Surgical Attachments & Drains Flashcards
What do the following words mean?
- Ectomy
- Otomy
- Oscopy
- Ostomy
Ectomy: Removal of
Otomy: Cutting into
Oscopy: Looking into
Ostomy: Opening into
What is a laparotomy incision used for?
- Removal of cancerous bowel, spleen, pancreas, gall bladder, stomach or liver
- Division of adhesions (scar tissue) interfering with bowel movement
- Repair of abdominal aortic aneurysm (AAA)
What is a sternotomy incision used for?
Cardiac surgery
- Cardiac artery bypass grafting (CABG)
- Aortic or mitral valve replacement
What is a thoracotomy incision used for?
Thoracic surgery
- Removal of lung cancer (pneumonectomy, lobectomy)
What are considered to be attachments?
Anything that is not part of a patient’s body but is connected to them in some way
What is an arterial line?
- Plastic catheter that goes into an artery
- Connected to transducer
- Most commonly in radial artery
- Only in ICU
What are the 2 main functions of an arterial line?
- Allows frequent/painless ABG sampling without a Dr present
- Constantly monitors BP
What would happen if an arterial line was dislodged?
Heavy arterial bleeding
Why is a resting splint sometimes used with an arterial line?
- To prevent it from being dislodged
- To keep the wrist neutral & prevent kinking in the artery
What is a central venous catheter (CVC) or central line?
- Tube into superior vena cava in right atrium
- Connected to transducer
- Can be jugular or subclavian
What are the 2 main functions of a central line?
- Fast administration of drugs/fluids
- Measurement of central venous pressure (CVP) - gives an indication of heart performance
What is a variation of a central line?
Peripherally inserted central catheter (PICC line) - Long term central line
What is an epidural?
- Injection into epidural space outside dura mater
- Combination of anaesthetic & opioid
- Can be at any spinal level
What is an epidural often used in?
- Childbirth
- AAA repair
- Hip replacement
- Intestinal surgery
What are some important things to note about epidurals?
- Very fine tubing, easy to dislodge (yellow stripe)
- Sensory vs motor block (motor block is bad, monitored with BP)
- Often require oxygen therapy
- Patient can be mobilised (check for motor block first)
What should be monitored on patients who have had an epidural?
Blood pressure
What is an intravenous catheter (ICV)?
- Simple catheter inserted into peripheral vein
- Allows delivery of fluids and medications (i.e. drip)
What is an indwelling catheter (IDC)?
- Catheter inserted into bladder, held via balloon
- Used to drain urine
- Attached to drainage bag
What is important to remember when handling patients with an IDC?
- Keep the bag below the bladder
- Keep the bag close to the patient (can hang off frame)
What is an intercostal catheter (ICC)?
- Tube inserted into pleural space
- Sutured in place
- Attached to underwater sealed drain (UWSD)
What is the function of an ICC?
Used to drain air (pnemothorax), blood or pleural effusion
What is the function of under water sealed drains (UWSDs)?
- Allows tube drainage but not air to rise back into pleural space
- Measures drainage in mL
- Attached to wall suction - constant pressure to prevent pneumothorax
- Can see ‘swing’ and ‘bubble’ (indicator of ongoing air leakage)
What are some of the safety issues associated with UWSDs?
Exam question
- Always have clamps nearby (clamp tube close to chest if UWSD fails/breaks to prevent air going in)
- Always keep UWSD below patient’s chest (avoid drainage running back into pleural space)
- Always check if patient requires continuous suction or is allowed to mobilise without suction
What is a naso gastric tube (NG)?
- Inserted through nose into stomach
- Inserted blind by medical staff
- Requires CXR to double check placement
- Secured with tape
What is the function of a NG?
Allows feeding directly into stomach or drainage of stomach
Why would you remove a NG when mobilising/exercising?
So digestion can be paused
What is an exception to removing a NG during mobilisation?
High insulin dependency requiring constant feed to maintain blood sugar level
What are pacing wires?
- Wires placed directly after cardiac surgery (ensures cardiac output)
- Attached to pacing box (set heart rate)
Where can a pacing box be placed when moving a patient?
Tucked into the patient’s cough teddy
When are pacing wires typically removed?
- 2-3 days post survey if spontaneous heart rhythm established
- Patient required to rest in bed for 1-2 hours post removal (check with nurses before mobilising cardiac surgery patients)
What is a cardiac portable telemetry?
- Mobile continuous ECG recording
- Externally attached ECG dots
- ECG relayed to monitor at nursing station and/or bedside monitor
What are ostomys and somas?
- Surgically created openings from internal organs to skin
- Allows excretion of faecal matter bypassing lower GI tract
- Attached to drainage bags
What are wound drains?
- Passive bags that drain fluid/blood without suction
What is important to remember about wound drains?
- Identify every drain
- Keep below incision site if possible
- Can be hung off walking frames if safe
- Patients may be able to carry small bags
What are TED stockings?
- Anti-embolism compression devices
- Routinely used post surgery
- Hole at toe end
What should you do to avoid a patient slipping in TED stockings?
- Slippers
- Roll up so at least ball of foot is exposed
What is the function of mechanical/sequential calf compressors?
- Inflation/deflation of balloons around calves
- Anti-embolism
- Attached with velcro, easily removed
