Procedures

Question 1

Central line definition

Answer 1

Cannula placed into large vein, form of venous access.
Used to give fluids/meds that would harm peripheral vein (e.g. chemotherapeutics or large vol. fluids/blood) OR to obtain central venous oxygen sats and central venous pressure.
Commonly in: internal jugular, subclavian, femoral or through arms as a PICC line

Question 2

central line indications

Answer 2

1. Difficult peripheral access
   
   2. Certain meds - vasopresssors, chemo, hypertonic solutions
   3. Prolonged IV therapies - parenteral nutrition or long term Abx
      Specialised treatment - haemodialysis, plasmaphoresis, invase haemodynamic monitoring

Question 3

central line Cx

Answer 3

1. Pnuemothorax (highest with subclavian) - risk minimised using USS. Mx with chest drain
   
   2. Vascular perf. - very rare esp. w/USS. If carotid arteCry is cannulated inform vascular surgeon
   3. Catheter related blood stream infection: Prevention by super cleaning using chlorhexidine. If suspectefdTake cultures, give Abx (most common organism Staph give emperical gram positive cover until cultures back)
   4. Occlusion: if non-thrombus occusion you can clean line with 0.1N HCl to flush lipids from TPN away
   5. DVT: can occur around central line site. Monitor along line for tenderness, consdier VTE proph w/LMWH. If suspected order doppler and think about treatment.
   6. Air embolism: (causing stroke, pulmonary oedema and sudden RHF leading to cardiogenic shock). If large suction can be attempted to remove it. OR position patient in left lateral decubitus

Question 4

Chest drain define

Answer 4

Flexible plastic tube inserted through chest wall into pleural space. Used to remove air, fluid, pus

Question 5

Chest drain indications

Answer 5

1. Pneumothorax
   
   2. Pleural effusion
   3. Empyema
      4, Haemothorax

Question 6

Chest drain Cx

Answer 6

1. Clogging can lead to large effusion putting pressure on RV. Can also lead to pneumothorax worsening. Change drain and make sure to use appropriate sized lumen.
   
   2. Insertion: haemorrage, infection, re-expansion pulmonary oedema. Also injury to liver/spleen. Insert in safe triangle.
      Minor: sub cut haematoma and seroma

Question 7

Amputation (upper limb) define

Answer 7

Surgical removal of part or all of the upper limb. Can occur at various levels: finger, partial hand, wrist disarticulation, transradial, elbow disarticulation, transhumeral, shoulder disarticulation, forequarter (including scapula and clavicle)

Question 8

define above knee amputation

Answer 8

Surgical removal of the lower limb above the level of the knee at the distal femur. Can be done at various levels (short AK, mid AK, supracondylar)

Question 9

below knee amputation define

Answer 9

Surgical removal of the lower limb below the level of the knee at the proximal tibia and fibula.

Question 10

Indications for upper limb amputation

Answer 10

1. Trauma beyond repair
   
   2. Ireeparable loss of blood supply (vascular disease, thrombus)
   3. Malignancy (osteosarcoma, chondrosarcoma)
   4. Diabetes Cx (cellulitis)
   5. Severe contracture (polio, cerebral palsy, muscular dystrophy)
   6. Untreatbale Infection/ gangrene (osteomyelitis, C. perfringens)
   7. Burns
      Frostbite

Question 11

Indications for above knee amputation

Answer 11

1. Trauma beyond repair (MESS score accounts for skeletal/soft tissue injury, ischaemia, shock, age
   
   2. Infection compromsing entire lower leg and unresectable (non healing diabetic wounds, Nec. Fasc.)
   3. Tumours that are unresctable or would leave lower leg without function
      Vascular compromise

Question 12

indications for below knee amputation

Answer 12

1. Infections without source control
   
   2. Haemorrhage where risk outweighs limb preservation
   3. Chronic unhealing ulcers (diabeteic or vascular)
   4. Infections with impending sepsis/systemic infection
   5. Full thickness burns covering majority of lower extremity
      Complete NV compromise

Question 13

Complications of amputation

Answer 13

1. Delayed wound healing (Abx, wound care)
   
   2. Oedema: immediate post-op rigid dressing, with ongoing compression, massage, elevation. And fluid balance/diuretics if needed)
   3. Impact on body image and self perception: ascertain patients feelings and refer to psychiatric team if having any troubles
   4. Phantom pain/sensation: NEUROpathic therefore pregabalin, gabapentin
   5. Residual limb pain: MSK in nature NSAIDS, paracetamol, opioids effective. Also consider compression, massage
      Contracture: exercises and stretching to maintain strength and ROM