minor surgical procedures
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MINOR SURGICAL MINOR SURGICAL PROCEDURESPROCEDURES
Celso M. Fidel, Celso M. Fidel, MD,FPSGS,FPCSMD,FPSGS,FPCS
Diplomate Philippine Board of Diplomate Philippine Board of SurgerySurgery
COMMON MINOR SURGICAL PROCEDURES COMMON MINOR SURGICAL PROCEDURES
Incision and DrainageIncision and Drainage
Central Venous Pressure Central Venous Pressure
MonitoringMonitoring
TracheostomyTracheostomy
ThoracentesisThoracentesis
PericardiocentesisPericardiocentesis
Paracentesis abdominisParacentesis abdominis
COMMON MINOR SURGICAL PROCEDURES COMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture
Intubation of Gastro-Intestinal Intubation of Gastro-Intestinal
TractTract
Urethral CatheterizationUrethral Catheterization
CircumcisionCircumcision
DebridementDebridement
Excision of MassExcision of Mass
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Incision and DrainageIncision and Drainage Ample or big enough to allow drainageAmple or big enough to allow drainage Done at dependent portion or area of Done at dependent portion or area of pointingpointing Indications for drainageIndications for drainage Incomplete hemostasisIncomplete hemostasis Incomplete removal of foreign bodiesIncomplete removal of foreign bodies Presence of divitalized tissues due to Presence of divitalized tissues due to trauma, hematoma, or abscess formationtrauma, hematoma, or abscess formation When in doubt- Always drainWhen in doubt- Always drain
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Incision and DrainageIncision and Drainage
Technique ( Hilton’ Method)Technique ( Hilton’ Method)
Asepsis and Antisepsis on Asepsis and Antisepsis on
operative siteoperative site
Do field block anesthesia using Do field block anesthesia using
procaine 1% solutionprocaine 1% solution
Using Blade 11, Puncture site at an Using Blade 11, Puncture site at an
obtuse angle directing sharp part obtuse angle directing sharp part
upwardsupwards
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Incision and DrainageIncision and Drainage Technique ( Hilton’ Method)Technique ( Hilton’ Method) Pair of small round nose Pair of small round nose forceps inserted into forceps inserted into opening to make it wideropening to make it wider Withdraw forceps with blades Withdraw forceps with blades opened. Allow free passage opened. Allow free passage of fluid contents to flowof fluid contents to flow Insert drainInsert drain Dressing with Sterile GauzeDressing with Sterile Gauze
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Incision and Drainage for CarbunclesIncision and Drainage for Carbuncles Technique ( Bridge Incision )Technique ( Bridge Incision ) Asepsis and Antisepsis on operative Asepsis and Antisepsis on operative sitesite Incision of skin and subcutaneous Incision of skin and subcutaneous tissue one above and one below tissue one above and one below the lesion following lines of the lesion following lines of Langer’s Langer’s Pair of Mayo scissors inserted Pair of Mayo scissors inserted connecting the two incisions connecting the two incisions
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Incision and Drainage for CarbunclesIncision and Drainage for Carbuncles
Technique ( Bridge Incision )Technique ( Bridge Incision )
Withdraw scissors with blades Withdraw scissors with blades
opened. Allow free passage opened. Allow free passage
of contents to flowof contents to flow
Insert a large rubber drain Insert a large rubber drain
Floppy Dressing with Sterile Floppy Dressing with Sterile
GauzeGauze
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure MonitoringCentral Venous Pressure Monitoring
In seriously ill patients the In seriously ill patients the vital problemvital problem is is
determination of the determination of the proper amountproper amount of of fluids fluids
and blood requirements necessary to and blood requirements necessary to
MAINTAIN an optimal blood volumeMAINTAIN an optimal blood volume in the: in the:
PreoperativePreoperative
OperativeOperative
PostoperativePostoperative
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure MonitoringCentral Venous Pressure Monitoring
CVP Monitoring is a reliable procedure CVP Monitoring is a reliable procedure
to evaluate properly and promptly to evaluate properly and promptly
optimal fluidoptimal fluid and and blood requirementblood requirement
in these patientsin these patients..
