17. minor surgical procedures copy

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


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


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


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


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


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


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


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


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


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)


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.


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. .


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



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.



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


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


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


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


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


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.


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.


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


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


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


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.


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


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


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


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


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



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


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.


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.


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.



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


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


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.


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.



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


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..


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


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



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



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



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


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


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


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

17. minor surgical procedures copy

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