PACES - Instruments Flashcards
what is this?
name, description, indications, contraindications, complications
absorbable suture broken down by enzymatic degradation + hydrolysis
- monocryl - monofilament, more throws for stable know
- vicryl - polyfilament, less throws but more issues with fraying and local inflammation
- uses - deep tissue which heals rapidly + hard to remove
complications
- tensile strength relies on diameter of thread
- clinical status affect rate of absorption e.g. sepsis
what is this?
name, description, indications
ABG needle used to obtain arterial sample for point of care testing
key results from it
- pH
- pO2 and pCO2 - identifies type of respiratory failure
- bicarbonate - renal and pH compensation
- lactate - poor perfusion
- Hb - anaemia
- Na+ and K+ - for monitoring and correction
- glucose
indications: hypoxia, acid-base disturbance, acutely unwell
what is this?
name, description, indications, contraindications, complications
blood bottles which are colour coded depending on tests that can be run with sample within
- purple - EDTA, haematology
- pink - EDTA, G&S + cross match
- blue - buffered sodium citrate, coagulation, needs to be filled to specific line
- yellow/gold - SST, silica particles and serum separating gel, used for serum analysis e.g. immunology, micro, biochem, endo, toxicology, oncology, U&E, LFTs
- grey - sodium fluoride + potassium oxalate, glucose + lactate
- red - silica, sensitive e.g. toxicology, drug levels, Ab, hormones and serology
- dark green - sodium heparin, ammonia, renin, aldosterone, insulin tests
- light green - aka PST, has lithium heparin and plasma suppressor gel, routing biochemistry
- rust top - viral immunology
what is the purple blood bottle for
- purple - EDTA, haematology
- FBC, ESR, blood film, reticulocyte count , HbA1c, PTH
what is the pink bottle for
- pink - EDTA, G&S + cross match
- EDTA is an anticoagulant
what is the blue bottle for
- blue - buffered sodium citrate, coagulation, needs to be filled to specific line
- coagulation screen, D-dimer, INR, anti-Xa assay (monitor high dose LMWH e.g. tinzaparin)
what is the yellow/gold bottle for?
- yellow/gold - SST, silica particles and serum separating gel, used for serum analysis e.g. immunology, micro, biochem, endo, toxicology, oncology, U&E, LFTs
- U&Es, CRP, LFTS, amylase, lipase, bone profile, Mg, iron studies, lipid, TFTs, CK, urate, osmolality
- tumour markers
- beta-hcg
- paracetamol
- HIV and viral heaptitis
- antibodies - RA, ds-DNA< ANA
- ACE
what is the grey bottle for?
- grey - sodium fluoride + potassium oxalate, glucose + lactate
- blood ethanol
what is the preferred order of draw for blood bottles?
- blue
- yellow
- purple
- pink
- grey
what is this?
name, description, indications, contraindications, complications
blood culture bottles
- blue - aerobic
- purple - anaerobic
- order of draw - blue then purple (aerobic then anaerobic cause of air in vacutainer)
- ASNTT
- case of pyrexia or suspected sepsis
- ideally before ABx given
- ideally > 1 set from different sites at spaced interval
- minimise contamination from air and commensals - if injecting (not use vacutainer, use a different needle than the blood draw one)
complications - wrong order, out of date, mislabelled, non-aseptic technique
what is this?
name, description, indications, contraindications, complications
capillary blood glucose monitoring kit
indication
- DM to determine insulin dosing
- part of initial A-E assessment
complications - calluses (repeated use), needle stick, bruising, not calibrated
what is this?
name, description, indications, contraindications, complications
breast implants
- different shapes and sizes to suit pt
- round or anatomical shaped
- silicone
- indications: breast augmentation, reconstruction, gender reassignment
- last 10-15 years
-
complications
- rare risk of anaplastic large cell lymphoma
- rupture
- infection
- capsular contracture
- erosion and degradation
- can be through skin
- migration
what is this?
name, description, indications, contraindications, complications
catgut suture
- absorbable
- natural
- uses: stomas, circumcision
- other surgeries been replaced by synthetic absorbable sutures
what is this?
