procedures Flashcards
Requisites for lumbar puncture
- incopad
- trash bag
- sterile towel
- LP needle ( appropriate size )
- disposable dressing set
- cleansing solution
> chlorhexidine 0.5% (blue color)
> povidine 10% - specimen bottle x 6
- lactate tube x 1 ( grey color )
- biohazard bag with ice x 1
- pressure bandage
- gauze
- op site spray
- tagaderm
- wet wipes
- diaper
For lumbar puncture, what position should the patient be lying in?
Lateral recumbent
Post-lumbar puncture management
- Apply pressure plaster to puncture site (keep for 24hrs)
- Pt to lie 4-6hrs supine to avert a spinal headache
- STAT POCT glucose
- Hourly para x 6, circulation chart (lower limbs), neurological chart (to monitor post dural puncture headache)
Contraindications of lumbar puncture in neonates
- Baby with unstable RR or haemodynamic status
- Platelet count < 80000/mm3 or other bleeding tendencies
- Recent seizure (within 30mins)
- Evidence of increased ICP from mass lesion
- Overlying skin infection/broken skin
Lumbar puncture is to collect what?
to collect cerebrospinal fluid surrounding the brain & spinal cord
Why is lumbar puncture needed?
- To diagnose or monitor infection (TRO serious intracranial infection)
- sometimes, to relieve high pressure in brain
Lumbar puncture: the CSF is collected & studied for?
colour, blood cell counts, protein, glucose & microbes
Some common complications of lumbar puncture
- Failure to obtain CSF specimen due to traumatic tap or dry tap
- Mixing of CSF and blood from intervening blood vessels
- Respiratory compromise
- Spinal hematuria
- Post LP headache
Requisites for blood cultures
- disposable dressing set
- 10 ml syringe
- needle 23G x1
- needle 19G x 1
- blood culture bottles
- sterile glove
- chlorhexidine 0.5% (blue color)
- povidine 10%
- gauze
- plaster
- alcohol wipes
- sharp box
- trash bag
Requisites for in-out cathetherization
- NGT ( appropriate size )
- lubricating gel
- chlorhexidine (pink color)
- specimen bottles
- incopad
- sterile gloves
- trash bag
Things to prep for septic workup
- IV plug setting
- Blood culture
- Lumbar culture
- In-out catherization
Purpose of in-out cathetherization
Sterile procedure to rule out UTI
Purpose of blood culture
To look for bacteremia
Complications of in-out
-Strictures: usually caused by using a catheter that is too large or by prolonged cathetrization
- Haematuria: usually transient
- Infection
- Trauma (in urethra or bladder)
Indications of lumbar puncture
- neonatal pyrexia (most common)
- meningitis/encephalitis
- measurement of intracranial pressure
- intrathecal chemo
- CNS inflmmatory conditions
Requisites for IV plug setting
- IV plug ( wing and without wing)
- alcohol wipes
- sharp box
- t connector and clove flush with posiflush
- IV advance tagederm
- 1 ml syringe with NaCl 0.9%
- tourniquet
- gauze
- plaster
- hand splint
- micropore
- blood tubes ( if required )
What is renal biopsy?
Procedure to remove small amount of kidney tissue. This tissue is used to examine for signs of kidney damage or disease
What to expect for renal biopsy procedure?
- obtain signed consent from parents
- blood investigations ( to check on bleeding tendencies)
- IV cannula insertion
- fasting is required for at least 6-8hrs before procedure
- IMPT: anticoagulants, NSAIDs, herbal supplements or other meds that affect blood clotting should be STOPPED 1 wk before procedure
Immediate care post renal biopsy
- Pt required to lie on back for 6-8hrs against the puncture site to apply direct pressure (prevents bleeding)
- Encourage to drink fluids to prevent blood clots in urine
- Vitals hrly x 6 (but depends on doc)
- Pt only allowed to start eating or drinking until fully awake from procedure
Concerning signs to look out for post renal biopsy
- Fever / chills
- Bleeding, swelling, redness at biopsy site
- Bright red blood or blood clots are seen in urine for more than 24hrs after biopsy
- Severe pain despite aft pain killer
- Inability to pass urine
