PACES - Instruments Flashcards

Question

what is this? name, description, indications, contraindications, complications

Answer 1

**NG feeding tube** * long term enteral feeding * narrow bore (\< 9 Fr) * insert via nostril having measure distance (nose tip - tragus - xiphisternum), lubricate + advance, test pH + x-ray for position, then remove guide wire * position - pH aspirate \< 4.5 or chest x-ray * _indications_ * short, medium term feeding (max 4-6 weeks) with functional GI tract * administration of drugs/contrast in unsafe swallow * _complications_ * aspiration pneumonia * pneumothorax * malposition in GI tract * obstruction, knotting, kinking * reflux oesophagitis * gastritis * visceral perforation (rare)

Answer 2

**5% dextrose** * 1 L has 50g of dextrose in 1L of water * average patient needs 50-100g per day

Answer 3

**IV giving set** * administration for IV drugs, blood products and medications via access lines * priming, sterile technique * **complications** - air embolism, inappropriate flow rate

Answer 4

**non-toothed forceps** (top) and **toothed forceps** (bottom) * toothed only used for skin * within peritoneal cavity only use non-toothed * used to grasp tissue

Answer 5

**fracture plate** * used in conjunction with screws for internal bone fixation * _complications_ - misplacement, screw snaps, surgical complications, infection * aesthetic/discomfort → in areas where bone close to surface e.g. wrist

Answer 6

**gelofusin** * artificial colloid solution * raises plasma oncotic pressure so expands intravascular compartment * alternative to natural (e.g. albumin or blood) * useful in shock e.g. sepsis or hypovolaemia

Answer 7

**plasmolyte/Hartmann solution** * crystalloid solution * has Na+ (131 mmol/L), K+ (5) Cl- (111), bicarbonate (29), lactate * similar to extracellular fluid composition * favourite with anaesthetists + surgeons, advocated for initial ATLS trauma * _complications_ - electrolyte imbalance, overload

Answer 8

**hemiarthroplasty** * hip prosthesis * intracapsular # NOF (pt with poor functional reserve) or avascular necrosis of femoral head * _complications:_ dislocation, osteolysis, metal sensitivity, nerve injury, chronic pain, septic arthritis

Answer 9

**hickmann line** (tunnelled central line) * long term central venous line * usually in subclavian vein * portion is tunnelled to reduce risk of infection * _indication_: long term TPN, long term IV Abx, chemotherapy * _CI_ - abnormal anatomy, active infection over site of insertion, coagulopathy

Answer 10

**total hip replacement** * femoral stem with femoral head * polyethylene acetabular cup inserted into acetabulum * _indications:_ total hip replacement (severe OA) * _complications_: DVTs, infection, dislocation (2%), peri-prosthetic fracture

Answer 11

**histology pot** * used for biopsies * set in formalin usually * part of WHO check out surgical checklist to ensure specimens are correctly labelled

Answer 12

**intramedullary femoral nail** * internal fixation of femoral shaft fractures * interlocking screws used to fix nail, usually removed after 12/18 months * anterograde - proximal, diaphyseal, deformity correction * retrograde - diaphyseal, distal #, deformity (from knee up) * _complications_ - neurovascular injury on insertion, hardware failure, non-union

Answer 13

**instillagel** * sterile gel with local anaesthetic and lubricant gel * used in male + female catheterisation

Answer 14

**cannula** * newer have premade dual lumen cannula which don't require priming * lumens need flushing to prevent clot formation * come in varying sizes with different diameters allowing for different flow rates/speed of infusion * _indications_: blood products, IV fluids, IV medications, emergency decompression of tension pneumothorax * _complications_ * dislodgement * extravasation * haematoma * phlebitis * thrombosis

Answer 15

for fast flow rates need short + large bore cannula

Answer 16

**laparoscopic port** * used during laparoscopic procedures * allow insertion of telescope for visualisation and instruments to perform procedure * _Complications_ * Vascular and visceral injury on introduction * surgical emphysema (on table if leak as CO2 doesn't just go into cavity intended) * _Delayed_ - hernia, infection and bleeding

Answer 17

**laryngeal mask airways (LMA) or iGEL** * supraglottic devices * non-definitive airway * _uses:_ elective, short procedures, cardiac arrest, prehospital airway management * _benefits_: reduced oropharynx trauma, can reduce admission in elective pt * iGEL * thermoplastic elastomer * moulds to perilaryngeal framework at pt temp * has a gastric channel to allow NG insertion into stomach for draining * seals oropharyngeal opening from larynx to prevent aspiration * can be intubation conduit * _complications_ * pressure lesions * nerve palsies after inflation