The procedure removes much of the The procedure removes much of the
guess work in rapid restoration and guess work in rapid restoration and
maintenance of adequate circulation maintenance of adequate circulation
w/o fear of overloading the heartw/o fear of overloading the heart
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure Monitoring (CVP)Central Venous Pressure Monitoring (CVP).. CVP measured anywhere in the SVC or IVC CVP measured anywhere in the SVC or IVC
or or their immediate their immediate
tributaries>>>Innominate, tributaries>>>Innominate, and the Common Iliac Veinsand the Common Iliac Veins It is determined by a complex interaction It is determined by a complex interaction
of:of: Blood VolumeBlood Volume Cardiac Pump ActionCardiac Pump Action Vascular ToneVascular Tone Serves as index of circulating blood volume Serves as index of circulating blood volume relative to the Cardiac Pump Actionrelative to the Cardiac Pump Action
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure Monitoring (CVP)Central Venous Pressure Monitoring (CVP)
CVP or the pressure in the Right Atrium & CVP or the pressure in the Right Atrium &
adjacent Caval system will reflect ability of adjacent Caval system will reflect ability of
the Cardiac Pump Action to handle the the Cardiac Pump Action to handle the
returning blood volume at that particular time.returning blood volume at that particular time.
Indications:Indications:
When Massive blood replacement is When Massive blood replacement is
instituted rapidly in rapid exsanguinating instituted rapidly in rapid exsanguinating
type of bleeding.type of bleeding.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Central Venous Pressure Monitoring (CVP)Central Venous Pressure Monitoring (CVP) Indications:Indications: In Acute blood volume deficit in cases In Acute blood volume deficit in cases operated for strangulating type of Intestinal operated for strangulating type of Intestinal Obstruction where rapid fluid replacement is Obstruction where rapid fluid replacement is indicatedindicated
In obscure cases of Shock immediately post-In obscure cases of Shock immediately post- op whether hypovolemic due to internal op whether hypovolemic due to internal bleeding or nonhypovolemic from Myocardial bleeding or nonhypovolemic from Myocardial Infarction.Infarction.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Central Venous Pressure Monitoring (CVP).Central Venous Pressure Monitoring (CVP).
IndicationsIndications::
In elderly patients with limited In elderly patients with limited cardiac cardiac
reserve undergoing difficult, time reserve undergoing difficult, time consuming operations.consuming operations.
In surgical patients with anuria due In surgical patients with anuria due to to
possible renal shutdown.possible renal shutdown.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Central Venous Pressure Monitoring (CVP).Central Venous Pressure Monitoring (CVP). Basic Facts about CVPBasic Facts about CVP.. Normal CVP is about 4 to 7 cmNormal CVP is about 4 to 7 cm
Low CVP 0-3 circulating blood vol. is Low CVP 0-3 circulating blood vol. is below the normal blood volume the below the normal blood volume the heart can handle.heart can handle.
High CVP 8-20 (more than the heart can High CVP 8-20 (more than the heart can handle)handle)
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure Monitoring (CVP).Central Venous Pressure Monitoring (CVP). TechniqueTechnique
Cannulation of the Superior Vena Cava Cannulation of the Superior Vena Cava through Basilic or Cephalic Veins.through Basilic or Cephalic Veins.
A polyethelene tube size French 8 and 42 A polyethelene tube size French 8 and 42 inches long is inserted at the Basilic Vein inches long is inserted at the Basilic Vein
just just above the elbow and pushed up to 20 above the elbow and pushed up to 20
inches.inches.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Central Venous Pressure Monitoring (CVP).Central Venous Pressure Monitoring (CVP). TechniqueTechnique Connect an Intravenous administration setConnect an Intravenous administration set to the venous catheter through which IV fluid, to the venous catheter through which IV fluid, may be administered.may be administered.
A Manometer is connected to IV set w/ a threeA Manometer is connected to IV set w/ a three way stopcock. Zero point should be at level ofway stopcock. Zero point should be at level of the Atrium or approximately at Midaxillary linethe Atrium or approximately at Midaxillary line. .
