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Flashcards in FLS Deck (26):

FLS equipment checklist

anesthesia, electronic table, two monitors, suction, electrosurgical unit, grounding pad, light source, insufflator, scalpels, towel clips, veress needle/hasson, gas insufflation tubing, fiber-optic cable light source, retractors, trocars


considering a small room, how might the table need to be positioned?



if C arm is used, where should electronic set up be?

furthest away from door to clear path


if the carbon dioxide cylinder tubing does not fit into the insufflator, what could it mean?

do not force it, the cylinder may contain a separate type of gas (O2)


how do you set-up for a laparoscopic procedure once patient is prepped and draped?

connect the light cable and camera to the scope, focus the scope and white balance it, warm the laparoscope, check the Veress needle/Hasson stay sutures, close stopcocks, check sealing caps, assure free movements of instruments


what is the of CO2 insufflation at low flow and high flow for a Veress needle?

1 L/min for low
2-2.5 L/min for high


what does a pressure reading >3 mmHg mean if the insufflator is on but not attached?

blockage in the tubing


what should the intra-abdominal pressure limit be for most surgeries?

12-15 mm Hg, greater pressures can decrease visceral blood flow, but may also be necessary for visualization in an obese patient


describe the Veress needle technique

10-20 degrees Trendelenburg, stab incision to either superior or inferior portion, pass the Veress at a 45-degree angle, pass 2 points of resistance, "click" into peritoneal cavity


once a Veress needle is placed, how do you test if it is in the correct position

aspirate for blood/feces/urine, flush w/ NS, aspirate for NS, allow fluid to "fall" into cavity from hub of syringe, advance 1-2 cm and check for resistance


with a Veress needle placed initially, what should abdominal pressure register as when insufflation is started at low flow (1L/min)

<10 mmHg


if high pressures are noted w/ initial insufflation through a Veress needle, what should be done?

high pressure is >10 mmHg; rotate the needle, make another pass w/ the Veress, do not continue insufflation


during initial insufflation with a Veress needle, what could it mean to have CO2 bubbles coming up around the needle?

preperitoneal placement


monitor the patient's pulse and blood pressure closely for during the early phase of insufflation for what insufflation specific reason?

a vagal reaction


during initial insufflation w/ a Veress, if the pulse falls precipitously, what should be done?

allow the CO2 to escape, administer atropine, and reinstitute insufflation slowly after a normal heart rate has returned


what is the next step after insufflation of about 1 L of CO2

change from low flow to high flow


in general, patients with prior low vertical midline scars should be approached through a trocar placed where?

at the lateral border of the rectus muscle in either the left or right upper quadrant


with previous upper vertical midline incision or multiple incisions near the midline, where can a trocar be placed?

right lower quadrant site may be appropriate


what exam and risk-reducing steps should be taken if placing a trocar in the upper abdomen?

percuss the positions of the liver/spleen, place the trocar two fingerbreadths below the costal margin, place NGT to decompress stomach


when placing a non-midline trocar in the lower abdomen, what is the preferred location? what risk-reducing steps should be taken?

right lower quadrant, near McBurney's point, is preferable to the left because many individuals have congenital adhesions between the sigmoid colon and anterior abdominal wall; decompress the bladder


describe how you would place a Hasson trocar?

2-3 cm incision, dissect the underlying tissue to reveal fascia, place S-retractors, Allis forceps can be used to grasp and raise the fascia, incise the fascia sharply, place stay sutures, hemostasts can be used grasp and raise the peritoneum, divide this sharply, insert the Hasson


in regards to trocar placement, what is the presentation and management of bleeding from the abdominal wall?

continuous dripping into the peritoneum or delayed hematoma, usually from inf epigastric; manage with direct pressure or suture ligation


in regards to Veress placement, what is the presentation and management of visceral injury?

if yellow/cloudy fluid is aspirated through a Veress, it may be d/t bowel injury; d/t small caliber of Veress, can simply remove and reattempt at another site w/ laparoscopic evaluation of the bowel later


in regards to laparoscopic trocar placement, what is the presentation and management of visceral injury?

formal open laparotomy and bowel repair or resection; laparoscopic suture repair of the bowel injury; laparoscopic resection of the injured bowel and reanastomosis; minilaparotomy, using an incision just large enough to exteriorize the injured bowel segment for repair or resection and reanastomosis


in regards to Veress placement, what is the presentation and management of vascular injury?

if Veress, remove and repuncture at another site, then re-evaluate laparoscopically to look for an expanding retroperitoneal hematoma; if there is a central or expanding retroperitoneal hematoma, laparotomy with retroperitoneal exploration is mandatory to assess for and repair major vascular injury; hematomas of the mesentery and those located laterally in the retroperitoneum are generally innocuous and may be observed


in regards to trocar placement, what is the presentation and management of vascular injury?

if there is a rush of blood through the trocar with associated hypotension, leave the trocar in place (to provide some tamponade of hemorrhage and assist in identifying the tract) and immediately perform laparotomy to repair what is likely to be an injury to the aorta, vena cava, or iliac vessels