Procedures for the Surgical Ward and Clinic Chapter9 P66-73

Question 1

COMMON PROCEDURES
How do you place a peripheral intravenous (IV) catheter?
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Answer 1

1. Place a rubber tourniquet above the site
2. Use alcohol antiseptic
3. Place IV into vein with “flash” of blood
4. Remove inner needle while advancing IV catheter
5. Secure with tape

Question 2

How do you draw blood from the femoral vein?

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Answer 2

Remember “NAVEL”: In the lateral to medial direction—Nerve, Artery, Vein, Empty space, Lymphatics—and thus
place needle medial to the femoral pulse

Question 3

How do you remove staples?

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Answer 3

Use a staple remover (see Chapter 7), then place Steri-Strips®

Question 4

How do you remove stitches?

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Answer 4

1. Cut the suture next to the knot
2. Pull end of suture out by holding onto the knot
3. Place Steri-Strips®

Question 5

How do you place Steri-Strips®?

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Answer 5

1. Dry the skin edges of the wound
2. Place adhesive (e.g., benzoin)
3. With the Adson pickup or with your fingers, place strips to gently appose epidermis (Note: Avoid any tension or blisters will appear!)

Question 6

How do you place a Foley catheter?

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Answer 6

1. Stay sterile
2. Apply Betadine® to the urethral opening (meatus)
3. Lubricate the catheter
4. Place catheter into urethra
5. As soon as urine returns, inflate balloon with saline (balloon size is given in cc on the catheter)

Question 7

How do you find the urethra in females?

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Answer 7

First find the clitoris and clitoral hood:
The urethra is just below these structures; wiping a Betadine®-soaked sponge over this area will often result in
having the urethra “wink” open

Question 8

Can you inflate the Foley balloon before you get urine return?
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Answer 8

No, you might blow up a balloon in the urethra!

Question 9

NASOGASTRIC TUBE (NGT) PROCEDURES
1. How do you determine how much of the NGT should be
advanced into the body for the correct position?
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Answer 9

Rough guide: from nose, around ear, to 5 cm below the xiphoid

Question 10

How do you place the NGT in a nare?

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Answer 10

First place lubrication (e.g., Surgilube®) then place NGT straight back—not up or down!

Question 11

3. What is the best neck position for advancing the
   NGT?
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Answer 11

Neck FLEXED! Also have the patient drink some water (using a straw)

Question 12

4. What if there is 3 liters/ 24 hours drainage from an NGT?

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Answer 12

Think DUODENUM—the NGT may be in the duodenum and not the stomach! Check an x-ray

Question 13

5. How can you clinically confirm that an NGT is in the stomach?
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Answer 13

Use a Toomey syringe to “inject” air while listening over the stomach with a stethoscope; you will hear the “swish” if the NGT is in place

Question 14

6. How do you tape an NGT?

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Answer 14

see picture

Question 15

7. What MUST you obtain and examine before using an NGT for feeding?
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Answer 15

LOWER chest/upper abdominal x-ray to absolutely verify placement into the stomach and NOT the LUNG—patients
have died from pulmonary tube feeding!

Question 16

8. How do you draw a radial arterial blood gas (ABG)?

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Answer 16

Feel for the pulse and advance directly into the artery; ABG syringes do not have to have the plunger withdrawn manually

Question 17

9. How do you drain an abscess?

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Answer 17

By incision and drainage (or “I & D”):
After using local anesthetic, use a #11 blade to incise and then open the abscess pocket; large abscesses are best drained with a cruciate incision or removal of a piece of skin; pack the open wound

Question 18

10. How do you remove an epidermal cyst or sebaceous
    cyst?
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Answer 18

1. Administer local anesthetic
2. Remove the ellipse of skin overlying the cyst, including the pore
3. Remove the cyst with the encompassing sac lining