PACES - Instruments Flashcards

1
Q

what is this?

name, description, indications, contraindications, complications

A

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
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2
Q

what is this?

name, description, indications

A

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

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3
Q

what is this?

name, description, indications, contraindications, complications

A

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
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4
Q

what is the purple blood bottle for

A
  • purple - EDTA, haematology
  • FBC, ESR, blood film, reticulocyte count , HbA1c, PTH
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5
Q

what is the pink bottle for

A
  • pink - EDTA, G&S + cross match
  • EDTA is an anticoagulant
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6
Q

what is the blue bottle for

A
  • 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)
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7
Q

what is the yellow/gold bottle for?

A
  • 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
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8
Q

what is the grey bottle for?

A
  • grey - sodium fluoride + potassium oxalate, glucose + lactate
  • blood ethanol
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9
Q

what is the preferred order of draw for blood bottles?

A
  • blue
  • yellow
  • purple
  • pink
  • grey
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10
Q

what is this?

name, description, indications, contraindications, complications

A

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

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11
Q

what is this?

name, description, indications, contraindications, complications

A

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

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12
Q

what is this?

name, description, indications, contraindications, complications

A

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
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13
Q

what is this?

name, description, indications, contraindications, complications

A

catgut suture

  • absorbable
  • natural
  • uses: stomas, circumcision
  • other surgeries been replaced by synthetic absorbable sutures
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14
Q

what is this?

name, description, indications, contraindications, complications

A

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
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15
Q

what is this?

name, description, indications, contraindications, complications

A

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
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16
Q

complications of central venous access

A

immediate

  • haemorrhage
  • pneumothorax
  • arterial puncture
  • arrhythmias
  • cardiac tamponade
  • air embolism

delayed

  • venous stenosis
  • thrombosis
  • erosion of vessel
  • line fracture
  • catheter colonisation
  • line related sepsis
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17
Q

what is this?

name, description, indications, contraindications, complications

A

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
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18
Q

what is this?

name, description, indications, contraindications, complications

A

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)
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19
Q

what is this?

name, description, indications, contraindications, complications

A

Denver’s retractor

used in open abdominal surgery

different sizes and types available

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20
Q

what is this?

name, description, indications, contraindications, complications

A

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
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21
Q

what is this?

name, description, indications, contraindications, complications

A

drainage bag

  • connected to surgical drain or NG tube
  • relies on gravity
  • closed passive drainage system
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22
Q

what is this?

name, description, indications, contraindications, complications

A

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)
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23
Q

what is this?

name, description, indications, contraindications, complications

A

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
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24
Q

what is this?

name, description, indications, contraindications, complications

A

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
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25
Q

what is this?

name, description, indications, contraindications, complications

A

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)
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26
Q

what is this?

name, description, indications, contraindications, complications

A

5% dextrose

  • 1 L has 50g of dextrose in 1L of water
  • average patient needs 50-100g per day
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27
Q

what is this?

name, description, indications, contraindications, complications

A

IV giving set

  • administration for IV drugs, blood products and medications via access lines
  • priming, sterile technique
  • complications - air embolism, inappropriate flow rate
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28
Q

what is this?

name, description, indications, contraindications, complications

A

non-toothed forceps (top) and toothed forceps (bottom)

  • toothed only used for skin
  • within peritoneal cavity only use non-toothed
  • used to grasp tissue
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29
Q

what is this?

name, description, indications, contraindications, complications

A

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
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30
Q

what is this?

name, description, indications, contraindications, complications

A

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
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31
Q

what is this?

name, description, indications, contraindications, complications

A

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
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32
Q

what is this?

name, description, indications, contraindications, complications

A

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
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33
Q

what is this?

name, description, indications, contraindications

A

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
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34
Q

what is this?

name, description, indications, contraindications, complications

A

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
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35
Q

what is this?

name, description, indications, contraindications, complications

A

histology pot

  • used for biopsies
  • set in formalin usually
  • part of WHO check out surgical checklist to ensure specimens are correctly labelled
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36
Q

what is this?

name, description, indications, contraindications, complications

A

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
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37
Q

what is this?

name, description, indications, contraindications, complications

A

instillagel

  • sterile gel with local anaesthetic and lubricant gel
  • used in male + female catheterisation
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38
Q

what is this?

name, description, indications, contraindications, complications

A

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
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39
Q

what are the sizes of cannula available and their flow rate?

A

for fast flow rates need short + large bore cannula

40
Q

what is this?

name, description, indications, contraindications, complications

A

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
41
Q

what is this?

name, description, indications, contraindications, complications

A

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
42
Q

what is this?

name, description, indications, contraindications, complications

A

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
43
Q

what is this?

name, description, indications, contraindications, complications

A

leg bag

  • attached to catheter and strapped around leg
  • allow pt to be mobile with short/long term catheter
44
Q

what is this?

name, description, indications, contraindications, complications

A

mannitol

  • osmotic diuretic
  • used in management of raised ICP or to drive urine output in obstructive jaundice to prevent hepato-renal syndrome
45
Q

what is this?

name, description, indications, contraindications, complications

A

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
46
Q

what is this?

name, description, indications, contraindications, complications

A

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
47
Q

what is this?

name, description, indications, contraindications, complications

A

nasal speculum

Thudichum nasal speculum

designed to open and expand the nasal canal for examination

48
Q

what is this?

name, description, indications, contraindications, complications

A

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
49
Q

what is this?