name, description, indications, contraindications, complications
catheter bag
- has a flexible tube and can collect urine
- has another port to empty bag/sample urine
- can add a urometer which allows for accurate recording of urine output
what is this?
name, description, indications, contraindications, complications
central line insertion pack
- seldinger kit with 3-5 lumen cannula, guide wire, dilator, scalpel, introducer needle
- also need suture
- insertion sites - internal jugular, subclavian vein, femoral vein
- short term use - days to 23 weeks
- insertion - USS guided, ASNTT, introducer needle into vessel, then guide wire, remove needle, use dilator, then thread cannula over guidewire, remove wire and stitch in place
- indications - central administration of medication (vasopressor, inotropes, TPN, chemotherapy); access for extracorporeal circuits, monitor CVP
- complications: pneumothorax, sepsis, thrombosis, misplacement , wire left in, air embolism
- need a CXR after insertion to check position
complications of central venous access
immediate
- haemorrhage
- pneumothorax
- arterial puncture
- arrhythmias
- cardiac tamponade
- air embolism
delayed
- venous stenosis
- thrombosis
- erosion of vessel
- line fracture
- catheter colonisation
- line related sepsis
what is this?
name, description, indications, contraindications, complications
chest drain bottle
- passive drainage
- underwater seal using positive expiratory pressure + gravity to drain pleural space
- sterile water used to fill (one way valve)
- keep below level of patient
- bubbling - in right space
- swinging - movement of water column, up with inspiration, down with expiration
- active drainage
- using suction to the top of bottle to make an active closed drainage system
- blood, pus, fluid
- clamping and suction only under senior supervision
what is this?
name, description, indications, contraindications, complications
manometer CSF
- opening pressure
- represent ICP when doing an LP
- measured in cm H2O
- normal is 10-18 if on their side or 20-30 if sat up
- send CSF for MC&S, glucose, protein, lactate, cytology with paired serum glucose + lactate
- CI: raised ICP, coagulopathy, local infection
-
complications
- pain, numbness, infection, bleeding (all procedure related not device)
what is this?
name, description, indications, contraindications, complications
Denver’s retractor
used in open abdominal surgery
different sizes and types available
what is this?
name, description, indications, contraindications, complications
rigid sigmoidoscope
- assess rectum and lower sigmoid colon
- requires light + air pump → left lateral position + DRE → lubricate + insert pointing to umbilicus, pump air to see direction of rectal lumen
-
indication
- assess PR bleeding, change in bowel habit
- biopsy of rectal mucosa e.g. in UC
-
complications
- painful, dignity, bleeding, perforation
what is this?
name, description, indications, contraindications, complications
drainage bag
- connected to surgical drain or NG tube
- relies on gravity
- closed passive drainage system
what is this?
name, description, indications, contraindications, complications
endotracheal tube
- definitive airway
- insertion - pre-oxygenation, under direct visualisation, laryngoscope and bougie, confirm position by auscultation + sats + Co2 monitor + no epigastric gurgling, inflate cuff, note level at teeth, secure with tie
- indications - trauma, GA, < 8 GCS
- contraindications - maxillofacial trauma, ENT/maxfax planned surgery
-
complications
- inappropriate placing (oesophageal)
- injury to larynx
- pneumothorax
- atelectasis
- infection
- dislodgement - usually slight down R bronchus so only 1 lung ventilated
- obstruction
- difficulty weaning
- barotrauma (ventilation associated)
what is this?
name, description, indications, contraindications, complications
epidural insertion pack
- epidural needle, epidural catheter (to deliver analgesia), catheter adapter (safe secure attachment)
- used to deliver local anaesthetic drugs either alone or with opioids/narcotics e.g. fentanyl
- indication- regional block anaesthesia (labour, rib #, major trauma, major op)
- complications - inadequate analgesia, failure to site, pain, nerve damage
what is this?
name, description, indications, contraindications, complications
stool sample pot
- used to identify pathogens
- MCS - 4/7 for results
- rotavirus, adenovirus, norovirus - same day
- C.Diff screen - Glutamine Dehyrogenase +ve/-ve
- C. Diff toxin test only if GDH +ve
- C. Diff ribotyping 2 weeks
- microscopy for ova, cysts, parasites - 4/7
- H. pylori - up to 1 week
what is this?
