Sa Tech Lab 2 - Critical Care

Front 1

what are two ways in which thoracocentesis is used for diagnosis?

Back 1

1. fluid evaluation - cytology and microbiology
2. facilitate radiographic assessment

Front 2

what are four pleural space diseases where thoracocentesis is performed?

Back 2

1. pyothorax
2. chylothorax
3. hemothorax
4. pneumothorax

Front 3

what equipment is needed for a thoracocentesis?

Back 3

1. clippers
2. sterile glove solution
3. sterile gloves
4. large syringe (10-60 mL)
5. 3-way stopcock
6. needle and extension tubing or butterfly catheter (19-23 gauge) - 7/8" needle for most cats and dogs; 1.5" needle in larger dogs
7. bowl

Front 4

where is the needle placed in a thoracocentesis:
- ICS?
- for pneumothorax?
- for pleural fluid?

Back 4

- 7th-9th ICS
- dorsal 1/3rd for pneumothorax
- ventral third for pleural fluid

Front 5

for a thoracocentesis, what is done just prior to scrubbing the site?

Back 5

lidocaine block

Front 6

where do intercostal veins, arteries, and nerves run?

Back 6

CAUDAL side of the rib

Front 7

in a thoracocentesis, where in the intercostal space should the needle be placed to as to avoid intercostal blood?

Back 7

cranial to the rib or in the mid-intercostal space

Front 8

describe the process of placing the needle in a thoracocentesis

Back 8

cranial to the rib or in the mid-intercostal space, insert needle at a 45° angle; after insertion, redirect the needle so that it is parallel to the body wall with the bevel out

Front 9

what are five complications of thoracocentesis?

Back 9

1. iatrogenic lung laceration - hemorrhage, pneumothorax
2. pneumothorax from improper technique
3. intrathoracic hemorrhage (laceration of intercostal blood vessels)
4. re-expansion pulmonary edema - severe, chronic pleural effusions; chronic lung collapse
5. exacerbation of dyspnea

Front 10

what is tracheotomy?

Back 10

surgical cut or opening made in the trachea

Front 11

what is tracheostomy?

Back 11

temporary or permanent opening (stoma) in the trachea

Front 12

when is a tracheostomy tube indicated? (3)

Back 12

1. respiratory compromise due to upper airway obstruction from the cranial to mid-cervical region
2. emergency procedure if unable to intubate
3. elective procedure - surgical intervention to the larynx or proximal trachea

Front 13

when is a cuffed tracheostomy tube used?

Back 13

for a ventilator or PPV

Front 14

what are eight supplies needed for tracheostomy?

Back 14

1. clippers
2. sterile scrub solution
3. sterile gloves
4. laceration pack
5. tracheostomy tube or sterile endotracheal tube
6. non-absorbable suture material (e.g., nylon)
7. white tape
8. umbilical tape or roll gauze

Front 15

how is the animal positioned and prepared for tracheostomy? (5)

Back 15

1. dorsal recumbency
2. place towel or fluid bag behind neck
3. extend neck and pull thoracic limbs caudally
4. secure legs lateral to thorax
5. clip and surgically prep the ventral region

Front 16

what are the landmarks for the ventral midline incision used to place a tracheostomy tube?

Back 16

cricoid cartilage to 6th tracheal ring

Front 17

what might you accidentally lacerate when making a ventral midline incision to place a tracheostomy tube?

Back 17

caudal thyroid vein

Front 18

after you make a ventral midline incision from the cricoid cartilage to the 6th trachel ring to place a tracheostomy tube, what do you do next?

Back 18

place stay sutured around the rings immediately cranial and immediately caudal to the tracheostomy site.

Front 19

in placing a tracheostomy tube, describe the incision into the trachea.

Back 19

- make a stab incision between the 3rd and 4th (or 4th and 5th) tracheal rings
- extend the incision laterally in both directions to encompass about 40% of the tracheal circumference

Front 20

after the incision is made, how is the tracheostomy tube placed?

Back 20

enter the stoma and push tube in parallel to the trachea in the caudal direction. Secure with GAUZE or umbilical tape, NOT SUTURE.

Front 21

what is the maximum size of the tracheostomy tube?

