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Surgery I - Skills

& Venapuncture

What should you never do when draping a patient? Reach over the patient
What should you have a patient do to facilitate placement of an NG tube? Swallow by drinking water
How does one confirm placement of an NG tube? By injecting air into the stomach and auscultating or by obtaining a chest radiograph
When should a jejunal- tube be placed instead of a gastric tube? When concerns for aspiration are present or in the setting of gastric ileus
What is an advantage to placement of a PEG (percutaneous endoscopic gastrostomy) tube? It avoids the need for general anesthesia and a large incision
Name the lays of the abdominal wall encountered when performing an inguinal hernia repair 1. skin 2. subcutaneous fat (camper's fascia) 3. Scarpa's fascia 4. external oblique 5. spermatic cord 6. cremasteric muscle 7. tranversalis fascia 8. pre-periotneal fat 9. parietal peritoneum
Indicate the proper positioning for central line placement Reverse trendelenburg to prevent air embolism
List 3 indications for performing a tracheostomy 1. prolonged mechanical ventilation 2. upper airway obstruction (tumors) 3. neurologic deficits preventing clearing of secretions and increasing risk of aspiraiton
List 4 common indications for performing a lung resection 1. lung cancer 2. atelectasis 3. emphysema 4. tuberculosis
Where should one perform a needle thoracostomy? midclavicular line at the 2nd intercostal space
Where should one place a chest tube? Anterior axillary line at the 4th or 5th intercostal space, make the incision above the 6th rib and enter above the 5th rib
How does a chest tube function under suction? Creates a negative pressure to prevent collapse of lung
Which location is first choice for IV placement? Cephalic vein, approx 10 cm above wrist (but should START with metacarpal)
What 4 areas should absolutely be avoided in IV placement? 1. Volar aspect of wrist 2. below compromised area 3. sclerosed veins 4. arm on the side of mastectomy, blood clot or infection 4. arm with fistula or shunt
What size catheters are idea for: **** 1. Trauma 2. Blood administration 3. Fluid infusion 1. 16 or 18 gauge 2. 18 gauge 3. 20 gauge
Which veins are not appropriate for irritating solutions? Metacarpals
How often should a peripheral IV be changed? Every 3-4 days (<5), or sooner if patient experiences pain
How long should a tourniquet be left on? No more than 3 minutes
Cite indications for a nontunneled central venous catheter Short term therapy < 7 days
Cite indications for a tunneled central venous catheter Long term therapy Note; must be placed in vascular radiology or surgery
What tow maintenances are required for implanted ports? 1. Flushing every 4 weeks with Heparin 2. Huber needle change every 7 days
What is the most common complication of IV therapy? Infiltration - fluid infusion in the tissues
What should one do if an extravasation (leakage of vesicant solutions out of vein) occurs? Stop the infusion immediately
What three pieces of Info should be documented on the IV site? 1. Date and time 2. Catheter size 3. initials of person who placed it
Created by: eedavila
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