name, description, indications, contraindications, complications
NG feeding tube
- long term enteral feeding
- narrow bore (< 9 Fr)
- insert via nostril having measure distance (nose tip - tragus - xiphisternum), lubricate + advance, test pH + x-ray for position, then remove guide wire
- position - pH aspirate < 4.5 or chest x-ray
-
indications
- short, medium term feeding (max 4-6 weeks) with functional GI tract
- administration of drugs/contrast in unsafe swallow
-
complications
- aspiration pneumonia
- pneumothorax
- malposition in GI tract
- obstruction, knotting, kinking
- reflux oesophagitis
- gastritis
- visceral perforation (rare)
what is this?
name, description, indications, contraindications, complications
5% dextrose
- 1 L has 50g of dextrose in 1L of water
- average patient needs 50-100g per day
what is this?
name, description, indications, contraindications, complications
IV giving set
- administration for IV drugs, blood products and medications via access lines
- priming, sterile technique
- complications - air embolism, inappropriate flow rate
what is this?
name, description, indications, contraindications, complications
non-toothed forceps (top) and toothed forceps (bottom)
- toothed only used for skin
- within peritoneal cavity only use non-toothed
- used to grasp tissue
what is this?
name, description, indications, contraindications, complications
fracture plate
- used in conjunction with screws for internal bone fixation
-
complications - misplacement, screw snaps, surgical complications, infection
- aesthetic/discomfort → in areas where bone close to surface e.g. wrist
what is this?
name, description, indications, contraindications, complications
gelofusin
- artificial colloid solution
- raises plasma oncotic pressure so expands intravascular compartment
- alternative to natural (e.g. albumin or blood)
- useful in shock e.g. sepsis or hypovolaemia
what is this?
name, description, indications, contraindications, complications
plasmolyte/Hartmann solution
- crystalloid solution
- has Na+ (131 mmol/L), K+ (5) Cl- (111), bicarbonate (29), lactate
- similar to extracellular fluid composition
- favourite with anaesthetists + surgeons, advocated for initial ATLS trauma
- complications - electrolyte imbalance, overload
what is this?
name, description, indications, contraindications, complications
hemiarthroplasty
- hip prosthesis
- intracapsular # NOF (pt with poor functional reserve) or avascular necrosis of femoral head
- complications: dislocation, osteolysis, metal sensitivity, nerve injury, chronic pain, septic arthritis
what is this?
name, description, indications, contraindications
hickmann line (tunnelled central line)
- long term central venous line
- usually in subclavian vein
- portion is tunnelled to reduce risk of infection
- indication: long term TPN, long term IV Abx, chemotherapy
- CI - abnormal anatomy, active infection over site of insertion, coagulopathy
what is this?
name, description, indications, contraindications, complications
total hip replacement
- femoral stem with femoral head
- polyethylene acetabular cup inserted into acetabulum
- indications: total hip replacement (severe OA)
- complications: DVTs, infection, dislocation (2%), peri-prosthetic fracture
what is this?
name, description, indications, contraindications, complications
histology pot
- used for biopsies
- set in formalin usually
- part of WHO check out surgical checklist to ensure specimens are correctly labelled
what is this?
name, description, indications, contraindications, complications
intramedullary femoral nail
- internal fixation of femoral shaft fractures
- interlocking screws used to fix nail, usually removed after 12/18 months
- anterograde - proximal, diaphyseal, deformity correction
- retrograde - diaphyseal, distal #, deformity (from knee up)
- complications - neurovascular injury on insertion, hardware failure, non-union
what is this?
name, description, indications, contraindications, complications
instillagel
- sterile gel with local anaesthetic and lubricant gel
- used in male + female catheterisation
what is this?
name, description, indications, contraindications, complications
cannula
- newer have premade dual lumen cannula which don’t require priming
- lumens need flushing to prevent clot formation
- come in varying sizes with different diameters allowing for different flow rates/speed of infusion
- indications: blood products, IV fluids, IV medications, emergency decompression of tension pneumothorax
-
complications
- dislodgement
- extravasation
- haematoma
- phlebitis
- thrombosis
what are the sizes of cannula available and their flow rate?