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
TracheostomyTracheostomy Operative opening into the trachea Operative opening into the trachea
maintained maintained for an indefinite period of time.for an indefinite period of time. Varieties:Varieties: High Tracheostomy – Above thyroid isthmusHigh Tracheostomy – Above thyroid isthmus Low Tracheostomy – Below thyroid Low Tracheostomy – Below thyroid
isthmus; isthmus; the type more commonly used.the type more commonly used. Indications;Indications; Comatous or Stuporous Patients due to:Comatous or Stuporous Patients due to: Cerebral Injuries Cerebral Injuries Brain Infections Brain Infections Certain Cases of Brain TumorsCertain Cases of Brain Tumors
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
TracheostomyTracheostomy
Indications;Indications;
Severe & Massive Injuries or Infection Severe & Massive Injuries or Infection
about the face and Neck.about the face and Neck.
Severe Tracheo-bronchitis & other Severe Tracheo-bronchitis & other
similar conditions. (Diphtheria)similar conditions. (Diphtheria)
All penetrating, Lacerating, and Severe All penetrating, Lacerating, and Severe
Crushing Injuries of the Trachea.Crushing Injuries of the Trachea.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
TracheostomyTracheostomy
Indications;Indications;
In Surgical procedures about Head & In Surgical procedures about Head &
NeckNeck
Radical Neck Dissection combined w/Radical Neck Dissection combined w/
Oral Procedure- Resection of a portion Oral Procedure- Resection of a portion
of the Mandible of the Mandible
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
TracheostomyTracheostomy Indications;Indications; Compression of the upper Airway due to Compression of the upper Airway due to Benign and Malignant Tumors of the:Benign and Malignant Tumors of the: Larynx Larynx Pharynx Pharynx Upper Trachea Upper Trachea Thyroid Thyroid Tongue Tongue MandibleMandible
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
TracheostomyTracheostomy Indications;Indications; Post-op severely ill patients w/ ineffective Post-op severely ill patients w/ ineffective cough.cough. In some Post-Thyroidectomy patientsIn some Post-Thyroidectomy patients
In Severe tissue reaction and edema of the In Severe tissue reaction and edema of the upper respiratory tract due to intense upper respiratory tract due to intense Irradiation for malignant tumors of the Irradiation for malignant tumors of the
NeckNeck
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Tracheostomy (Technique )Tracheostomy (Technique )
Emergency – heroic measure for Emergency – heroic measure for patient patient
choking to death.choking to death.
Neck is hyper-extended Neck is hyper-extended
Asepsis & Antisepsis on operative siteAsepsis & Antisepsis on operative site
Under local Anesthesia a vertical skin Under local Anesthesia a vertical skin
incision is made over the Cricoid incision is made over the Cricoid Cartilage Cartilage
areaarea
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Tracheostomy (Technique )Tracheostomy (Technique )
The thyroid isthmus w/c occupies 2The thyroid isthmus w/c occupies 2ndnd
to 4to 4thth ring is divided between clamps ring is divided between clamps
and securedand secured
Round Windows are made on the 3Round Windows are made on the 3rdrd
and 4and 4thth rings rings
Specific size Cannula is insertedSpecific size Cannula is inserted
Adults size of Cannula- 10-12 Adults size of Cannula- 10-12 mm mm diameter diameter
Children under 18 months>> 4mm in Children under 18 months>> 4mm in
diameter. diameter.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES ThoracentesisThoracentesis >>>> A minor surgical A minor surgical procedure where a needle is inserted at procedure where a needle is inserted at the posterior axillary line ,7the posterior axillary line ,7thth intercostal intercostal space for the purpose of tapping the space for the purpose of tapping the pleural Cavity.pleural Cavity. SynonymsSynonyms : : Paracentesis ThoracisParacentesis Thoracis Thoracocentesis Thoracocentesis Pleurocentesis Pleurocentesis Indications:Indications: Diagnostic Diagnostic TherapeuticTherapeutic Palliative Measures Palliative Measures Artificial Artificial PneumothoraxPneumothorax