Back 21

no larger than 75% of the tracheal luminal diameter

Front 22

how long should a tracheostomy tube be?

Back 22

6-7 tracheal rings in length

Front 23

what is it important to do when incising the ventral neck for placement of a tracheostomy tube?

Back 23

stay on the midline

Front 24

how often should a tracheostomy tube be changed?

Back 24

1-2 times per day

Front 25

how should a tracheostomy tube site be dressed?

Back 25

± a small bandage over the site

Front 26

how is a tracheostomy closure performed?

Back 26

allow to heal by 2nd intention

Front 27

what are nine complications of placing a tracheostomy tube?

Back 27

1. dislodgement
2. infection
3. hemorrhage
4. subcutaneous emphysema
5. damage to peritracheal structures
6. obstruction of the tube
7. pneumomediastinum
8. pneumothorax
9. tracheal irritation

Front 28

what are three indications for a thoracostomy tube?

Back 28

1. frequent thoracocentesis requires (e.g., rapidly forming pleural effusion or recurring pneumothorax)
2. tension pneumothorax
3. after thoracic surgery

Front 29

what are nine supplies needed for placing a thoracostomy tube?

Back 29

1. clippers
2. sterile scrub solution
3. sterile gloves
4. laceration pack
5. sterile commercial chest tube OR red rubber catheter
6. Christmas tree adapter
7. 3-way stopcock
8. C-clamp
9. quarter drapes

Front 30

what are thoracostomy tube sizes for the following:
- cats and dogs < 7kg?
- dogs 7-15 kg?
- dogs 16-30 kg?
- dog > 30 kg?

Back 30

- cats and dogs < 7kg: 14-16 Fr
- dogs 7-15 kg: 18-22 Fr
- dogs 16-30 kg: 22-28 Fr
- dog > 30 kg: 26-30 Fr

Front 31

what position is an animal for thoracostomy tube placement?

Back 31

lateral recumbency

Front 32

what area should be clipped and prepped for a thoracostomy tube?

Back 32

over the later thorax from just caudal to the scapula to the last rib, and from the dorsal spine to the ventral midline

Front 33

how to you measure thoracostomy tube length?

Back 33

from tube site of insertion to the cranial thorax at the level of the 2nd rib

Front 34

where is the incision made for thoracostomy tube placement?

Back 34

10th or 11th ICS on the dorsal 3rd of the lateral thoracic wall

Front 35

how is a thoracostomy tube placed into the chest after the skin incision is made?

Back 35

- advance subcutaneously for 3-4 ICS to create a SQ tunnel (↓pneumothorax)
- with the trocar and tube, push through muscle and pleura perpendicular to the chest wall until the chest wall is entered; may feel a "pop"
- with one hand resting on the body wall to stabilize, advance the tube off of the trocar in a cranial-ventral direction, directing the tip to the 2nd or 3rd sternebra
- clamp the tube with hemostats

Front 36

how is a thoracostomy tube secured to the body wall?

Back 36

purse-string suture with a Chinese finger trap suture

Front 37

after the thoracostomy tube is sutured to the body wall, how is the tube set-up completed?

Back 37

- place a C-clamp
- cap the tube with a Christmas tree adapter, 3-way stopcock, and injection cap

Front 38

in what direction is a thoracostomy tube placed for
- pleural effusions?
- pneumothorax

Back 38

- pleural effusions: cranioventral
- pneumothorax: craniodorsal

Front 39

what should be done to the thoracostomy tube when it is not being drained (besides the stop-cock being closed)?

Back 39

clamp with tube with a C-clamp or hemostat

Front 40

how is correct thoracostomy tube placement verified?

Back 40

radiograph

Front 41

how is a thoracostomy tube dressed?

Back 41

bandage

Front 42

how often should a patient with a thoracostomy tube be monitored?

Back 42

24/7

Front 43

what are the three types of material used for thoracostomy tubes and comment on their reactivity?

Back 43

1. PVC - less reactive
2. silicone - less reactive
3. red rubber feeding tube - more reactive

Front 44

what is the maximum size holes that should be cut in a red rubber feeding tube that is going to be used for a thoracostomy tube?

Back 44

1/3 the circumference

Front 45

how should a red rubber tube be held with the curved hemostats for proper placement as a thoracostomy tube?