for fast flow rates need short + large bore cannula
what is this?
name, description, indications, contraindications, complications
laparoscopic port
- used during laparoscopic procedures
- allow insertion of telescope for visualisation and instruments to perform procedure
-
Complications
- Vascular and visceral injury on introduction
- surgical emphysema (on table if leak as CO2 doesn’t just go into cavity intended)
- Delayed - hernia, infection and bleeding
what is this?
name, description, indications, contraindications, complications
laryngeal mask airways (LMA) or iGEL
- supraglottic devices
- non-definitive airway
- uses: elective, short procedures, cardiac arrest, prehospital airway management
- benefits: reduced oropharynx trauma, can reduce admission in elective pt
- iGEL
- thermoplastic elastomer
- moulds to perilaryngeal framework at pt temp
- has a gastric channel to allow NG insertion into stomach for draining
- seals oropharyngeal opening from larynx to prevent aspiration
- can be intubation conduit
-
complications
- pressure lesions
- nerve palsies after inflation
what is this?
name, description, indications, contraindications, complications
laryngoscope
- aid intubation with visualising larynx
- Macintosh - curved blade (pictured)
- Miller - straight blade
-
complications
- mild soft tissue injury
- tooth damage
- laryngeal and pharyngeal scarring
- ulceration
- abscess
what is this?
name, description, indications, contraindications, complications
leg bag
- attached to catheter and strapped around leg
- allow pt to be mobile with short/long term catheter
what is this?
name, description, indications, contraindications, complications
mannitol
- osmotic diuretic
- used in management of raised ICP or to drive urine output in obstructive jaundice to prevent hepato-renal syndrome
what is this?
name, description, indications, contraindications, complications
monopolar diathermy
- used for coagulation and dissection of tissue during open or laparoscopic surgery
- Complications
- Burns - uses electrical circuit
- Fires - if using alcohol in the cleaning solution
- Pacemaker dysfunction
- Environmental safety - toxic smokes for the HCP involved
what is this?
name, description, indications, contraindications, complications
nasal cannulae
- common O2 delivery method for hospital + community (LTOT COPD), mild hypoxia (>90%)
- 1-4L O2 per minute
- deliver 28-44% O2
-
complications
- nasal sores
- epistaxis
what is this?
name, description, indications, contraindications, complications
nasal speculum
Thudichum nasal speculum
designed to open and expand the nasal canal for examination
what is this?
name, description, indications, contraindications, complications
nasopharyngeal airway
- non definitive airway inserted into nasal passage
- airway managed in decreased GCS or decreased gag reflex
- sizing - diameter to little finger, size from soft to soft (tragus to incisor)
- also by height, 6 for female, 7 for male
-
complications
- ulceration
- epistaxis
- contraindication - severe head injury, maxillofacial trauma esp. if signs of basal skull fracture
what is this?
name, description, indications, contraindications, complications
nebuliser mask and chamber
- used to administer bronchodialtors or nebulised medications
- aerosol drug effectiveness depends on quality of delivery to lungs
- uses: acute - asthma, saline nebs in COPD; chronic - prophylaxis CF, COPD
-
complications
- oxygen has to be reduced to enable neb so may become hypoxic
what is this?
name, description, indications, contraindications, complications
needle holders
used during suturing, designed to allow accurate placement and ease of procedure
what is this?
name, description, indications, contraindications, complications
neurology kit
- contains:
- 128 Hz tuning fork - vibration
- 512 Hz tuning fork - Weber’s and Rinne’s
- neurotips - blunt and sharp sensation
- orange stick - Babinski reflexes (plantar)
- tendon hammer - reflex
- other aids: snellen chart, ophthalmoscope, tongue depressors
what is this?
name, description, indications, contraindications, complications
non absorbable suture
- ethilon (nylon) - monofilament, 9 knowns for strong knot over time
- prolene
- high tensile strength, low reactivity
- ethilon tend to loosen so restricted to percutaneous closure
-
uses:
- percutaneous wound closure
- bowel anastomosis - prolene
- vascular anastomosis - prolene
what is this?