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES ThoracentesisThoracentesis Equipment and SuppliesEquipment and Supplies Local Anesthetic >>> Procaine 1%Local Anesthetic >>> Procaine 1% Anticoagulant >>> Sodium CitrateAnticoagulant >>> Sodium Citrate Syringe, 5 and 50 cc; Needles gauge Syringe, 5 and 50 cc; Needles gauge
16, 16, 20, 25 about 3 inches long; 3 way 20, 25 about 3 inches long; 3 way stopcock; Forcepsstopcock; Forceps Sterile Test Tubes for culture; Sterile Test Tubes for culture; Sterile bottles for :Sterile bottles for : Specific gravitySpecific gravity Cell CountCell Count Guinea pig inoculation if desiredGuinea pig inoculation if desired
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Thoracentesis Thoracentesis TechniqueTechnique Position of Patient>> Sitting w/ elevated Position of Patient>> Sitting w/ elevated arms supported by a pillow; If weak arms supported by a pillow; If weak lateral decubitus lateral decubitus Site of Puncture>>> 6Site of Puncture>>> 6thth or 7 or 7thth ,posterior ,posterior axillary Upper Border of the lower rib axillary Upper Border of the lower rib Procedure( Sterile Technique) Procedure( Sterile Technique) Local Infiltration Anesthesia skin>> Local Infiltration Anesthesia skin>> Pleura Pleura
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Thoracentesis Thoracentesis
Procedure( Sterile Technique)Procedure( Sterile Technique)
Attach 50 cc syringe with stopcock & Attach 50 cc syringe with stopcock &
gauge16 needle; slowly insert gauge16 needle; slowly insert
needle into preferred site of needle into preferred site of
puncture until fluid can be puncture until fluid can be
aspiratedaspirated
Grasp needle with mosquito forceps Grasp needle with mosquito forceps
close to skin to make needle firm. close to skin to make needle firm.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Thoracentesis Thoracentesis
Procedure( Sterile Technique)Procedure( Sterile Technique)
Aspirate fluid slowly into syringe and Aspirate fluid slowly into syringe and
discharge to a container thru tubing discharge to a container thru tubing
connected to the stopcock.connected to the stopcock.
After the desired amount of fluid is After the desired amount of fluid is
removed, the needle is withdrawn removed, the needle is withdrawn
Apply antiseptic to puncture site. Apply antiseptic to puncture site.
Apply Sterile Dressing.Apply Sterile Dressing.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
ThoracentesisThoracentesis
Complications:Complications:
Infection Infection
PneumothoraxPneumothorax
Shock Shock
Injury to intercostal vessels and Injury to intercostal vessels and
nerves nerves
Injury to Lung ParenchymaInjury to Lung Parenchyma
Breakage of needle at puncture siteBreakage of needle at puncture site
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
PericardiocentesisPericardiocentesis Synonyms:Synonyms: Paracentesis Pericardii Paracentesis Pericardii Pericardial Pericardial ParacentesisParacentesis IndicationsIndications DiagnosticDiagnostic Therapeutic for serous or purulent Therapeutic for serous or purulent pericardial effusion.pericardial effusion. As an Emergency in Cardiac TamponadeAs an Emergency in Cardiac Tamponade Equipments and SuppliesEquipments and Supplies>>>Same as >>>Same as Thoracic Paracentesis except that an 18 Thoracic Paracentesis except that an 18 gauge needle is used instead of the gauge gauge needle is used instead of the gauge 16 needle16 needle
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
PericardiocentesisPericardiocentesis ProcedureProcedure (Sterile Technique is Observed) (Sterile Technique is Observed)
