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42 Cards in this Set
- Front
- Back
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how long until a sutured wound epithelializes
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24-48 hours
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when do you remove dressing after primary closure
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POSTOP day 2
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when can patient take a shower after a primary closure
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after POSTOP day 2
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things that inhibit wound healing
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infection
ischemia diabetes malnutrition anemia steroids cancer radiation |
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how to reverse effects of steroids on wound healing
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vitamin A
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what is abdominal wound dehiscence
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opening of the fascial closure (not skin)
RETURN TO OR |
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how to treat dehiscence
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return to OR for immediate fascial rclosure
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what is Dakin solution
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dilute sodium hypochlorite (bleach) used in contaminated wounds
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2 purposes of drains
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- withdrawal of fluids
- apposition of tissues to remove a potential space by suction |
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Jackson Pratt (JP) drain?
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closed drainage system attached toa suction bulb
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Jackson Pratt drain removal
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Three Ss
- Stitch removal - Suction discontinuation - Slow steady pull |
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Penrose drain
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open drainage system composed of a thin rubber hose
associated with increased infection rate in clean wounds Penrose pus |
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G tube
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gastrostomy tube for
-draining -feeding |
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J-tube
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jejunostomy tube
used only for feeding (vs G tube which is also used for drainage) |
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Cholecystostomy tube
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drains the gallblatter
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T tube
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placed along CBD with ascending and descending limb that forms a T
drains percutaneously usually placed after CBD exploration |
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Thoracostomy tube
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chest tube
purpose:- to appose parietal and visceral pleura by draining blood, pus, fluid, chyle or air |
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Insertion method for a chest tube
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1) local anesthetic
2) incise skin in 4th-5th space between mid and anterior-axillary lines 3) blunt Kelly-clamp dissection over rib into pleural space 4) finger exploration to confirm intrapleural placement 5) place tube posteriorly and superiorly |
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where are vessels and nerves relative to rib
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below
the Bad is Below |
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Goals of chest tube
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- drain pleural cavity
- appose parietal and visceral pleura to seal any visceral pleural holes |
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where should chest tube be positioned
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posteriorly into apex
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3 chambers of a chest tube?
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1) collection chamber (collects & measures)
2) water seal (air removed from pleural space but can't go back -- there's a one way valve, as in a straw) 3) suction control (height of water column controls amt of suction) |
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how to tell if chest tube is sealed off by pleura
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turn pleuravac off and see if fluid moves with respiration/ventilatin (=tidling)
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usual tx for a pneumothorax
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1) suction until PTX resolves and air leak is gone
2) water seal for 24 hours 3) remove chest tube or no PTX/air leak after 24 hours of water seal |
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how fast is a small, stable PTX absorved
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1% daily, so 10 days for a 10% PTX
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steps in removing a chest tube
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1) cut stitch
2) ask for maximum inhale OR exhale 3) remove tube v v rapidly and at same time place petroleum jelly gauze covered by 4x4s and then tape 3) get CXR |
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what is the blue port in an NG tube
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the incoming air tube. Make sure it's always above the stomach!!!
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does the NG tube always have to be on suction
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yes, low continuous suction
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when does the NGT have excessive draining
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when in duodenum and getting pancreatic fluid and bile
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can you feed through an NG tube?
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no, only Dobbhoff feeding tube, which has only one lumen
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what's a Coude catheter
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Foley with a small, curved tip to get around a large prostate
coude curve |
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next step if you can't get a foley in
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anesthetize urethra with lidocaine jelly and try a LARGER tube
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if there's been uretheral injury what do you do instead of placing a Foley catheter
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place a suprapubic catheter
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main complications from central lines
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PTX
bleeding malposition dysrhythmias |
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purpose of the cuff in a central line
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ingrowth of fibrous tissue to
- hold line in place - form a barrier to bacteria |
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external central line tunneled under skin with a cuff
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Hickman
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central line that has a port buried under the skin that must be accessed through the skin, percutaneously
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Port-A-Cath
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what's a cordis
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a massive central line catheter used for massive fluid resuscitation or for placing a Swan Ganz catheter
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if you fail to get a central line in on one side, what do you do before getting the next one?
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CXR to avoid bilateral PTX!!!
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how to convert from French size to mm
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divide by pi, or 3.14, or just 3
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which is larger, a 14 or 21 guage needle
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14! because it's 1/14th vs 1/21st
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what's a Tenckhoff catherter
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placed in peritoneal cavity for peritoneal dialysis
you can take a Tenckoff with a Tenckhoff |
