Injections and anasthesia Flashcards Preview

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Flashcards in Injections and anasthesia Deck (24):

Where does the spinal cord terminate in the adult?

L1/L2 vertebrae


Where does the spinal cord terminate in children?

L2/L3 vertebrae


Where does the subarachnoid space (filled with CSF) terminate?

S2 vertebrae


What does the supracristal plane mark?

The higest point of the iliac crest

L4 spinous process


Describe how a lumbar spinal puncture is performed

Lumbar punctures are performed to obtain a sample of CSF.

The patient is positioned leaning forward or lying onthe side with back flexed. This spreads teh laminae and spinous processes apart.

The needs is inserted into the subarachnoid space at the midline between the spinous process of L3/L4 vertebrae in an anterosuperior direction (15 degree angle)



What region of the spine is anaesthesia administered to the CSF?

Between L3/L4 to L5/S1

Needle is passed into the subarachnoid space where teh anesthetic is administered


Where would you administer caudal anasethesia?

Sacral hiatus

Blocks S2-S5



What is the effect of epidural anaesthesia?

An anesthetic agent can be injected into the epidural space by inserting a sterile needly into the spine between the spinous processes of L3/L4.

The anesthetic has a direct effect on the spinal nerve roots of the cauda equina after they exit from the dural sac. The patient loses sensation inferior to the level of the block.

The angle at which the needle is inserted depends on the region of the spine injected. e.g. in thoracic region angle of needle increases towards the head.


Describe the two methods used to deliver IM injections in the gluteal region

1. Vertical line from the highest point of the iliac crest. Horizontal line midway between the ighest point of the iliac crest and the ischial tuberosity. Inject in the upper lateral quadrant

2. Vertical line from the highest point of the iliac crest. Horizontal line from the PSIS to the greater trochanter. Inject in the upper lateral quadrant



Sampling of blood from superficial veins

Normally perfoemd at cubital fossa of upper limb. Can access cephalic (safest), basilic or median cubital vein


Use of a cannula in taking blood

Put in place where repeat blood samples are required

Used for short term venous access

IV fluid infusion (fluid, blood drugs)

Repeated drug administration

Measuring central venous pressure


Borders of the cunital fossa

Epicondylar line,

pronator teres



Stae 4 complicatins of superficial venous cannulation

Venous inflammation


Thrombophlebitis (clot and inflammation)


Tissue infusion



What are the common locations for superficial vein cannulation?

Cubital fossa

Dorsum of the hand

Anatomical snuffbox

Medial ankle (with a cutdown)


What are theborders of tha anatomical snuffbox?

Superior: Extensor pollicis longus 

Inferior: Extensor pollicis brevis and 
Abductor pollicis longus


Describe the course of the great saphenous and small saphenous vein

Great saphenous vein: Passes from the dosrum of the foot anterior to the medial malleolus up the medial aspect  of the lower limb. Runs along the medial tibial border with the saphenous cutaneous nerve, posterior to the patella and up the medial thigh to the saphenous opening at the pubic tubercle where it drains into the femoral vein.

Small saphenous vein: Passes from the lateral part of the foot, posterior to the lateral malleolus into the posterior leg. It ascends in the midline along the sural cutaneous nerve then enters teh popliteal fossa to drain into the popliteal vein. 


Where would you cannulate a child?

Cubital fossa

Dorsum of the hand

External jugular vain


Interosseous of anterior tibia

Venous cutdown (saphenous vein)


Describe the ligation method of cannulating the saphenous vein

Blunt dissection of saphenous vein from saphenous nerve for 2cm. 

Ligate teh distal mobilised vein

Pass a tie around the proximal part of the vein

Make a small incision in the vein

Introduce a cannula and tie with the proximal suture

Attach IV line to cannula


When would arterial cannulation be required?

To asess acid-base status

Measuremen of arterial blood gases

Assessment of respiratory/cardiac/renal failure

Drug overdose


Lactic acidosis

Cardiac catheterisation


State 4 complications of arterial cannulation


Arterial spasm leading to ischemia

Retrograde embolism

Traumatic aneurysn



Name three arteries commonly accessed for cannulation

Brachail artery

Radial artery

Femoral artery


What are the borders of the femoral triangle?

Inguinal ligament


Adductor longus


Describe the standard method for cannulating the saphenous vein

Blunt dissection of the saphenous nerve from the saphenous vein

Puncture the vein with an IV catheter

Introduce the cannula and withdraw the needle

Confirm free flow of blood

Attach IV line to cannula


How do you access the saphenous vein for cannulation?

Identify the medial malleolus

Palpate the great saphenous vein (2cm anterior)

Measure 1cm anterior and superior to medial malleolus

Make an inscision 2.5cm from the anterior point to the posterior border of the tibia

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