Position>> Patient sitting at 60 degrees Position>> Patient sitting at 60 degrees
supported by back rest or pillowsupported by back rest or pillow
Site of PunctureSite of Puncture
55thth Left Interspace, just inside the lateral Left Interspace, just inside the lateral
border of Cardiac Dullnessborder of Cardiac Dullness
Left Costo-ensiform pointLeft Costo-ensiform point
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
PericardiocentesisPericardiocentesis ProcedureProcedure (Sterile Technique is (Sterile Technique is
Observed)Observed)
Actual ProcedureActual Procedure
Asepsis and Antisepsis on siteAsepsis and Antisepsis on site
Infiltrate the Skin and Subcutaneous Infiltrate the Skin and Subcutaneous
Tissue with local AnesthesiaTissue with local Anesthesia
Connect a 50 cc syringe to a Connect a 50 cc syringe to a
stopcock and 18 gauge needle.stopcock and 18 gauge needle.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES PericardiocentesisPericardiocentesis Actual ProcedureActual Procedure If at 5If at 5thth Left Interspace inside lateral border Left Interspace inside lateral border
of Cardiac dullness; Insert the needle of Cardiac dullness; Insert the needle slowlyslowly at an angleat an angle directed posteriorlydirected posteriorly andand towards towards thethe SPINESPINE at the lower border of at the lower border of the interspace.the interspace. If at the Left costo-ensiform point direct theIf at the Left costo-ensiform point direct the needleneedle UPWARDUPWARD and to theand to the LEFTLEFT Aspirate slowly and discharge fluid Aspirate slowly and discharge fluid accordingly by a rubber tubing into a accordingly by a rubber tubing into a container.container.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
PericardiocentesisPericardiocentesis
Dangers or ComplicationsDangers or Complications
Injury to the Heart MuscleInjury to the Heart Muscle
Injury to the coronary and Injury to the coronary and
internal mammary arteriesinternal mammary arteries
Injury to the PleuraInjury to the Pleura
Injury to the PeritoneumInjury to the Peritoneum
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Paracentesis AbdominisParacentesis Abdominis>>>> A minor A minor
surgical procedure where the abdominal surgical procedure where the abdominal
Cavity is punctured or tapped Cavity is punctured or tapped
SynonymsSynonyms : :
Abdominocentesis Abdominocentesis
PeritoneocentesisPeritoneocentesis
IndicationsIndications::
DiagnosticDiagnostic
To remove fluids for examinationTo remove fluids for examination
To introduce a peritoneoscopeTo introduce a peritoneoscope
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Paracentesis AbdominisParacentesis Abdominis IndicationsIndications cont’dcont’d TherapeuticTherapeutic To Administer Therapeutic AgentsTo Administer Therapeutic Agents To introduce Air before PeritoneoscopyTo introduce Air before Peritoneoscopy Palliative>> To remove Ascitic fluid which Palliative>> To remove Ascitic fluid which may embarrass respirationmay embarrass respiration Equipments and SuppliesEquipments and Supplies>>>Same as >>>Same as Thoracic Paracentesis except that a Thoracic Paracentesis except that a Trocar with Obturator and sharp pointed Trocar with Obturator and sharp pointed scalpel are needed.scalpel are needed.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Paracentesis AbdominisParacentesis Abdominis TechniqueTechnique Preparation of the PatientPreparation of the Patient Evacuate bowels using Fleet enema Evacuate bowels using Fleet enema Empty the Urinary Bladder (Catheterize)Empty the Urinary Bladder (Catheterize) Position>> Patient sitting upright on a Position>> Patient sitting upright on a
chair chair or dorsal decubitus will do or dorsal decubitus will do Site of PunctureSite of Puncture Midline between Umbilicus and PubisMidline between Umbilicus and Pubis Left side opposite McBurney’s Point. Left side opposite McBurney’s Point.
