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Flashcards in Instruments Deck (11):
1

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

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This is a chest drain. It is a closed, therapeutic drain and can be either active or passive.

Its indication for use is as a connection to a chest drain tube, which can be draining blood, fluid or pus from the pleural space.

It works by being filled to its 'prime level' with sterile water, and being connected to a chest drain tube which then lies beneath the water level, creating an underwater seal.

It must be kept underneath the patient's bed to prevent sudden changes in pressure and to prevent retrograde movement of air back up the chest drain.

When connected, the chest drain will bubble as air flows into it. If it stops bubbling then all the fluid or air has been drained or it has become blocked.

Suction can be attached to it, creating an active drain system, or left without to be a passive drain.


General complications of any drain are increased risk of infection, bleeding, pain, blockage, scar, damage to local structures

Complications of a chest drain arise when the drain is raised above the patient's bed causing re-entry of fluid into the patient's lung.

 

2

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a redivac drain. It is a closed, active drain.

The indication for its use is post-operatively where an area of free space has been left, such as in a mastesctomy, where it drains any blood/seroma collection present.

General complications of any drain are increased risk of infection, bleeding, pain, blockage, scar, damage to local structures.

 

 

3

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a Robinson drain. It is a passive, closed drain.

It's use is prophylactic, for examplefollowing major abdominal surgery a Robinson drain can be placed to prevent seroma collection.

It works solely by gravity as it is a passive drain. Once it is draining only 30-50mls a day it can be removed.

General complications of any drain are increased risk of infection, bleeding, pain, blockage, scar, damage to local structures.

4

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a bile bag, it is a closed passive drain.

 

 

 

General complications of any drain are increased risk of infection, bleeding, pain, blockage, scar, damage to local structures

5

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

 

General complications of any drain are increased risk of infection, bleeding, pain, blockage, scar, damage to local structures

6

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

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This is a Vicryl suture. It is an absorbable, synthetic suture which is most commonly braided.

 

7

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

 

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This is a proctoscope.

It's used to examine the anal canal and lower rectum. Biopsies can be taken using a proctoscope and haemorrhoids can be investigated as well.

With the patient in the left lateral position a DRE is performed and then the proctoscope is lubricated and inserted, with an external light inserter into the lower chamber to allow the physician to visualise the anal canal and lower rectum.

Complications are pain, haemorrhage and perforation, especially if a biopsy is taken.

8

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a rigid sigmoidoscope.

It's indications are rectal bleeding, query colonic neoplasia and inflammatory bowel disease. It allows the physician to visualise the rectume and recto-sigmoid junction, and also enables them to take a biopsy.

With the patient in the left lateral position (Sims' position). The bowels are previously emptied with a suppository, and a DRE is first performed. The sigmoidoscope is lubricated and inserted with obturator in general direction of the navel. The direction is then changed and the obturator is removed so that the physician may progress further with direct vision. Bellows are used to insufflate air to distend the rectum. Lateral movements of the sigmoidoscope's tip negotiate the Houston valve and the recto-sigmoid junction.

Complications are haemorrhage and perforation, especially if a biopsy is taken.

9

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

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10

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a laryngeal mask airway.

It is a non-definitive airway used in short day-case surgeries where a patient doesn't require intubation. May also be used in an emergency situation if not able to insert an endotracheal tube. One of it's main features is an inflatable cuff which creates a seal over the larynx.

Method of insertion: Cuff is deflated and lubricated with aquagel. Inserted with the open end pointined down towards the tongue. Sits in orifice over the larynx. Cuff inglated and tube secured with tape. As with any airway breathing should be checked to ensure correct, unhindered respiration.

Complications of this airway are dislodgement, leading to poor ventilation, there can be a leak which affects ventilation, it can cause pressure necrosis of the airway. Perhaps most importantly as it is a non-definitive airway it does nothing to prevent aspiration.

11

What is this instrument called?

What are the indications for its use?

How does it work/is it used?

What are the complications for its use?

Q image thumb

This is a Ryles nasogastric tube.

It is indicated for use in part of the "drip and suck" management of bowel obstruction, for draining the stomach and in patients with persistent vomiting such as pancreatitis.

Its features are that it's wide-bore, stiffer than a feeding nasogastric tube, contains a radio-opaque line and a metal tip. The metal tip acts as a guiding point for facilitating advancement of the nasogastric tube, weighs it down in the stomach and provides a visual guide on radiograph.

Method of use is first by gaining consent and explaining the procedure to the patient. Then size the tube by meauring from tip of patients nose, around their ear down to their epigastrium. After lubricating the tip with aquagel insert the tube asking the patient to swallow with water when they feel it at the back of their throat. Secure with tape when position is confirmed.

In order to check correct position you can aspirate gastric contents and check pH, which should be less than 4. Another method is insufflating air and auscultating for bubbling over the stomach but this is not advised in bowel obstruction. Finally a chest radiograph should demonstrate the radio-opaque line in the correct position with the metal tip below the diaphragm.