Answer 18

**laryngoscope** * aid intubation with visualising larynx * Macintosh - curved blade (pictured) * Miller - straight blade * _complications_ * mild soft tissue injury * tooth damage * laryngeal and pharyngeal scarring * ulceration * abscess

Answer 19

**leg bag** * attached to catheter and strapped around leg * allow pt to be mobile with short/long term catheter

Answer 20

**mannitol** * osmotic diuretic * used in management of raised ICP or to drive urine output in obstructive jaundice to prevent hepato-renal syndrome

Answer 21

**monopolar diathermy** * used for coagulation and dissection of tissue during open or laparoscopic surgery * Complications * Burns - uses electrical circuit * Fires - if using alcohol in the cleaning solution * Pacemaker dysfunction * Environmental safety - toxic smokes for the HCP involved

Answer 22

**nasal cannulae** * common O2 delivery method for hospital + community (LTOT COPD), mild hypoxia (\>90%) * 1-4L O2 per minute * deliver 28-44% O2 * _complications_ * nasal sores * epistaxis

Answer 23

**nasal speculum** Thudichum nasal speculum designed to open and expand the nasal canal for examination

Answer 24

**nasopharyngeal airway** * non definitive airway inserted into nasal passage * airway managed in decreased GCS or decreased gag reflex * sizing - diameter to little finger, size from soft to soft (tragus to incisor) * also by height, 6 for female, 7 for male * _complications_ * ulceration * epistaxis * _contraindication_ - severe head injury, maxillofacial trauma esp. if signs of basal skull fracture

Answer 25

**nebuliser mask and chamber** * used to administer bronchodialtors or nebulised medications * aerosol drug effectiveness depends on quality of delivery to lungs * uses: acute - asthma, saline nebs in COPD; chronic - prophylaxis CF, COPD * _complications_ * oxygen has to be reduced to enable neb so may become hypoxic

Answer 26

**needle holders** used during suturing, designed to allow accurate placement and ease of procedure

Answer 27

**neurology kit** * contains: * 128 Hz tuning fork - vibration * 512 Hz tuning fork - Weber's and Rinne's * neurotips - blunt and sharp sensation * orange stick - Babinski reflexes (plantar) * tendon hammer - reflex * other aids: snellen chart, ophthalmoscope, tongue depressors

Answer 28

**non absorbable suture** * ethilon (nylon) - monofilament, 9 knowns for strong knot over time * prolene * high tensile strength, low reactivity * ethilon tend to loosen so restricted to percutaneous closure * _uses_: * percutaneous wound closure * bowel anastomosis - prolene * vascular anastomosis - prolene

Answer 29

**non rebreath mask** * requires patient to be able to breath unassisted * reservoir which is connected to oxygen * 10-15L flow rate per minute * up to 90% concentration, FIO2 80-85% * first line in acute unwell patient, aim for 94-98%

Answer 30

**0.9% sodium chloride** * 154 mmol NaCl * can be used to provide maintenance fluid or replace additional losses

Answer 31

**nylon suture** * form of synthetic non-absorbable suture * monofilament * closes skin wounds

Answer 32

**oropharyngeal airway** or **guedel** * airway adjunct for pt with reduced GCS * measure - incisor to angle of jaw (hard to hard) * insert upside down and rotate in oral cavity, insert without rotation in children * works by lifting tongue off posterior pharyngeal wall * risk of vomiting/aspiration of gag reflex present * _complications_ * mucosal damage soft tissue * gag reflex * laryngospasm

Answer 33

**paediatric oxygen mask**

Answer 34

**PICC line** * peripheral IV central catheter * has features of central and peripheral * placed percutaneously into peripheral vein and advanced into large central vein * basilic/cephalic veins with tip in SVC * long-term vascular access * _uses_: blood sampling, chemo, infusion of hyperosmolar solution (e.g. TPN), poor peripheral access *

Answer 35

**procotoscope** * visualise the anal canal and lower rectum * left lateral position, DRE performed, insert with light source + lubrication into rectum * _uses_: visual assessment, injection/banding haemorrhoids

Answer 36

**Ryle's tube** * wide bore (17-18 Fr) * used for decompression of bowel obstruction ("drip and suck") * need lubricant, bladder syringe, drainage bag and pH dipstick * confirm position: pH, insert air and auscultate epigastrium for bubbling, x-ray * _uses_ - decompression, insert drugs or contrast into GI tract