Right Right side can also be usedside can also be used
COMMON MINOR SURGICAL PROCEDURES COMMON MINOR SURGICAL PROCEDURES
Paracentesis AbdominisParacentesis Abdominis TechniqueTechnique Actual ProcedureActual Procedure Asepsis and antisepsisAsepsis and antisepsis Infiltrate Skin, Subcutaneous tissue and Infiltrate Skin, Subcutaneous tissue and the Peritoneum with local anesthesiathe Peritoneum with local anesthesia Make a small skin incision (1/2cm ) at siteMake a small skin incision (1/2cm ) at site Grasp the Trocar and with a firm pressureGrasp the Trocar and with a firm pressure introduce it through skin incision just to introduce it through skin incision just to reach the peritoneum reach the peritoneum “DON’T HURRY”“DON’T HURRY”
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Paracentesis AbdominisParacentesis Abdominis Actual ProcedureActual Procedure Attach a rubber tube to the trocar. Pull out Attach a rubber tube to the trocar. Pull out the Obturator, and collect fluid in a the Obturator, and collect fluid in a container.container. After the paracentesis, apply sterile After the paracentesis, apply sterile dressing and secure the area with tight dressing and secure the area with tight Abdominal binder.Abdominal binder. Complications:Complications: Infection Infection Shock Shock Injury to the Abdominal Viscera Injury to the Abdominal Viscera
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture >> The insertion of a >> The insertion of a needle into the Subarachnoid space in needle into the Subarachnoid space in the Spinal canalthe Spinal canal Indications Indications
To obtain a specimen of the fluid for To obtain a specimen of the fluid for analysis and for cultureanalysis and for culture To establish any alteration in usual CSF To establish any alteration in usual CSF pressurepressure To relieve pressureTo relieve pressure To inject drugs To inject drugs To inject dye for x-ray visualizationTo inject dye for x-ray visualization
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture
Contraindications Contraindications
Increased intracranial Pressure due to:Increased intracranial Pressure due to:
Tumor Tumor
Old HematomaOld Hematoma
Brain AbscessBrain Abscess
Existence of a pyogenic infection and/or Existence of a pyogenic infection and/or
dermal condition in the lumbar areadermal condition in the lumbar area
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture TechniqueTechnique
Position the patient sitting on a stool with Position the patient sitting on a stool with
thethe arms and Head resting on a table; arms and Head resting on a table; However if you wish to know something However if you wish to know something about intracranial pressure or the about intracranial pressure or the
patency patency of the spinal arachnoid pathway, then of the spinal arachnoid pathway, then patient should lay on his side,patient should lay on his side, with the knees drawn up close to the with the knees drawn up close to the head.head.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture TechniqueTechnique Surgeon should observe aseptic technique Surgeon should observe aseptic technique and left hand should rest on the iliac crest. and left hand should rest on the iliac crest. Site is the Site is the 44thth lumbar interspace lumbar interspace. . The interspace w/c is approximately in the The interspace w/c is approximately in the same transverse plane as the same transverse plane as the crest of thecrest of the iliumilium is firmly palpated w/ the thumb. Skin is firmly palpated w/ the thumb. Skin over the area is anesthetized with 2 cc of over the area is anesthetized with 2 cc of Procaine.Procaine.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture TechniqueTechnique Gauge 18 needle is introduced into the Gauge 18 needle is introduced into the midline; If bony resistance is midline; If bony resistance is
encountered encountered withdraw the needle 1-2 cms & withdraw the needle 1-2 cms &
reintroduce reintroduce in a modified direction.in a modified direction. As the spinal Cord is approached, move As the spinal Cord is approached, move
the the needle forward 1cm or less at a time and needle forward 1cm or less at a time and
the the stylet is removed; When there is CSF it is stylet is removed; When there is CSF it is reinserted.reinserted.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Lumbar PunctureLumbar Puncture
TechniqueTechnique
Proceed with contemplated evaluation.Proceed with contemplated evaluation.
When procedure is completed, needle is When procedure is completed, needle is
removed & sterile dressing is applied.removed & sterile dressing is applied.
Place patient in dorsal recumbent Place patient in dorsal recumbent
position without a pillow. position without a pillow.
Lumbar TapLumbar Tap
Lumbar TapLumbar Tap
Lumbar TapLumbar Tap
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal Tract Intubation of Gastro-Intestinal Tract
Indications Indications
To extract gastric juice for AnalysisTo extract gastric juice for Analysis
Tube feedingTube feeding
Duodenal Drainage Duodenal Drainage
Pre-operative decompression Pre-operative decompression
Post-operative decompressionPost-operative decompression
Removal of swallowed poison Removal of swallowed poison
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract
Contraindications:Contraindications:
Aneurysms especially Aortic (Retching may Aneurysms especially Aortic (Retching may
cause bleeding). cause bleeding).
