Instruments for PACES station Flashcards
What is this?
Absorbable sutures
What are absorbable sutures broken down by?
Physiological processes: enzymatic degradation + hydrolysis
Clinical status e.g. sepsis can affect rate of absorption
Compare the 2 types of absorbable sutures
Monocryl: monofilament, increased throws for stable knot (5-7).
Vicryl: polyfilament is braided; so is less likely to loosen at the surgical knot, less throws (3)
What does the tensile strength of sutures depend on?
Diameter of thread
The more 0’s the finer the thread
What are the disadvantages of vicryl sutures?
Increased fraying issues
Additional trauma + local tissue inflammation: Generate high friction + drag
Increased infection risk (gaps between strands + capillarity)
What is this?
Arterial blood gas syringe
What information do you get from an ABG?
pH
pO2 + pCO2: for identification of resp failure (arterial)
Bicarbonate
Lactate
Hb
Na+/K+
What does the purple blood bottle contain, and what is it used for?
EDTA
Haematology
What does the pink blood bottle contain and what is it used for?
EDTA
Group + Save and cross match
What does the blue bottle contain and what is it used for?
Buffered sodium citrate
Used for coagulation screening
What does the yellow/ gold blood bottle contain and what is it used for?
Silica particles + serum separating gel
Used for tests that require separated serum for analysis inc. immunology, microbiology, biochemistry, endocrinology, toxicology, oncology, U+E’s + LFT
What does the grey blood bottle contain and what is it used for?
Sodium fluoride + potassium oxalate
Used for glucose + lactate
What does the red blood bottle contain and what is it used for?
Silica particles
Sensitive tests eg toxicology, drug levels, antibodies, hormones, bacterial + viral serology
What does the dark green blood bottle contain and what is it used for?
Sodium heparin
Used for ammonia, renin, aldosterone + insulin tests
What does the light green blood bottle contain and what is it used for?
Lithium heparin + plasma separator gel
Used for routine biochemistry
What is the rust top blood bottle used for?
Viral immunology
What are these?
Blood culture bottles
Aerobic = Blue top (fill first)
Anaerobic = Purple top
Blue = Before
What is this? What is it used for?
Blood glucose monitoring kit
Test real-time capillary blood glucose
Give 2 examples of how blood glucose monitoring kits are used
Patients use to guide insulin dosing
Acutely to guide Tx in diabetic crises, such as DKA, non-ketotic hyperglycaemia, hypoglycaemia + reduced GCS
What are these? What are they made from? How long do they last?
Breast implants
Round or anatomical shaped
Made from silicone
Last ~10-15y
Recall 6 possible complications of breast implants
Rupture (last 10-15y, may rupture after this)
Infection
Capsular contracture
Erosion
Migration
ALCL (anaplastic large cell lymphoma)
What is this, and when might it be used?
Catgut suture
Natural absorbable suture
Rarely used nowadays but sometimes still used in formation of stomas + circumcision
What is this?
Catheter bag
Urethral or Suprapubic
What is this? List the contents
Seldinger central line insertion pack:
3-5 lumen cannula
Guide wire
Dilator
Scalpel
Introducer needle
Which veins might a central line be inserted into?
Subclavian
Internal jugular
What can central lines be used for?
- Delivery of medications/ fluids that may be harmful orally or peripherally
- Blood tests + central venous pressures
Give 4 indications for a central line
Parenteral nutrition
Emergency venous access
Fluid resuscitation
Infusion of irritant drugs, vasopressors, inotropes
Recall 4 possible complications of central line insertion
Pneumothorax
Sepsis
Thrombosis
Misplacement
What is this?
Chest drain bottle
Give 6 indications for a chest drain
Pleural effusion
Pneumothorax
Haemothorax
Empyema
Talc pleurodesis
Post-thoracic cavity procedures e.g. cardiac surgery
What are the 2 types of chest drain bottle?
Passive drainage system: employs a positive expiratory pressure and gravity to drain the pleural space, helps recreate a -ve pressure in the pleural space (Contains a small amount of water)
Active closed drainage system: delivers suction (to help the lung re-expand), allows to measure if there is any ongoing air leak between the lung + pleural cavity.
