Emergency Surgical Procedure And Feeding Tubes Flashcards Preview

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Flashcards in Emergency Surgical Procedure And Feeding Tubes Deck (30):
1

How do you treat an upper airway obstruction that is expected to reproved with appropriate treatment?

Temporary tracheostomy

Eg
Brachycephalic airway disease
Largyneal paryalysis
Mass (treatable)causing obstruction of upper airway
Oropharygneal or laryngeal trauma or foreign body

2

T/F: you should use the largest size that can be easily accommodated by the trachea for a tracheostomy

True

3

How is the patient positioned to place a tracheostomy tube?

Dorsal recumbency with neck placed over a rolled town

Clip and prep from mid mandible to manubrium

4

How is a tracheostomy tube placed?

Ventral midline incision 4-5cm to caudal edge of cricoid

Dissect between strap muscles — gelpi retractors aid in visualization

Transfer expense interannular incision (at 3-4 or 4-5 rings)

Place stay sutures around tracheal rings cranial and caudal to incision

Pull ET tube if resent

Remove obturator and replace with inner cannula
Can partially close incision if too long

Umbilical tape used to secure tube around neck

5

What nursing care is required for tracheostomy tubes?

Continuous monitoring

Removed inner cannula and replace with new one :

Nebulize 20 mins
Pre-oxygenate for 3-5mins
Suction trachea with sterile suction tip to level or carina
Oxygen for 3-5mins
Replace cleaned inner cannula
Clean skin around tracheostomy incision
Replace tube every 24hours

6

Complications that can caries from tracheostomy?

Tube occlusion — respiratory distress and death (mucous plug, dried secretions within tube)

Airway suctioning — hypoxemia, atelectasis, vagally mediated bradycardia and collapse

Pneumomediastium
Surgical site infection
Coughing, gagging, vomiting
Aspiration pneumonia

7

How do you remove a tracheostomy tube?

Challenge patient
-deflate cuff
- temporarily remove tube
-place a smaller tube

Allow site to heal by second intention

Suturing site can result in SQ emphysema that can progress to pneumomediastum or pneumothorax

8

Purpose or thoracocentesis?

Therapeutic or diagnostic

- can be performed with local block and sedation
- useful in patients in distress due to pleural effusion or pneumothorax — PRIOR to chest rads and thoracotomy tube placements

9

Generally, what location do you do thoracocentesis?

6th, 7th, 8th intercostal space, near costochondral junction or pleural effusion, mor dorsal with pneumothorax

10

What are thoractostomy tubes used for?

Pneumothorax
Pyothorax
Hemothorax

Placed aspectically under generalized anesthesia

11

How do you pick tube size for thoracostomy tubes?

Based on need for evacuation

- larger tube for supperative effusion
- smaller tube for air

Width of tube should be

12

how long should a thoracostomy tube be?

Should start dorsal 1/3rd of thoracic wall at 7-9th intercostal space and end at the point of the elbow

13

How do you place a thoracostomy tube?

Incision at dorsal 1/3rd of ICS 10-12 (2-3 rib spaces caudal to desired intercostal entry point

Secure tube with Kelly hemostat and advance tube sQ and cranially
At ICS 7-9, reposition tube perpendicular to thorax and apply pressure to hemostat and tube through intercostal muscles


Advance catheter with trochar/hemostat prior to feeing catheter, then advance to ICS 2-3rd as trochar is removed

Cap or clamp tube

Secure with purse string and finger trap suture pattern (non absorbable nylon)

14

T/F: if position of a thoracostomy tube needs to be change, you can back out the tube but not insert if further into thorax

True

15

What is used to ensure a close thoracotomy tube system?

C- clamp

Christmas tree adapter

3-way stop-cock

Wire/nylon suture

16

When should your thoracostomy tube be removed?

When air or fluid production is decreased

Air: absence of penumothorax for 12-24hrs

Fluid: production of less than 2mls/kg/day

- sutures are removed and the tube pulled out quickly
-site covered with bandage

17

What type of feeding tubes can you place>

Naso-esophageal/gastric/duodenal

Esophagostomy/pharyngostomy

Gastrotomy

Enerostomy

18

What types of catheters can be used for gastrotomy tubes?

D Pezzer (mushroom tip) cathete

Foley catheter

19

Where are enterostomy tubes placed?

Through pyloris into distal duodenum/proximal jejunum

20

How is a gastrotomy tube sutured in place?

Purse-string around tube

Gastropexy also done to secure stomach to body wall

21

The initial suture of the purse string for a gastrotomy tube should engage what layers?

Fascia and skin

22

How long MUST a gastrotomy tube be placed for

2 weeks

23

In what patients would you consider an enterostomy tube?

Vomiting
Desired to “rest” upper GI tract

24

A 10 g needle can fit at _____Fr catheter

8

25

A 12g needle can fit at _____F catheter

5

26

A 14 or 16g catheter can fit a _______Fr catheter

3.5

27

How is an enterotomy tube placed?

Needed inserted through intestinal wall obliquely

Needle removed

Purse string placed around hold

Insert tube through sutured hold

Advance tube abnormally 8-12inches

Secure tube with purse string

Enteropexy — pexy tube to body wall with 4 quadrant sutures/interlocking box

28

How is an enterostomy tube secured externally?

Friction sutures

Should engage fascia of body wall to minimize siding of tube

29

How are gastro/entersostomy tubes maintained?

Flush with saline intraop


Start feeding when recovered from anesthetics

Remove when no longer needed

30

Complications due to enterostomy tubes?

Leakage — peritonitis/cellulitis

Premature removal

Obstruction

Kinking

Breaking