Practical

Question 1

LP?

Answer 1

• Lie on left side and square hips and shoulders, curl round to open space
• palpate iliac crest and go across to find L4-5, mark a spot in middle
• clean and drape area
• anaesthetise skin and deeper with small 25g and then larger needle
• go straight in, will encounter hard dermis then resistance just prior to csf space
• once in, take few drops for appearance? Then attach manometer and wait till it oscillates around a fixed point - assistant can help hold
• then fill 3 tubes to line
• done - retract and bandage

Question 2

Knee aspiration?

Answer 2

Landmarks are superior medial and lateral borders of patella

• can mark spot
• clean and drape area
• anaesthetise skin bleb then deeper, but not to joint space as this will contaminate
• insert aspirate needle from superolaterally to inferiorly at about 45 degree angle, can use medial edge to raise a space
• aspirate fluid and finish , if need more leave needle and change syringe

Question 3

Thoracentesis?

Answer 3

• Safe triangle from nipple line to axilla bordered by pec major and lats.
• feel ribs and find space to mark just above lower rib - neurovascular bundle is inferior to rib
• raise arm or sit forward with arms on desk
• wash and drape
• anaesthetise skin and then deeper until in pleura, then retract and anaesthetise pleura
• dilate entry with provided knife, remove tip from needle and insert until fluid drains, then insert slightly more and thread catheter in until near hilt
• drain small amount and check colour or to send off
• attach bag and drain up to 1L and a half max
• if cough can pause and wait or retract a little, then continue
• note how much was drained and appearance , normal is thin straw coloured
• remove and bandage

Question 4

Chest drain removal

Answer 4

• first check if draining anything since last check, if swinging or bubbling ( normal swing is 5cm or less, bubble means pneumothorax). If draining then describe fluid
• double clamp tube opposite ways then retract
• Unwind purse strings and cut knot off, then double round with free ends.
• Cut anchor close to skin
• practice once then real - Breathe in, out, in and hold, no breathe out (once finger over tightened knot).
• tie knot with single throws a few times
• clean and bandage, if not closed satisfactorily by mattress stitch then add butterflies first