Back 45

tube lumen on the convex side of the clamp and points of the hemostat forward of the beginning of the tube

Front 46

how is a red rubber catheter, clamped to curved hemostats, placed as a thoracostomy tube?

Back 46

- stab incision over 8th or 9th ICS
- force the hemostats, with the tube, with the closed hemostat at the cranial edge of the 7th or 8th rib and "pop" through
- feed the catheter through the OPEN hemostats

Front 47

what is a technical contraindication for using a red rubber tube as a thoracostomy tube?

Back 47

when there is going to be continuous suction

Front 48

when is it indicated to remove a thoracostomy tube?

Back 48

- no air production for more than 12 hours
- fluid production has decreased and the character is serous to serosanguinous

Front 49

what are nine complications of a thoracostomy tube and its placement?

Back 49

1. PNEUMOTHORAX
2. improper positioning
3. laceration of an intercostal vessel
4. intercostal nerve damage
5. injury to diaphragm and thoracic or abdominal organs
6. infection
7. pain
8. premature removal
9. clogging of the tube or suction apparatus

Front 50

what are three general indications for vascular access? (3)

Back 50

1. delivery: fluids, blood or blood components, meds, parenteral nutrition, anesthetics, sedatives
2. venous or arterial blood sampling
3. intravascular pressure monitoring

Front 51

what are four indications for central venous access?

Back 51

1. central venous pressure monitoring
2. frequent blood sampling
3. TPN
4. administering irritant solutions

Front 52

where do central venous catheters terminate?

Back 52

cranial or caudal vena cava

Front 53

what lab result should you obtain before placing a central venous catheter?

Back 53

coagulation profile

Front 54

what are the veins most frequently used to place a central venous catheter? (2)

Back 54

jugular and lateral saphenous

Front 55

what are two contraindications of a specific site to placement of a central venous catheter at that site?

Back 55

1. disease or infection of the skin or subcutaneous tissue
2. fractures or venous disruption proximal to the site

Front 56

what is the disadvantage of using a through-the needle catheter?

Back 56

hole in the vein is larger than the catheter, so you get hemorrhage around the catheter insertion site

Front 57

what are your two landmarks for where a jugular catheter runs?

Back 57

angle of the mandible and thoracic inlet

Front 58

what are 11 things you need for a central venous jugular catheter?

Back 58

1. surgical scrub
2. sterile gloves
3. sterile prep solution
4. quarter drapes
5. catheter
6. scalpel blade
7. suture material
8. porous tape
9. heparinized saline
10. injection port
11. bandaging material

Front 59

after the site is sterilely prepped, how is a jugular catheter placed into the jugular vein, before it is secured?

Back 59

1. extend the neck and occlude the vein at the thoracic inlet
2. make a stab incision over the vein at the proposed insertion site (usually cranial aspect)
3. insert the needle into the jugular vein and look for the flash of blood
4. advance the catheter while holding the needle
5. after the catheter has been advanced, back the needle out of the vein WITHOUT PULLING OUT THE CATHETER
6. break open and peel away the needle
7. attach an injection port to the catheter and flush with heparinized saline

Front 60

how is a jugular central venous catheter secured to the body and dressed?

Back 60

1. butterfly a bandage over the catheter hub and suture to the neck.
2. apply a light bandage (4x4) to keep the catheter in place
3. wrap the neck lightly with gauze and Vet wrap

Front 61

what do you do to protect the lumen of a central venous catheter?

Back 61

heparin lock; remove heparin before using catheter

Front 62

what are 3 indications for venous cutdown to place a catheter?

Back 62

1. shock
2. cardiopulmonary arrest
3. hypovolemia/hypotension

Front 63

as a rule of thumb, how long should you give yourself to put in an IV catheter in an emergency before you do a cutdown?

Back 63

4-5 minutes

Front 64

how is the lateral saphenous vein occluded when placing a central venous catheter?

Back 64

a tourniquet

Front 65

when placing a lateral saphenous central venous catheter, when is the tourniquet released?

Back 65

after the catheter is placed

Front 66

what is often indicated if a patient is going to walk with a lateral saphenous catheter?

Back 66

a firm splint in the bandage to prevent kinking

Front 67

central venous catheters:
- how long can they remain?
- how often should the bandage be checked?
- how often and in what manner should the bandage be changed?