Where does the chest drain act?
It drains air/ blood/ pus etc from the pleural space
What can be seen once a chest drain has been inserted?
Bubbling as air leaves pleural space
Instructions to pt about chest drain?
- Bottle must always be below level of waist
- May be asked to cough so HCP can check if it’s working
- You will have a waterproof dressing over the suture site
What is this?
CSF manometer
What is a CSF manometer used for?
Identification of opening pressures- represent intracranial pressure in LP
Measurement is in cm H2O
What are the ranges of normal opening pressures on LP?
10-18cm H2O lying on their side
20-30cm H2O when sat up
What is this and what is it used for?
Devers retractor
Retraction in abdominal surgery
What is this? What is it used for?
Diathermy (monopolar)
Coagulation + dissection of tissue
What are the possible complications of diathermy?
- Risk of burning hands
- Risk of fire if alcohol wash used
What is this? What is it used for?
Disposable rigid sigmoidoscope
Inspection of rectum + lower sigmoid colon
Can take biopsies of rectal mucosa
Describe use of disposable rigid sigmoidoscope
Light source + air pumping device attached
Patient in left lateral position
Lubricate scope
Insert pointing towards umbilicus
Air pumped into rectum to allow visualisation of lumen
What is this?
Drainage bag that may be attached to NG tube/ abdo drain
(closed passive drainage system, relies on gravity)
What is this? When is it used?
Endotracheal tube with tape and syringe
= definitive airway
used in trauma cases, surgery with GA + patients with GCS <8
How is an endotracheal tube inserted?
Using a laryngoscope + Eschmann Tracheal Tube Introducer (ETTI aka bougie)
Balloon at end inflated with air through blue side port to maintain position + protect from aspiration
Tape secures the airway
Connected to O2 + ensures adequate gaseous exchange
How is positioning of an endotracheal tube checked?
Looking for symmetrical rising of the chest on ventilation, breath sounds bilaterally + no gurgling over the epigastrium indicating oesophageal intubation
List 5 complications of endotracheal tube usage
Inappropriate placing (oesophageal)
Injury to larynx
Pneumothorax
Atelectasis
Infection
What is this?
Epidural insertion pack (needle, catheter, catheter adaptor)
What type of needle is used for epidurals?
Touhy needle with clear depth marking for accurate insertion depth reading
What is the epidural catheter specially designed for?
Short + long term anaesthesia + pain relief
Adaptor for safe + secure attachment to catheter for convenience of procedure
What is this?
Faeces sample pot
What tests can be used on a stool sample? How long does it take for results to come back?
MCS: up to 4d
Rotavirus/ Adenovirus/ Norovirus: same day
Glutamine Dehydrogenase (GDH): C.diff
C.DIff Toxin test: only performed if GDH +ve
C.Difficile ribotyping: up to 2w
Microscopy for Ova, Cysts + parasites: 4d
Helicobacter antigen testing: up to 1w
What is this? What is it used for?
Feeding NG tube (clinifeed tube)
Long term enteral nutrition
How is a feeding NG tube specially designed?
Thin bore + soft: more comfortable
Silastic: blocks less often
How is an NG tube inserted? How is correct positioning checked?
Lubricate tube
Wire inside aids introduction
Advance tube as patient swallows
Position checked with XR for wire
Wire removed if in correct position + feed attached
What is this?
5% dextrose solution
What does 1L of 5% detrose contain?
50g dextrose in 1L water
Sugar in the fluid is metabolised to CO2 + water, you are essentially giving them water
What is this?
Fluid giving set
What are these?
Toothed Forceps (bottom)
Non-toothed Forceps (top)
What are dissecting forceps often known as? What are they used for?
Ramsay Forceps
Used for grasping tissue
General rules:
* tooth only used for skin
* in peritoneal cavity, only non-tooth used
What is this?
Fracture plate
Used in conjunction with screws to interally fix a bone fracture