name, description, indications, contraindications, complications
non rebreath mask
- requires patient to be able to breath unassisted
- reservoir which is connected to oxygen
- 10-15L flow rate per minute
- up to 90% concentration, FIO2 80-85%
- first line in acute unwell patient, aim for 94-98%
what is this?
name, description, indications, contraindications, complications
0.9% sodium chloride
- 154 mmol NaCl
- can be used to provide maintenance fluid or replace additional losses
what is this?
name, description, indications, contraindications, complications
nylon suture
- form of synthetic non-absorbable suture
- monofilament
- closes skin wounds
what is this?
name, description, indications, contraindications, complications
oropharyngeal airway or guedel
- airway adjunct for pt with reduced GCS
- measure - incisor to angle of jaw (hard to hard)
- insert upside down and rotate in oral cavity, insert without rotation in children
- works by lifting tongue off posterior pharyngeal wall
- risk of vomiting/aspiration of gag reflex present
-
complications
- mucosal damage soft tissue
- gag reflex
- laryngospasm
what is this?
name, description, indications, contraindications, complications
paediatric oxygen mask
what is this?
name, description, indications, contraindications, complications
PICC line
- peripheral IV central catheter
- has features of central and peripheral
- placed percutaneously into peripheral vein and advanced into large central vein
- basilic/cephalic veins with tip in SVC
- long-term vascular access
-
uses: blood sampling, chemo, infusion of hyperosmolar solution (e.g. TPN), poor peripheral access
*
what is this?
name, description, indications, contraindications, complications
procotoscope
- visualise the anal canal and lower rectum
- left lateral position, DRE performed, insert with light source + lubrication into rectum
- uses: visual assessment, injection/banding haemorrhoids
what is this?
name, description, indications, contraindications, complications
Ryle’s tube
- wide bore (17-18 Fr)
- used for decompression of bowel obstruction (“drip and suck”)
- need lubricant, bladder syringe, drainage bag and pH dipstick
- confirm position: pH, insert air and auscultate epigastrium for bubbling, x-ray
- uses - decompression, insert drugs or contrast into GI tract
what is this?
name, description, indications, contraindications, complications
disposable scalpel (top)
non-disposable scalpel (bottom)
- cutting skin and tissue during surgical procedures
- different seizes for the procedure
- number indicates blade size and shape
what is this?
name, description, indications, contraindications, complications
seldinger chest drain insertion pack
- used in wards or OP for chest drain insertion
-
indications
- pneumothorax (in ventilated or large spontaneous, after tension decompression)
- symptomatic malignant pleural effusions
- empyema
- traumatic haemothorax (wide bore chest drain)
- post surgical - cardiac, thoracic, oesophagus
-
complications
- insertion
- damage to nearby structure (intercostal artery, solid organ)
- SC emphysema
- pneumothorax
- position
- obstruction
- kinking
- dislodgement
- re-expansion pulmonary oedema (max output 1.5L before need for clamp)
- infection - wound, pneumonia, empyema
- insertion
what is this?
name, description, indications, contraindications, complications
self retaining retractor
- holds wounds open
- e.g. during hernia repair or an appendicectomy
what is this?
name, description, indications, contraindications, complications
self inflatable bag-valve mask
- high levels of oxygen even at low flow rates
- 100% with flow rates > 10L/min
what is this?
name, description, indications, contraindications, complications
shouldered syringe
- can be used for haemorrhoid injrection treatment
- 5% phenol in almond oil, above dentate line, done using proctoscope
what is this?
name, description, indications, contraindications, complications
drainage type silastic foley urinary catheter
- made of silicon
- more appropriate for long term catheterisation than latex one
what is this?
name, description, indications, contraindications, complications
single lumen central venous cannula
- into superior vena cava via internal jugular or subclavian
- single lumen
- can be triple lumen
- uses: central administration of drugs (amiodarone, dopamine, chemo)
what is this?
name, description, indications, contraindications, complications
triple lumen central venous cannula
what is this?