Back 67

- central lines can remain as long as needed as long is it is appropriately maintained and handled
- check bandage every 4-6 hours
- every 3 days, change the bandage in a sterile manner

Front 68

when you sterilely change a bandage of a central venous catheter, what are 5 complications to check for?

Back 68

1. pain
2. redness
3. swelling
4. discharge
5. sudden fever of unknown origin

Front 69

after a central venous catheter is removed, how long should you hold off the vein to prevent hemorrhage?

Back 69

3-5 minutes of direct pressure

Front 70

what are 5 complications of central venous catheters?

Back 70

1. hemorrhage
2. subcutaneous hematoma formation
3. infection
4. thrombophlebitis
5. occlusion of catheter

Front 71

what are five common sites for interosseus catheters?

Back 71

1. trochanteric fossa of the femur (most common)
2. proximal medial tibia
3. wing of the ileum
4. greater tubercle of the humerus
5. ischium

Front 72

what are 5 supplies needed for intraosseous catheter placement?

Back 72

1. #11 blade
2. local anesthetic
3. 18-gauge hypodermic needle, spinal needle, bone marrow needle, or commercial IO catheter
4. T-connector with heparinized saline
5. tape, dressing, bandage material

Front 73

describe the placement of an interosseous catheter

Back 73

1. local to level of periosteum
2. stab incision
3. insert needle/canula into bone by twisting through cortex and into medullary cavity
4. remove stylet
5. flush with heparinized saline and attach T-set
6. secure with suture or tape
7. cover with sterile non-adherent dressing ± bandage

Front 74

interosseus catheter care:
- how long can it stay in?
- how do you maintain it?
- what happens if it is obstructed?
- how often should bandages be examined and changed?
- what 5 complications should be monitored for at the site?
- when should it be removed?

Back 74

- short time use
- maintain by running IVF or intermittent flush with heparinized saline
- if obstructed, remove
- examine ± change bandage BID
- monitor site for heat, erythema, swelling, pain, or SQ leakage
- remove when not required

Front 75

what are 3 contraindications for an IO catheter?

Back 75

1. sepsis
2. bone or skin infection
3. recent fracture at a site

Front 76

what are 5 complications of an IO catheter?

Back 76

1. sciatic nerve injury
2. injury to growth plate
3. osteomyelitis (especially if not placed aseptically)
4. pain during fluid administration
5. SQ leakage of fluids or medications

Front 77

what are 2 indications for diagnostic peritoneal lavage?

Back 77

1. repeat abdominocentesis is unsuccessful
2. if negative ultrasound-guided aspirate

Front 78

what should you always do before performing a diagnostic peritoneal lavage?

Back 78

empty the urinary bladder

Front 79

what are four contraindications for diagnostic peritoneal lavage?

Back 79

1. severe coagulopathy
2. marked distention of abdominal viscus
3. marked organomegaly
4. suspected neoplasia

Front 80

what are 5 supplies needed for diagnostic peritoneal lavage?

Back 80

1. #11 or #15 scalpel blade
2. 10-14 gauge over the needle catheter
3. 500 mL pre-warmed 0.9% NaCl or LRS
4. extension tubing and 3-way stopcock
5. EDTA (lavender tube), red-top tube, slides

Front 81

how is a diagnostic peritoneal lavage catheter fenestrated?

Back 81

in a spiral pattern, no more than 30% of diameter

Front 82

what is the procedure for a diagnostic peritoneal lavage?

Back 82

1. left lateral recumbency
2. aseptic prep
3. local skin block 1 cm on midline caudal to umbilicus
4. stab incision through the skin
5. pass catheter into the linea and aim caudally
6. remove stylet
7. attach tubing and 3-way stopcock
8. infuse saline via gravity flow (20 mL/kg)
9. massage abdomen and drain samples into tubes
10. if no fluid is returned, aspirate with 3-mL syringe

Front 83

what are 5 complications to diagnostic peritoneal lavage?

Back 83

1. iatrogenic injury to abdominal organs
2. plugging the catheter
3. leakage of fluids in the subcutaneous tissue
4. contamination or infection of the wound
5. dissemination of neoplasia