Answer 37

**disposable scalpel** (top) **non-disposable scalpel** (bottom) * cutting skin and tissue during surgical procedures * different seizes for the procedure * number indicates blade size and shape

Answer 38

**seldinger chest drain insertion pack** * used in wards or OP for chest drain insertion * _indications_ * pneumothorax (in ventilated or large spontaneous, after tension decompression) * symptomatic malignant pleural effusions * empyema * traumatic haemothorax (wide bore chest drain) * post surgical - cardiac, thoracic, oesophagus * _complications_ * insertion * damage to nearby structure (intercostal artery, solid organ) * SC emphysema * pneumothorax * position * obstruction * kinking * dislodgement * re-expansion pulmonary oedema (max output 1.5L before need for clamp) * infection - wound, pneumonia, empyema

Answer 39

**self retaining retractor** * holds wounds open * e.g. during hernia repair or an appendicectomy

Answer 40

**self inflatable bag-valve mask** * high levels of oxygen even at low flow rates * 100% with flow rates \> 10L/min

Answer 41

**shouldered syringe** * can be used for haemorrhoid injrection treatment * 5% phenol in almond oil, above dentate line, done using proctoscope

Answer 42

**drainage type silastic foley urinary catheter** * made of silicon * more appropriate for long term catheterisation than latex one

Answer 43

**single lumen central venous cannula** * into superior vena cava via internal jugular or subclavian * single lumen * can be triple lumen * uses: central administration of drugs (amiodarone, dopamine, chemo)

Answer 44

**triple lumen central venous cannula**

Answer 45

**specimen swabs** * sterile used for MRSA screen (nasopharyngeal, groin) * bluetop transwab amies - aerobes, anaerobes, fastidious organisms * specimens from wounds, skin, urogenital tract, throat

Answer 46

**spinal needles** * *traumatic needles* * cutting needles (top) * related with higher risk of post-LP headache (35%) * severe may need blood patching treatment * *pencil point (atraumatic) needle* * blunt tipped for blunt dissection * 1st choice not for LP (not epidural) as reduced LP headache and backache

Answer 47

**stiff neck cervical collar** * stabilise cervical neck in trauma patients when used with 2 sand bags and tape (triple immobilisation) * sized by number of fingers from clavicle - angle of mandible and compared to measuring peg on stiff neck collar

Answer 48

**stoma bag** * prosthetic medical device to collect waste from surgically diverted bowel * closed or draining type * Complications * Psychological impact of having stoma * Leaks * Poor fit → irritation, dermatitis due to adhesive on stoma

Answer 49

**surgical chest drain** * emergency/trauma * sizing in French (Ch) * smaller calibre for pneumothorax * larger for haemothorax, effusion or empyema * _uses_ - pneumothorax, malignant pleural effusion, empyema, traumatic pneumothorax, haemothorax, peri-operative * _complications_ * insertion * damage to nearby structure (intercostal artery, solid organ) * SC emphysema * pneumothorax * position * obstruction * kinking * dislodgement * re-expansion pulmonary oedema (max output 1.5L before need for clamp) * infection - wound, pneumonia, empyema

Answer 50

**swan ganz catheter** * measure pressure in heart, pulmonary artery wedge pressure and CO * ICU * inserted into central vein

Answer 51

**thromboembolic deterrent stocking (TED)** * for those undergoing surgery or immobile to prevent VTE * different sizes * may be used with low dose SC heparin * _contraindications_ - severe peripheral vascular disease, severe skin breakdown (ulceration, infection), frequent falls

Answer 52

**temporary tracheostomy** * definitive airway * _uses_: long term ventilation on ICU, upper airway obstruction, after laryngeal/maxfax surgery * allows efficient ventilation with decreased dead space and more effective suctioning, reduces pt discomfort and sedation * _complications_ * infection, dislodgement, blockage * long term - tracheomalacia, fistula, tracheal stenosis

Answer 53

**trucut needle** * biopsy needle used to take a histological specimen (breast, lumps, livers) * under LA usually

Answer 54

**urinary catheter** * french (ch) - 14 common * the larger the french the greater the diameter * *foleys* (central) * short term up to 28 days * usually latex (yellow) * *long-term* (left) * up to 3/12 * silicone (transparent usually) * *three way catheter* (right) * haematuria, clot retention, bladder washout/irrigation * attached to irrigation fluid * larger Ch needed as 3 lumens * curved tip - can aid insertion past an enlarged prostate, only by urology * _indications_ * urinary retention (acute or chronic) * monitor UO * during abdominal or pelvic surgery * neurogenic bladder, immobility, end of life care (for comfort), urinary incontinence, sacral or perineal ulceration * _complications_ * early/immediate * urethral trauma * allergic reaction * balloon rupture * obstruction * bypass/leak * bladder perforation * pseudo-tracts * delayed * UTI, pyelonephritis * urethral stricture

