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