Heart Failure Heart Failure
Hypertension or Marked Arteriosclerosis Hypertension or Marked Arteriosclerosis
Gastric Ulcer > It should be used with care Gastric Ulcer > It should be used with care
It should not be used when Corrosive It should not be used when Corrosive
Poisons have been swallowed.Poisons have been swallowed.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract Types of Tubes UsedTypes of Tubes Used Ewald Tube Ewald Tube Large tube especially for gastric Large tube especially for gastric Analysis or Tube Feeding F 30 or largerAnalysis or Tube Feeding F 30 or larger Rehfuss Tube Rehfuss Tube Small oral tube with a metal Small oral tube with a metal “ “Oral tip” which helps the patient to Oral tip” which helps the patient to swallow the tube and by its weight, it falls swallow the tube and by its weight, it falls into the dependent portion of the stomach. into the dependent portion of the stomach. Used for gastric juice analysis and for Used for gastric juice analysis and for emptying stomach.emptying stomach.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract
Levine TubeLevine Tube –Most used of all stomach –Most used of all stomach tubes. It is a round tipped nasal tubes. It is a round tipped nasal
catheter, catheter, size 14-16 with 4 openings at its size 14-16 with 4 openings at its
terminal.terminal. Uses:Uses: To obtain gastric juice for analysisTo obtain gastric juice for analysis For decompressionFor decompression For Duodenal DrainageFor Duodenal Drainage
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract Wangensteen TubeWangensteen Tube – – A Levine type tube with A Levine type tube with lead at its end, which helps it enter into the lead at its end, which helps it enter into the duodenum. Has 9 openings in its terminal duodenum. Has 9 openings in its terminal
10 10 inches.inches. Use:Use: Mainly for intestinal decompressionMainly for intestinal decompression Harris TubeHarris Tube - - Modified Miller-Abbot. It has a Modified Miller-Abbot. It has a single lumen with a thin rubber sac single lumen with a thin rubber sac containing Mercury at its tip which makes containing Mercury at its tip which makes its insertion much easierits insertion much easier..
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract Types of Tubes Used cont’dTypes of Tubes Used cont’d Miller-Abbot Tube Miller-Abbot Tube -- size 16 F and about 2.5 size 16 F and about 2.5 meters long with double lumen. Smaller meters long with double lumen. Smaller channel inflates a balloon in the tip of the channel inflates a balloon in the tip of the tube. Inflation is done after the tube has tube. Inflation is done after the tube has passed the mid-portion of the duodenum. passed the mid-portion of the duodenum. Larger Channel is for aspiration. TheLarger Channel is for aspiration. The openings of tube are proximal and distal to openings of tube are proximal and distal to balloonballoon
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract Miller-Abbot Tube-Miller-Abbot Tube- Uses: Uses: Diagnostic Diagnostic Decompression Decompression Feeding Feeding Irrigation Irrigation Technique of IntroductionTechnique of Introduction Anatomical Points to rememberAnatomical Points to remember Ave. distance from Teeth to Cardia >>18 Ave. distance from Teeth to Cardia >>18 inchesinches From Cardia to Pylorus 11 inches (28cms. From Cardia to Pylorus 11 inches (28cms. Nasal route is 2 inches( 5cm. ) longer Nasal route is 2 inches( 5cm. ) longer than oralthan oral
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract
Other Helpful TipsOther Helpful Tips An emesis basin should be held by the An emesis basin should be held by the patientpatient Psychological ReassurancePsychological Reassurance Retching can be controlled by active Retching can be controlled by active pantingpanting Control Marked Pharyngeal spasm Control Marked Pharyngeal spasm
with with local anesthesialocal anesthesia Use water as lubricantUse water as lubricant Remove tube if the patient coughsRemove tube if the patient coughs
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract
Technique of Introduction (Oral)Technique of Introduction (Oral) Keep tube in Ice-Water until insertion.Keep tube in Ice-Water until insertion. Push tube into Pharynx telling patient to Push tube into Pharynx telling patient to swallow and at same time pushing 3-4swallow and at same time pushing 3-4 inches of tube.inches of tube. Once the tube has been inserted at Once the tube has been inserted at about 20 in. from the teeth aspirate to about 20 in. from the teeth aspirate to make sure that it is in stomach.make sure that it is in stomach.
