Flashcards in Exam 4 Therapeutic Procedures Deck (39):
Cerumen Impaction Removal indicated when? (4)
Cerumen Impaction Removal contraindicated when? (4)
Prior ear surgery
Suspect TM perf
Cerumen Impaction Removal complications? (4)
Internal Auditory Canal abrasion
Subungual Hematoma is?
Evacuation indicated when?
Contraindicated when? (2)
Bleed b/w nail and digit from trauma
Involves > 50% of nail
Subungual Hematoma Evacuation procedure?
Heated paperclip or cautery ->
place on nail
Nasogastric Tube Insertion indicated when? (4)
Decompress stomach from outlet obstruction or ileus
Gastric lavage for overdose or bleeding
Nasogastric Tube Insertion contraindicated when? (4)
Basilar skull fxr
NG Tube complications? (3)
Aspiration PNA (keep head elevated)
I&D indicated when?
Located in nasolabial folds (drain into sphenoid sinus)
Wound check 24-48 hrs
Arthrocentesis indicated when? (2)
C/I when? (5)
Cellulitis or broken skin
Joint prosthesis (refer)
Arthrocentesis needle gauges?
22-27 for injection
18-21 for aspiration
Thoracentesis indicated when? (3)
Remove air/fluid from chest (pleural effusion, empyema, pneumothor)
Instill sclerosing meds
Thoracentesis C/I when? (2)
Thoracentesis lidocaine injected where?
Aspiration needle inserted where? (3)
Tip of needle pointing up for what?
Down for what?
Above rib to avoid neuromuscular bundle that runs below rib
1-2 ICS below level of ↓BS, dull percussion
Above 9th rib to avoid diaphragm puncture
Midway b/w spine and post axillary line
Up for air
Down for fluid
(air will rise above fluid)
Thoracentesis complication? (3)
Re-expansion edema (Do not take > 1L, do not perform bilaterally)
Paracentesis indicated when?
C/I when? (5)
Ascites (dx and therapeutic)
Infection at site
Pt supine w/ raised HOB or L lat decubitus
Insert 1/3 distance b/w umbilicus and ant iliac crest
Rare: perf, infection, hematoma
Lumbar Puncture indicated for diagnostics when? (5)
Normal Pressure Hydrocephalus
Lumbar Puncture indicated for tx when? (2)
Admin meds (anesthesia, chemo, ABX)
Remove CSF (pseudotumor cerebri)
Lumbar Puncture C/I when? (3)
Intracranial lesion (focal deficit, papilledema)
Local skin infect
Coagulopathy or thrombcytopenia
Lumbar Puncture insert where?
20-30° towards umbilicus
Opening pressure at lumbar puncture tells us?
Normal pressure values?
↑ pressure = tumor, infect, bleeding, MS
N lying pressure = 5-14 mmHg
Sitting = 5-27
Lumbar Puncture complications? (4)
CSF leak w/ HA
Central Venous Catheter indicated when? (7)
Hemo/CV pressure monitoring
Meds (pressors, chemo, ABX)
No viable peripheral sites
Emergent vascular access
Repetitive blood draws
Central Venous Catheter C/I when? (4)
Infection at site
Pneumo- hemothorax on contralat side
Central Venous Catheter sites? (4)
Central Venous Catheter landmarks for Internal Jugular approach?
Apex of triangle formed by sternal and clavicular heads of SCM mm and clavicle
Central Venous Catheter: Benefits of subclavian approach? (2)
More comfortable for pt
Higher risk of pneumothor
Central Venous Catheter complications? (4)
Immediately post-placement, do what?
CXR to verify placement and no hemo- pneumo-
Tip should be in SVC near RA
Chest Tube indicated when? (4)
Recurrent pleural effusion
Penetrating chest truma
Chest Tube C/I when (3)
Loculated pleural eff (confined to one or more fixed pockets)
Previous chest tube
Chest Tube insertion location?
Procedure? (3 steps)
4th/5th ICS, anterior axillary or MCL
2-4 cm incision parallel to ICS
Blunt dissection -> SQ tunnel over top of next rib
Chest Tube complications? (3)
Bone Marrow Aspiration/Bx indicated when? (6)
Unexplained anemia/leuko or thrombo penias
Abn periph smear
Bone Marrow Aspiration/Bx C/I when? (2)
Bone Marrow Aspiration/Bx site?
Iliac crest ->
3 fingers from midline and 2 inferior to iliac crest