Surgical Attachments & Drains

Question 1

What do the following words mean?

• Ectomy
• Otomy
• Oscopy
• Ostomy

Answer 1

Ectomy: Removal of
Otomy: Cutting into
Oscopy: Looking into
Ostomy: Opening into

Question 2

What is a laparotomy incision used for?

Answer 2

• Removal of cancerous bowel, spleen, pancreas, gall bladder, stomach or liver
• Division of adhesions (scar tissue) interfering with bowel movement
• Repair of abdominal aortic aneurysm (AAA)

Question 3

What is a sternotomy incision used for?

Answer 3

Cardiac surgery

• Cardiac artery bypass grafting (CABG)
• Aortic or mitral valve replacement

Question 4

What is a thoracotomy incision used for?

Answer 4

Thoracic surgery

- Removal of lung cancer (pneumonectomy, lobectomy)

Question 5

What are considered to be attachments?

Answer 5

Anything that is not part of a patient’s body but is connected to them in some way

Question 6

What is an arterial line?

Answer 6

• Plastic catheter that goes into an artery
• Connected to transducer
• Most commonly in radial artery
• Only in ICU

Question 7

What are the 2 main functions of an arterial line?

Answer 7

• Allows frequent/painless ABG sampling without a Dr present

- Constantly monitors BP

Question 8

What would happen if an arterial line was dislodged?

Answer 8

Heavy arterial bleeding

Question 9

Why is a resting splint sometimes used with an arterial line?

Answer 9

• To prevent it from being dislodged

- To keep the wrist neutral & prevent kinking in the artery

Question 10

What is a central venous catheter (CVC) or central line?

Answer 10

• Tube into superior vena cava in right atrium
• Connected to transducer
• Can be jugular or subclavian

Question 11

What are the 2 main functions of a central line?

Answer 11

• Fast administration of drugs/fluids

- Measurement of central venous pressure (CVP) - gives an indication of heart performance

Question 12

What is a variation of a central line?

Answer 12

Peripherally inserted central catheter (PICC line) - Long term central line

Question 13

What is an epidural?

Answer 13

• Injection into epidural space outside dura mater
• Combination of anaesthetic & opioid
• Can be at any spinal level

Question 14

What is an epidural often used in?

Answer 14

• Childbirth
• AAA repair
• Hip replacement
• Intestinal surgery

Question 15

What are some important things to note about epidurals?

Answer 15

• Very fine tubing, easy to dislodge (yellow stripe)
• Sensory vs motor block (motor block is bad, monitored with BP)
• Often require oxygen therapy
• Patient can be mobilised (check for motor block first)

Question 16

What should be monitored on patients who have had an epidural?

Answer 16

Blood pressure

Question 17

What is an intravenous catheter (ICV)?

Answer 17

• Simple catheter inserted into peripheral vein

- Allows delivery of fluids and medications (i.e. drip)

Question 18

What is an indwelling catheter (IDC)?

Answer 18

• Catheter inserted into bladder, held via balloon
• Used to drain urine
• Attached to drainage bag

Question 19

What is important to remember when handling patients with an IDC?

Answer 19

• Keep the bag below the bladder

- Keep the bag close to the patient (can hang off frame)

Question 20

What is an intercostal catheter (ICC)?

Answer 20

• Tube inserted into pleural space
• Sutured in place
• Attached to underwater sealed drain (UWSD)

Question 21

What is the function of an ICC?

Answer 21

Used to drain air (pnemothorax), blood or pleural effusion

Question 22

What is the function of under water sealed drains (UWSDs)?

Answer 22

• Allows tube drainage but not air to rise back into pleural space
• Measures drainage in mL
• Attached to wall suction - constant pressure to prevent pneumothorax
• Can see ‘swing’ and ‘bubble’ (indicator of ongoing air leakage)

Question 23

What are some of the safety issues associated with UWSDs?

Exam question

Answer 23

• Always have clamps nearby (clamp tube close to chest if UWSD fails/breaks to prevent air going in)
• Always keep UWSD below patient’s chest (avoid drainage running back into pleural space)
• Always check if patient requires continuous suction or is allowed to mobilise without suction

Question 24

What is a naso gastric tube (NG)?

Answer 24

• Inserted through nose into stomach
• Inserted blind by medical staff
• Requires CXR to double check placement
• Secured with tape

Question 25

What is the function of a NG?

Answer 25

Allows feeding directly into stomach or drainage of stomach

Question 26

Why would you remove a NG when mobilising/exercising?

Answer 26

So digestion can be paused

Question 27

What is an exception to removing a NG during mobilisation?

Answer 27

High insulin dependency requiring constant feed to maintain blood sugar level

Question 28

What are pacing wires?

Answer 28

- Wires placed directly after cardiac surgery (ensures cardiac output) - Attached to pacing box (set heart rate)

Question 29

Where can a pacing box be placed when moving a patient?

Answer 29

Tucked into the patient's cough teddy

Question 30

When are pacing wires typically removed?

Answer 30

- 2-3 days post survey if spontaneous heart rhythm established - Patient required to rest in bed for 1-2 hours post removal (check with nurses before mobilising cardiac surgery patients)

Question 31

What is a cardiac portable telemetry?

Answer 31

- Mobile continuous ECG recording - Externally attached ECG dots - ECG relayed to monitor at nursing station and/or bedside monitor

Question 32

What are ostomys and somas?

Answer 32

- Surgically created openings from internal organs to skin - Allows excretion of faecal matter bypassing lower GI tract - Attached to drainage bags

Question 33

What are wound drains?

Answer 33

- Passive bags that drain fluid/blood without suction

Question 34

What is important to remember about wound drains?

Answer 34

- Identify every drain - Keep below incision site if possible - Can be hung off walking frames if safe - Patients may be able to carry small bags

Question 35

What are TED stockings?

Answer 35

- Anti-embolism compression devices - Routinely used post surgery - Hole at toe end

Question 36

What should you do to avoid a patient slipping in TED stockings?

Answer 36

- Slippers | - Roll up so at least ball of foot is exposed

Question 37

What is the function of mechanical/sequential calf compressors?

Answer 37

- Inflation/deflation of balloons around calves - Anti-embolism - Attached with velcro, easily removed