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33 Cards in this Set
- Front
- Back
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principles of consent |
Explain indication, procedure & risks. Ask if there are any questions |
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indications for a chest drain |
Pneumothorax Haemothorax Chlyothorax Empyema Pleural effusion |
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how to insert a chest drain |
Select correct size tube Patient in supine or 45°, arm behind head Landmark - 5th intercostal space, mid-axillary line Incision Blunt dissection with finger Insert tube without trocar Connect drainage device Look for respiration-related swing in fluid level of the water seal Secure with sutures and sealing suture Apply occlusive dressing CXR to check position |
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risks / complications of chest drain insertion |
Misplacement of the tube Bleeding Haemothorax Haemoperitoneum Organ perforation Tube dislodgement Empyema |
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record keeping after chest drain insertion |
Technique Length of drain inserted CXR position |
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indications for urinary catheter insertion |
Collection of sterile urinary specimen Bladder dysfunction Perioperative monitoring of urinary output Acute & chronic urinary retention Aid to abdominal /pelvic surgery Incontinence Monitoring the critical ill surgical patient |
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how to insert a urinary catheter |
Clean the genital area Aseptic technique Frog leg position Retract foreskin (male) Apply lubricant Pass catheter and await back flow Inflate balloon with10ml water Attach to bag |
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risks / complications of urinary catheter insertion |
Failure (common in men >65yrs due to BPH) Blockage Urethral bleeding Infection Urethral damage |
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record keeping after urinary catheter insertion |
Indication and technique Post-void volume |
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indications for ABG |
Identify respiratory and metabolic or mixed acid-base disorders Partial pressures of respiratory gases Assess response to therapeutic interventions Oxyhaemoglobin, carboxyHb, metHb Acute emergency blood sample |
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ABG procedure
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Allens test Prepare skin over palable artery Local anaesthetic Advance angled heparinised needle and syringe Await arterial blood flashback Pressure on incision for 5 mins (use assistant) Analyse the sample |
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risks / complications of ABG |
Pain Missed vessel / venous sample Haematoma / bleeding Compartment syndrome Laceration of vessel Infection |
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indications for rigid sigmoidscopy |
Investigation of anorectal symptoms Visualisation of the rectum Biopsy Passing a flatus tube alongside the sigmoidoscope allows for decompression of sigmoid volvulus |
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how to do rigid sigmoidoscopy |
Get a chaperone Gloves & apron (if decompression) Position patient on left lateral side with hips flexed and knees part extended PR exam Lubricate sigmoidoscope Insert with obturator in place Remove obturator, add light source, insufflator and eye piece Advance under direct vision Withdraw under direct vision Clean patient |
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risks / complications of rigid sigmoidoscopy |
Pain Uncomfortable desire to defecate/pass flatus Bleeding Infection |
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record keeping after rigid sigmoidoscopy |
Lesions - size and position according to clock face biopsy |
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indications for proctoscopy |
Anorectal conditions Removal of foreign body from anal canal Cytological screening Injection of haemorrhoids |
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how to do proctoscopy |
Get a chaperone Patient in lateral position with legs flexed at the knee and hip Visual inspection & PR Lubricating jelly Slowly advance proctoscope whilst patient bears down Once fully inserted, remove obturator Get light source Examine mucosa during slow withdrawal |
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risks / complications of proctoscopy |
mucosal irritation bleeding |
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indication for NG tube insertion |
Intestinal obstruction Paralytic ileus Perioperative gastric decompression in trauma Enteral feeding (feeding tube) |
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how to insert NG tube |
Prepare with cup of ice water Position patient with head tilted forward Estimate required tube length from alar to stomach Lubricate NGT with gel Pass tube horizontally along floor of nose to occiput As tube engages pharynx, ask patient to swallow sips Check position via CXR |
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risks / complications of NG tube insertion |
Discomfort Epistaxis Respiratory tree intubation Oesophageal perforation A misplaced NGT must not be used |
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record keeping after NG tube insertion |
Size and type of tube Length passed Coughing during procedure CXR confirmation - A misplaced NGT must not be used |
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indications for IV cannulation |
Venous access for administration of IV fluids, drugs, or blood IV radiological contrast |
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procedure for IV cannulation |
Apply tourniquet Clean site over suitable palpable vein Tether skin and insert cannula 1cm distal to point of entry Await flashback Advance cannula alone keeping needle fixed Remove tourniquet and compress vein proximal to cannula and remove needle Secure with dressing Flush with heparinised saline if not using immediately |
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risks / complications of IV cannulation |
Pain Failure Arterial puncture Thrombophlebitis Peripheral nerve palsy Compartment syndrome Skin and soft tissue necrosis |
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indications for lumbar puncture |
Suspected meningitis Suspected SAH Guillian Barre or carcinomatous meningitis |
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procedure for lumbar puncture |
Patient in lateral recumbent position, chin, hips & knees flexed towards chest Locate L3-L4 interspace Sterile and prep Local anaesthesia to skin Advance needle till pop into dura Await fluid return Connect manometer for pressure Collect CSF samples Withdraw needle Sterile dressing |
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risks / complications of lumbar puncture |
Headache Bloody tap Dry tap Infection Haemorrhage Dysaesthesia Cerebral herniation |
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record keeping after lumbar puncture |
Any headache / blood, keep patient in. Any neurological deficit, get a neurologist |
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indications for a central line insertion |
Volume resuscitation Venous access Nutritional support CVP monitoring - rare Transvenous pacing wire Haemodialysis |
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how to insert a central line |
Patient positioned supine with 15° Trendelenburg (head down) Cardiac monitor Aseptic technique and prep Identify needle insertion site via USS visualisation Local anaesthetic Insert introducer needle towards sternal notch until venous blood freely aspirated Insert guide wire into vein Stab incision against wire Thread dilator over wire and twist to dilate, remove dilator Thread catheter overwire, remove wire Flush, suture and clean dressing Get CXR to check position (tip at junction of SVC and right atrium), check for pnemothorax /haemothorax |
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risks / complications of central line insertion |
Arterial puncture (carotid) Haematoma Haemothorax Pneumothorax Thrombosis if left in Infection Air embolus Dysrhythmia |