name, description, indications, contraindications, complications
specimen swabs
- sterile used for MRSA screen (nasopharyngeal, groin)
- bluetop transwab amies - aerobes, anaerobes, fastidious organisms
- specimens from wounds, skin, urogenital tract, throat
what is this?
name, description, indications, contraindications, complications
spinal needles
-
traumatic needles
- cutting needles (top)
- related with higher risk of post-LP headache (35%)
- severe may need blood patching treatment
-
pencil point (atraumatic) needle
- blunt tipped for blunt dissection
- 1st choice not for LP (not epidural) as reduced LP headache and backache
what is this?
name, description, indications, contraindications, complications
stiff neck cervical collar
- stabilise cervical neck in trauma patients when used with 2 sand bags and tape (triple immobilisation)
- sized by number of fingers from clavicle - angle of mandible and compared to measuring peg on stiff neck collar
what is this?
name, description, indications, contraindications, complications
stoma bag
- prosthetic medical device to collect waste from surgically diverted bowel
- closed or draining type
- Complications
- Psychological impact of having stoma
- Leaks
- Poor fit → irritation, dermatitis due to adhesive on stoma
what is this?
name, description, indications, contraindications, complications
surgical chest drain
- emergency/trauma
- sizing in French (Ch)
- smaller calibre for pneumothorax
- larger for haemothorax, effusion or empyema
- uses - pneumothorax, malignant pleural effusion, empyema, traumatic pneumothorax, haemothorax, peri-operative
-
complications
- insertion
- damage to nearby structure (intercostal artery, solid organ)
- SC emphysema
- pneumothorax
- position
- obstruction
- kinking
- dislodgement
- re-expansion pulmonary oedema (max output 1.5L before need for clamp)
- infection - wound, pneumonia, empyema
- insertion
what is this?
name, description, indications, contraindications, complications
swan ganz catheter
- measure pressure in heart, pulmonary artery wedge pressure and CO
- ICU
- inserted into central vein
what is this?
name, description, indications, contraindications, complications
thromboembolic deterrent stocking (TED)
- for those undergoing surgery or immobile to prevent VTE
- different sizes
- may be used with low dose SC heparin
- contraindications - severe peripheral vascular disease, severe skin breakdown (ulceration, infection), frequent falls
what is this?
name, description, indications, contraindications, complications
temporary tracheostomy
- definitive airway
- uses: long term ventilation on ICU, upper airway obstruction, after laryngeal/maxfax surgery
- allows efficient ventilation with decreased dead space and more effective suctioning, reduces pt discomfort and sedation
-
complications
- infection, dislodgement, blockage
- long term - tracheomalacia, fistula, tracheal stenosis
what is this?
name, description, indications, contraindications, complications
trucut needle
- biopsy needle used to take a histological specimen (breast, lumps, livers)
- under LA usually
what is this?
name, description, indications, contraindications, complications
urinary catheter
- french (ch) - 14 common
- the larger the french the greater the diameter
-
foleys (central)
- short term up to 28 days
- usually latex (yellow)
-
long-term (left)
- up to 3/12
- silicone (transparent usually)
-
three way catheter (right)
- haematuria, clot retention, bladder washout/irrigation
- attached to irrigation fluid
- larger Ch needed as 3 lumens
- curved tip - can aid insertion past an enlarged prostate, only by urology
-
indications
- urinary retention (acute or chronic)
- monitor UO
- during abdominal or pelvic surgery
- neurogenic bladder, immobility, end of life care (for comfort), urinary incontinence, sacral or perineal ulceration
-
complications
- early/immediate
- urethral trauma
- allergic reaction
- balloon rupture
- obstruction
- bypass/leak
- bladder perforation
- pseudo-tracts
- delayed
- UTI, pyelonephritis
- urethral stricture
- early/immediate
what is this?
name, description, indications, contraindications, complications
urine dipstick and urine sample pot
- dipstick
- blood
- protein
- nitrites
- leukocytes
- glucose
- ketones
- bilirubin and urobilinogen
- positive blood and protein should be sent for urine protein: creatinine ratio
what is this?
name, description, indications, contraindications, complications
urometer
- monitor UO
- assess each hour
- used post-op, ICU, monitor fluid status
what is this?
