it easier to breahe by removing dead space
* Long-term mechanical ventilation
* Neurological conditions - such as spinal cord injury or brainstem damage
* Obstructive sleep apnea

Complications:
* Numerous and can be fatal
* Inner tube (& pipe cleaner) used to prevent obstruction
* DOPE ( Displacement/Obstruction)
* Infections
* Bleeding
* Airway obstruction if gets blocked or dislodged
* Tracheal stenosis
* Voice changes
* Psychological impact

What is it, what are they used for, what are their complications

Trucut Needle

This is a trucut biopsy needle which is used to take histological specimens from lesions, e.g. breast lumps or liver
The procedure can be performed under local anaesthetic.

Indications
* Suspected cancer
* Lesions or masses
* Abnormal results from imaging tests
* Diagnosing infections
* Monitoring the progression of a disease

Complications
* Pain
* Bleeding
* Infection
* Tissue damage
* Missed diagnosis
* False-positives

What is it, what are they used for, what are their complications

Urinary Catheter

Flexible tube inserted into the bladder, can be used in urinary retention, post- operative phase of Sx/Mx of pt with acute renal failure(pre-peri/post causes)

Catheter sizes are measured in French (Ch). A 14Ch is a common starting point for catheters. The larger the Ch, the greater the diameter.

The three common types of urinary catheters include:
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.

Indications:
* Urinary retention
* Surgery
* Monitoring urine output
* For medical proceudres like cystoscopy
* Post-operative care - to monitor urine output and prevent complications like UTI
* Kidney failure, severe UTIs

Complications:
* General –infection, bleeding, soft tissue trauma
* Specific - pseudotracts, bladder trauma
* UTIs
* Bladder spasms
* Uretheral injury
* Bloodstream infections
* Catheter blockage
* Bladder stone fomrations
* Allergic reactions

What is it, what are they used for, what are their complications

Urine Dip + Universal Sterile Container

Urine dipstick testing is very useful in the acute clinical environment and in primary care.

Key elements assessed in urine dipstick testing are blood (microscopic/macroscopic haematuria), protein (renal disease), nitrites (active infection), and leukocytes (inflammatory processes), glucose (diabetes), ketones (DKA), bilirubin and urobilinogen (haemolysis and liver pathology)

Positive tests for Nitrites and Leukocytes should be sent for urine MCS

Positive blood and protein should be sent for Urine Protein:Creatinine Ratio

Indications:
* UTIs
* Kidney problems - presence of protein or blood
* Diabetes - glycosuria
* Liver disease - ketones
* Preeclampsia - high levels of protein in urine
* Monitoring fluid balance - testing specific gravity
* Routine health assessments

Complications
* Medication intererence (Abx usage)
* False postives/negatives

What is it, what are they used for, what are their complications

Urometer Drainage Bag

The urometer drainage bag allows monitoring of urine collection as it is designed with a clear graduation scheme. It reflects the accurate amount of urinary output per hour. It is used during surgery, postoperatively and to monitor fluid status.

What is it, what are they used for, what are their complications

Venturi Mask

Device used to give a fixed concentration of O2 and at a specific flow rate *Bernoulli principle (change in flow across fixed orifice)

Venturi masks are often using in COPD, where it is important not to over-oxygenate the patient
It delivers 24-60% oxygen. The flow rate varies depending on the colour. The correct flow rate to use with each colour it is shown on mask, along with the percentage of oxygen delivered.

Types:
–BLUE = 2-4L/min = 24% O2
–WHITE = 4-6L/min = 28% O2
–YELLOW = 8-10L/min = 35% O2
–RED = 10-12L/min = 40% O2
–GREEN = 12-15L/min = 60% O2

Indications
* COPD
* Pneumonia
* Asthma
* Congestive heart failure
* Anaemia
* Post-operative use
* Respiratory distress

Complications:
* Incorrect flow rate = incorrect Fio2
* Oxygen toxcitiy
* CO2 retention
* Inadequat eoxygen delivery
* Air leak
* Skin irritation
* Discomfort