instruments in surgery

8/10/2019 Instruments in Surgery

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Instruments in SurgeryPradeep Chopra, MBBS,MS,FRCS Ed


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Life saving


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Life Saving


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Tracheostomy

Obstruction of upper air passages

Improve respiratory function

Respiratory paralysis Operations on upper airway

Prolonged ETT, ICU


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Tracheostomy

Obstruction of upper air passages

FB impaction

Acute infections

Odema of the glottis Bilateral abductor paralysis

Tumours of the larynx

Trauma, crushed larynx Congenital webs or atresia


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Tracheostomy

Improve respiratory function

Reduce dead space, anatomical

Aspiration of bronchial secretions

Bronchopneumonia Chronic bronchitis with emphysema

Chest injuries, flial chest


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Tracheostomy

Respiratory paralysis

Helps in PPV and toilet

Unconsciousness, head or facio-maxillary injury

Coma

Bulbar polymelitis

Tetanus

Endotracheal intubation


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Tracheostomy

After care

Bedside; tracheal dilator, oxygen

Humidifier

Suction with sterile catheter Inner tube care, crusting


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Tracheostomy

Complications

Crusting

Surgical emphysema

Mediastinal emphysema Tracheal stenosis


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Percutaneous tracheostomy

Used in the ICU


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Endotracheal intubation

Substitute for tracheostomy, respiratory

paralysis

Less desirable in long term:

Toilet is easy with tracheostomy

Intubation granuloma of vocal folds and

subsequent stricture


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Life Saving


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Treatment of massive haemorrhage

3rd

stopped3rdoozing

3rdheavily bleeding

Resuscitation Arrest of Haemorrhage General Management Prevention

Blood Tx

Avoid sodium

Care with opiates

Tamponade

Drugs

Sclerotherapy

Operations

Devascularisation

Transection

Shunt operations*

*best avoided

Decrease protein load- bowel

Lactulose

Clears bowel

BacteriaNeomycin

Blood catharticRepeated Sclerotherapy

2 weeks,1m,6m

nonthrombosed, new

Operations


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Life Saving


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Intercostal Drainage

Indications:

Trauma: Haemothorax, Pneumothorax

Surgery: Entering pleural space

Pleural Effusions:

Transudate- CCF

Exudate- infections (turbid) and tumours

Blood stained- trauma, tumour, Tb, infarction,pancreatitis

Chyle


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Intercostal drainage

Site

Space

Procedure

Direction

Removal

Precautions


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Intercostal drainage

underwater seal


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Pneumothorax

Spontaneous

Rupture of bulla

Trauma: penetrating, # ribs, iatrogenic( lung Bx, Central line)

PPV

Rare: asthma, cystic fibrosis, resuscitation &ventilation of new born.


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Haemothorax

Indication for thoracotomy

Initial drainage > 1000 ml

Continued bleeding of > 250 ml/ hr first 4-5 hr or >

2000 ml in 24 hrs.


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Life Saving

Central Venous

Pressure Monitoring

Haemodialysis

TPN

Chemotherapeutic

drugs

TIPPS IVC filters


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Limb/Life Saving

Embolectomy

catheter (Fogarty)

Acute Ischaemia of

the limb Embolus retrieval

Acute on chronic

Pulmonary embolus

Endoscopic retrievalof CBD stones


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Essential


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Essential


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Drains

Types:

Open: gloved, penrose, corrugated

Closed:

Gravity

Suction

Sump


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Drains and indications

Nonfunctioning GI tract

Extensive dissection in closed space

Large flaps

Abscesses that do not communicate

Difficult abdominal surgeries

Certain operations: LN dissection, thyroid,

pancreatic, pelvis, peritonitis etc., Peritoneal lavage: peritonitis, pancreatitis,

peritoneal dialysis


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Drains and complications

FB reaction and isolation

Colonisation by bacteria

Not a substitute for hemostasis Erode: blood vessel, intestines (rigid)

Excessive suction: necrosis (intermittent love

level suction safer)

Break, dislodge (radio-opaque marker)


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When to remove the drain

Fulfilled their purpose

No further drainage is present or if the

drainage is minimal

Document

Note the completeness of removal

C/S if indicated


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Essential


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Essential


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Nice to Know

Condom catheter


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Essential

T tube

CBD exploration

Injury to the CBD

Traumatic Iatrogenic

Surgery on CBD ie.,

anastamosis

Size at least 14F

MTBE

Removal after 3-4 weeks


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Essential

Isotonic Solutions


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Essential

Hypertonic Solutions


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Essential


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Essential

Colloids


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Nice to Know


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Complications of TPN

Insertion related

air embolism

arterial puncture

arrhythmias catheter embolus

chylothorax

Haemo/hydro

pericardium

Hematoma

Hemothorax

Hydro-TPN-othorax

Malposition Pneumothorax

Late complication

infection/sepsis

thrombosis displacement


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Essential

TED Stockings

SCD


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Essential

Colostomy

Temporary (loop/end)

Defunction anastomosis

Injury to colon / rectum High fistula in ano

Hartmans procedure

Mucous fistula

Permanent (end)

APR for ca rectum


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Colostomy complications

Prolapse

Retraction

Necrosis Stenosis

Parastomal hernia

Internal herniationintestinal obstruction Bleedinggranulomas around margin

Diarrhoea


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Other ostomies

Loop ileostomy

Caecostomy

Impeding perforation, colonic obstruction


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Essential


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Haemorrhoids Treatment


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Nice to Know

Laparoscopic

instruments

Indications Insuffulation

gases

Techniques

Contraindication


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Nice to Know


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instruments in surgery

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