name, description, indications, contraindications, complications
venturi
- COPD
- titrate oxygen therapy deliver 24-60%
- flow rate varies with colour due to diameter or holes to spout altering mixing of room air with oxygen
- need right flow rate to work
- types
- blue - 2-4L, 24%
- white - 4-6L, 28%
- yellow - 8-10L, 35%
- red - 10-12L, 40%
- green - 12-15L, 60%
indications for tunnelled central line
- examples - Tesio (RRT), Hickman
- usually subclavian with a portion tunnelled in SC layer
- long term use (months to years)
- indications: IV administration of drugs (Abx, chemo), regular vascular access, renal replacement therapy, blood sampling
what is are the borders of the triangle of safety?
- Lateral edge of pectoralis major (A)
- Lateral edge of latissimus dorsi (B)
- Fifth intercostal space (C)
- Apex of axilla (D)
- Inserted above rib to avoid neurovascular bundle
- Position confirmed with Chest X-Ray
features on CXR of NG in correct position
must be reported by a radiologist for it to be deemed safe to use
What is used for post-pyloric feeding? what indications?
- NJ tube (into jejenum having been passed through pylorus)
-
indications
- gastroparesis e.g. critical illness, DM, PD/neuro, scleroderma
- gastric outlet obstruction
- recurrent aspiration
- pancreatitis (less stimulation of pancreas)
complications of urinary catheterisation
- early/immediate
- urethral trauma
- allergic reaction
- balloon rupture
- obstruction
- bypass/leak
- bladder perforation
- delayed
- UTI, pyelonephritis
- urethral stricture
complications of intubation
early
- can’t intubate, can’t ventilate
- trauma - lose teeth, oropharynx
- bleeding
- cuff perforation
- endobronchial intubation
delayed
- tracheal necrosis → tracheo-oesophageal fistula
- tracheal stenosis
escalation of airway management
what is a definitive airway?
a device which is infraglottic (crosses the cords)
secure (cuffed)
prevents aspiration of gastric contents
can deliver maximum concentrations of oxygen
indications for intubation
Decreased consciousness and loss of airway reflexes (GCS <8)
- Failure to protect against aspiration
Failure to oxygenate (T1RF)
- Respiratory pathology, ARDS, pulmonary oedema
Failure to ventilate (T2RF)
- Eg. Tiring patient (life threatening asthma)
Failure to maintain airway patency
- Upper airway obstruction
- Angioedema
- Facial/upper airway trauma
- Burns
- Anaphylaxis
what are the escalation for oxygen delivery instruments?
what is this?
name, description, indications, contraindications, complications
intermittent pneumatic compression
- Inflatable sleeves that are wrapped around the calves
- Inflated one side at a time at regular intervals
- Reduce venous stasis and the risk of VTE
- Commonly used as mechanical thromboprophylaxis
- Post abdominal/orthopaedic surgery
- Post stroke (when LMWH contra-indicated)
Contraindications
- Severe peripheral vascular disease
- Severe skin breakdown (e.g ulceration, infection)
what is this?
name, description, indications, contraindications, complications
intermittent pneumatic compression
- Inflatable sleeves that are wrapped around the calves
- Inflated one side at a time at regular intervals
- Reduce venous stasis and the risk of VTE
- Commonly used as mechanical thromboprophylaxis
- Post abdominal/orthopaedic surgery
- Post stroke (when LMWH contra-indicated)
Contraindications
- Severe peripheral vascular disease
- Severe skin breakdown (e.g ulceration, infection)
complications of ABG
complication
- painful
- local haematoma
- infection at puncture site
- vessel laceration
- needle-stick injury
- air/thrombus embolism
- radial artery stenosis - repeated ABG e.g. COPD
general blood bottle complications
- mislabelling
- out of date
- wrong order
- haemolysis of sample and aberrant reading
ET tube complications
- inappropriate placing (oesophageal)
- injury to larynx
- pneumothorax
- atelectasis
- infection
- dislodgement - usually slight down R bronchus so only 1 lung ventilated
- obstruction
- difficulty weaning
- barotrauma (ventilation associated)