Answer 55

**urine dipstick and urine sample pot** * dipstick * blood * protein * nitrites * leukocytes * glucose * ketones * bilirubin and urobilinogen * positive blood and protein should be sent for urine protein: creatinine ratio

Answer 56

**urometer** * monitor UO * assess each hour * used post-op, ICU, monitor fluid status

Answer 57

**venturi** * COPD * titrate oxygen therapy deliver 24-60% * flow rate varies with colour due to diameter or holes to spout altering mixing of room air with oxygen * need right flow rate to work * types * blue - 2-4L, 24% * white - 4-6L, 28% * yellow - 8-10L, 35% * red - 10-12L, 40% * green - 12-15L, 60%

Answer 58

* examples - Tesio (RRT), Hickman * usually subclavian with a portion tunnelled in SC layer * long term use (months to years) * _indications:_ IV administration of drugs (Abx, chemo), regular vascular access, renal replacement therapy, blood sampling

Answer 59

* Lateral edge of pectoralis major (**A**) * Lateral edge of latissimus dorsi (**B**) * Fifth intercostal space (**C**) * Apex of axilla (**D**) * Inserted above rib to avoid neurovascular bundle * Position confirmed with Chest X-Ray

Answer 60

must be reported by a **radiologist** for it to be deemed safe to use

Answer 61

* NJ tube (into jejenum having been passed through pylorus) * _indications_ * gastroparesis e.g. critical illness, DM, PD/neuro, scleroderma * gastric outlet obstruction * recurrent aspiration * pancreatitis (less stimulation of pancreas)

Answer 62

* early/immediate * urethral trauma * allergic reaction * balloon rupture * obstruction * bypass/leak * bladder perforation * delayed * UTI, pyelonephritis * urethral stricture

Answer 63

**early** * can't intubate, can't ventilate * trauma - lose teeth, oropharynx * bleeding * cuff perforation * endobronchial intubation **delayed** * tracheal necrosis → tracheo-oesophageal fistula * tracheal stenosis

Answer 64

a device which is infraglottic (crosses the cords) secure (cuffed) prevents aspiration of gastric contents can deliver maximum concentrations of oxygen

Answer 65

**Decreased consciousness and loss of airway reflexes (GCS \<8)** * Failure to protect against aspiration **Failure to oxygenate (T1RF)** * Respiratory pathology, ARDS, pulmonary oedema **Failure to ventilate (T2RF)** * Eg. Tiring patient (life threatening asthma) **Failure to maintain airway patency** * Upper airway obstruction * Angioedema * Facial/upper airway trauma * Burns * Anaphylaxis

Answer 66

**intermittent pneumatic compression** * Inflatable sleeves that are wrapped around the calves * Inflated one side at a time at regular intervals * Reduce venous stasis and the risk of VTE * Commonly used as mechanical thromboprophylaxis * Post abdominal/orthopaedic surgery * Post stroke (when LMWH contra-indicated) ***Contraindications*** * Severe peripheral vascular disease * Severe skin breakdown (e.g ulceration, infection)

Answer 67

**intermittent pneumatic compression** * Inflatable sleeves that are wrapped around the calves * Inflated one side at a time at regular intervals * Reduce venous stasis and the risk of VTE * Commonly used as mechanical thromboprophylaxis * Post abdominal/orthopaedic surgery * Post stroke (when LMWH contra-indicated) ***Contraindications*** * Severe peripheral vascular disease * Severe skin breakdown (e.g ulceration, infection)

Answer 68

**complication** * painful * local haematoma * infection at puncture site * vessel laceration * needle-stick injury * air/thrombus embolism * radial artery stenosis - repeated ABG e.g. COPD

Answer 69

* mislabelling * out of date * wrong order * haemolysis of sample and aberrant reading

Answer 70

* inappropriate placing (oesophageal) * injury to larynx * pneumothorax * atelectasis * infection * dislodgement - usually slight down R bronchus so only 1 lung ventilated * obstruction * difficulty weaning * barotrauma (ventilation associated)

PACES - Instruments Flashcards

(96 cards)