name, description, indications, contraindications, complications

A

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
50
Q

what is this?

name, description, indications, contraindications, complications

A

needle holders

used during suturing, designed to allow accurate placement and ease of procedure

51
Q

what is this?

name, description, indications, contraindications, complications

A

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
52
Q

what is this?

name, description, indications, contraindications, complications

A

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
53
Q

what is this?

name, description, indications, contraindications, complications

A

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%
54
Q

what is this?

name, description, indications, contraindications, complications

A

0.9% sodium chloride

  • 154 mmol NaCl
  • can be used to provide maintenance fluid or replace additional losses
55
Q

what is this?

name, description, indications, contraindications, complications

A

nylon suture

  • form of synthetic non-absorbable suture
  • monofilament
  • closes skin wounds
56
Q

what is this?

name, description, indications, contraindications, complications

A

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
57
Q

what is this?

name, description, indications, contraindications, complications

A

paediatric oxygen mask

58
Q

what is this?

name, description, indications, contraindications, complications

A

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
    *
59
Q

what is this?

name, description, indications, contraindications, complications

A

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
60
Q

what is this?

name, description, indications, contraindications, complications

A

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
61
Q

what is this?

name, description, indications, contraindications, complications

A

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
62
Q

what is this?

name, description, indications, contraindications, complications

A

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
63
Q

what is this?

name, description, indications, contraindications, complications

A

self retaining retractor

  • holds wounds open
  • e.g. during hernia repair or an appendicectomy
64
Q

what is this?

name, description, indications, contraindications, complications

A

self inflatable bag-valve mask

  • high levels of oxygen even at low flow rates
  • 100% with flow rates > 10L/min
65
Q

what is this?

name, description, indications, contraindications, complications

A

shouldered syringe

  • can be used for haemorrhoid injrection treatment
    • 5% phenol in almond oil, above dentate line, done using proctoscope
66
Q

what is this?

name, description, indications, contraindications, complications

A

drainage type silastic foley urinary catheter

  • made of silicon
  • more appropriate for long term catheterisation than latex one
67
Q

what is this?

name, description, indications, contraindications, complications

A

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)
68
Q

what is this?

name, description, indications, contraindications, complications

A

triple lumen central venous cannula

69
Q

what is this?

name, description, indications, contraindications, complications

A

specimen swabs

  • sterile used for MRSA screen (nasopharyngeal, groin)
  • bluetop transwab amies - aerobes, anaerobes, fastidious organisms
  • specimens from wounds, skin, urogenital tract, throat
70
Q

what is this?

name, description, indications, contraindications, complications

A

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
71
Q

what is this?

name, description, indications, contraindications, complications

A

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
72
Q

what is this?

name, description, indications, contraindications, complications

A

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
73
Q

what is this?

name, description, indications, contraindications, complications

A

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
74
Q

what is this?

name, description, indications, contraindications, complications

A

swan ganz catheter

  • measure pressure in heart, pulmonary artery wedge pressure and CO
  • ICU
  • inserted into central vein
75
Q

what is this?

name, description, indications, contraindications, complications

A

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
76
Q

what is this?

name, description, indications, contraindications, complications

A

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
77
Q

what is this?

name, description, indications, contraindications, complications

A

trucut needle

  • biopsy needle used to take a histological specimen (breast, lumps, livers)
  • under LA usually
78
Q

what is this?

name, description, indications, contraindications, complications

A

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
79
Q

what is this?

name, description, indications, contraindications, complications

A

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
80
Q

what is this?

name, description, indications, contraindications, complications

A

urometer

  • monitor UO
  • assess each hour
  • used post-op, ICU, monitor fluid status
81
Q

what is this?

name, description, indications, contraindications, complications

A

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%
82
Q

indications for tunnelled central line

A
  • 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
83
Q

what is are the borders of the triangle of safety?

A
  • 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
84
Q

features on CXR of NG in correct position

A

must be reported by a radiologist for it to be deemed safe to use

85
Q

What is used for post-pyloric feeding? what indications?

A
  • 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)
86
Q

complications of urinary catheterisation

A
  • early/immediate
    • urethral trauma
    • allergic reaction
    • balloon rupture
    • obstruction
    • bypass/leak
    • bladder perforation
  • delayed
    • UTI, pyelonephritis
    • urethral stricture
87
Q

complications of intubation

A

early

  • can’t intubate, can’t ventilate
  • trauma - lose teeth, oropharynx
  • bleeding
  • cuff perforation
  • endobronchial intubation

delayed

  • tracheal necrosis → tracheo-oesophageal fistula
  • tracheal stenosis
88
Q

escalation of airway management

A
89
Q

what is a definitive airway?

A

a device which is infraglottic (crosses the cords)

secure (cuffed)

prevents aspiration of gastric contents

can deliver maximum concentrations of oxygen

90
Q

indications for intubation

A

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
91
Q

what are the escalation for oxygen delivery instruments?

A
92
Q

what is this?

name, description, indications, contraindications, complications

A

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)
93
Q

what is this?

name, description, indications, contraindications, complications

A

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)
94
Q

complications of ABG

A

complication

  • painful
  • local haematoma
  • infection at puncture site
  • vessel laceration
  • needle-stick injury
  • air/thrombus embolism
  • radial artery stenosis - repeated ABG e.g. COPD
95
Q

general blood bottle complications

A
  • mislabelling
  • out of date
  • wrong order
  • haemolysis of sample and aberrant reading
96
Q

ET tube complications

A
  • 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)