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES Intubation of Gastro-Intestinal TractIntubation of Gastro-Intestinal Tract Insertion of NASAL TubesInsertion of NASAL Tubes Tube is kept in water at room temperatureTube is kept in water at room temperature Push the tube into the nostril aiming Push the tube into the nostril aiming towards the occiput until it has been felt to towards the occiput until it has been felt to have turned into the pharynx.have turned into the pharynx.
Tell the patient to swallow and at the same Tell the patient to swallow and at the same time push 6-8 of the tube.time push 6-8 of the tube. Introduce about 22 inches and aspirate Introduce about 22 inches and aspirate
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Urethral CatheterizationUrethral Catheterization
Uses Uses
Empty Bladder of retained UrineEmpty Bladder of retained Urine
Explore the UrethraExplore the Urethra
Amount of Residual Urine Determination Amount of Residual Urine Determination
To Obtain sterile urine, To Obtain sterile urine, especially especially in womenin women
Measure Capacity of the BladderMeasure Capacity of the Bladder
Measure Urinary Bladder Pressure Measure Urinary Bladder Pressure
Introduce opaque materials for Introduce opaque materials for CystographyCystography
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Urethral CatheterizationUrethral Catheterization Types of CathetersTypes of Catheters Soft Rubber CathetersSoft Rubber Catheters sizes from 8 F- 28 Fsizes from 8 F- 28 F Semi-rigid Rubber CathetersSemi-rigid Rubber Catheters Solid tip Urethral Catheters>> Solid tip Urethral Catheters>>
Coudetip; Coudetip; Olive tipOlive tip Woven Catheters Woven Catheters Metal Catheters Metal Catheters Retention Catheters Retention Catheters Self Retaining Self Retaining CathetersCatheters
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
Urethral CatheterizationUrethral Catheterization Preparing for CatheterizationPreparing for Catheterization Thorough scrubbing of the hands of the Thorough scrubbing of the hands of the SurgeonSurgeon Sterile Catheter is placed on a sterile Sterile Catheter is placed on a sterile tray covered by sterile drapetray covered by sterile drape Surgeon uses sterile gloves Surgeon uses sterile gloves Sterile Lubricant should be available Sterile Lubricant should be available Antiseptic is used to clean Urethral Antiseptic is used to clean Urethral Opening Opening Gentle and Gradual Insertion of the Gentle and Gradual Insertion of the CatheterCatheter
Urethral CatheterizationUrethral Catheterization
Urethral CatheterizationUrethral Catheterization
COMMON MINOR SURGICAL PROCEDURESCOMMON MINOR SURGICAL PROCEDURES
CircumcisionCircumcision
Indications Indications Congenital Phimosis Congenital Phimosis Paraphimosis Paraphimosis Adherent Prepuce Adherent Prepuce Redundant Prepuce causing Uncleanliness Redundant Prepuce causing Uncleanliness
Recurrent Attacks of Balanoposthitis Recurrent Attacks of Balanoposthitis Dermatitis of Prepuce; Herpes & Venereal Dermatitis of Prepuce; Herpes & Venereal WartsWarts Ritual Ritual
Operating Room FM CenterOperating Room FM Center
Injecting AnesthesiaInjecting Anesthesia
Applying 2 forceps at tipApplying 2 forceps at tip
Making the Dorsal SlitMaking the Dorsal Slit
First Suture at the angle of SlitFirst Suture at the angle of Slit
Removing part of prepuce on both sidesRemoving part of prepuce on both sides
Finished ProductFinished Product
Gunshot Wound ButtocksGunshot Wound Buttocks
Wound Showing Clots and Necrotic TissueWound Showing Clots and Necrotic Tissue
Wound after CurettageWound after Curettage
Subcutaneous Tissue RepairSubcutaneous Tissue Repair
Closure of the woundClosure of the wound
Sebaceous CystsSebaceous Cysts
Application of AnesthesiaApplication of Anesthesia
Start of ExcisionStart of Excision
The final outcomeThe final outcome
Sebacceous CystSebacceous Cyst