Instruments

Station one: Dr.Hatim

1-Sengstaken tube:
 Uses:
• Upper GIT bleeding mainly in case of ruptured esophageal varices.
NOTE:
• Never use it in duodenal ulcer.
• Must do X-ray before insertion.
• Don’t exceed 40 mmhg.
• Duration of blowing 24 hr
 Complication:
1) Aspiration pneumonia
2) Injury to the esophagus
3) Necrosis of the esophagus.
 Contraindication:
1) variceal bleeding stops or slows
2) Recent surgery that involved the esophagogastric junction
3) Known esophageal stricture.
4) Head injury

2- T- tube :
 Uses:
1. Exploration of the gall bladder
2. Decompression of common bile
duct.
 Complication:
1. Displacement
2. Obstruction
3. Infection( peritonitis,
pancreatitis)

By: Emtenan AlSahafi

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3-Nasogastric tube:
 Uses:
1) Aspiration of gastric
content.
2) Preparation of upper
endoscopy.
3) Gastric feeding.
4) Gastric lavage.
5) Decompression in case of
intestinal obstruction.
 Complication:
1. Local injury and trauma of the nose.
2. Sinusitis.
3. Destruction of nasal ala and necrosis.
4. Tracheal intubation  pt cyanosed and sever cough.
5. Erosion of esophagus  esophagitis.
6. Reflux esophagitis because of non functioning sphincter.
 Contraindication:
1) Facial trauma.
2) Base skull fracture ( sign : raccoon eye , bruising behind the ear )
3) Altered mental status
4) Impaired airway.
5) Esophageal abnormality.

4-Wound drainage system:

 Uses:
Closed system with or
without suction of fluid
and blood at the site of
wound postoperatively.

By: Emtenan AlSahafi

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  Indication :
1. Intra peritoneal without suction to not cause an obstruction
Ex. Abdominal surgery
2. Extra-peritoneal with suction : thyroidectomy
Complication:
1) Infection
2) Pressure necrosis of adjacent tissues
3) Blockade by coagulated blood within the tube.

5-Foley catheter:
 Uses:
1. In comatose patient.
2. Monitor urine output.
3. Drain bladder.
4. Measurement of the hydration,
trauma, or shock.
5. Obstruction.
6. Benign prostatic hypertrophy.
7. Incontinences.
 Complication:
1) Rupture of the urethra due to Increase Inflation.
2) UTI (Candida more common long term infection).
3) Bleeding secondary to trauma.
 Contraindication:
1. Hematuria.
2. Scrotal hematoma.
3. High riding prostate.
4. Pelvic trauma. (we use supra-pubic catheter)

By: Emtenan AlSahafi

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 Station two: Dr.Bassim
1-Chest tube:
 Uses:
Drainage of fluid including blood,
pus, water or air.
 Site:
Ant.Axilary line in the 5th
intercostal space above the rib
under sedation or local anesthesia
in sterile condition
 Proper position:
 Drainage of fluid : basal
 Drainage of air : Ant.Sup
 Obtain a chest radiograph, like the one below, to ensure correct
placement of the chest tube.
 Complication:
1. Infection
2. Penetration (lung, liver, diaphragm, spleen, heart or aorta)
3. Pulmonary edema.
4. Hemorrhage.(most common , penetration of intercostal vesslse)
5. Blockage  not functioning.
 Contraindication:
1. Refractory coagulopathy.
2. Lack of cooperation by the patient.
3. Diaphragmatic hernia.
4. scarring in the pleural space

By: Emtenan AlSahafi

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2-Central venous line:
 Uses:
1. Monitoring of venous pressure
(Hemodynamic).
2. Long-term Intravenous antibiotics.
3. Long-term Parenteral nutrition especially in
chronically ill patient
4. Long-term pain medications
5. IV vasopressin.
6. Chemotherapy (permcath)
7. Fluid resuscitation (cordis central line)
 Site:
A - Internal Jugular vein (Lateral to carotid
artery), subclavian vein, Femoral vein.
B- Peripherally inserted central catheter (PICC): central venous
catheter inserted into a biracial vein in the arm.
 Complication:
1) Pneumonia
2) Hemorrhage
3) Arrhythmia.
4) Air embolism.
5) Infection ( common )
 Contraindications:
1) Infection over the insertion site
2) Suspected injury to the superior vena cava
3) Coagulopathies including anticoagulation therapy (Relative
Contraindications )
4) Pneumothorax or hemothorax on the contralateral side
5) Uncooperative patients
6) Morbid obesity
7) Children less than 2 years (higher complication rates)
8) Fracture or suspected fracture of ipsilateral upper ribs or clavicle

By: Emtenan AlSahafi

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3-Fluid:
 Types of replacement fluids:
1- Colloid: including Starch , Albumin and
blood.
2- Crystalloid: including Normal
Saline(NS), Ringer's Lactate(LR) and D5
normal saline.
Normal saline: Isotonic, PH:6.5 , contain Na & cl.
Ringer's Lactate: PH: 5.5 , contain : Lactic acid , Cl, Na ,K ,Ca

Station three: Dr. Mazin

1-Oral Airway:
 Uses:
1. Suction purpose.
2. Breathing.
3. Prevention of teeth clenching .
 Complication:
Usually, NO complication

2-Laryngoscope:
 Uses:
1. Helps in intubation.
2. Detects causes of voice p problems.
3. Detects causes of throat and ear pain.
4. Detects strictures or injury to the throat, or
obstructive masses in the airway.
5. Evaluates difficulty in swallowing.
 Complication: Break teeth.

By: Emtenan AlSahafi

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  Contraindication:
1) Anticipated difficult intubation due to multiple anatomic features .
2) Severe limitation of mouth opening
3) Unstable cervical spine or unstable atlanto-occipital joint.
4) Major trauma, abnormal anatomy, or tumor of the mandible, maxilla,
larynx, neck, mediastinum, or trachea
5) History of extensive radiation therapy of the airway with a fixed
larynx

3-Laryngeal Mask Airway

(LMA):
 Uses : Conduit for intubation
1) The LMA can be used as a
conduit for intubation,
particularly when direct
laryngoscopy is unsuccessful.
2) An ETT can be passed directly
through the LMA or ILMA.
Intubation may also be assisted
by a bougie or fiberoptic
scope.
 Contraindication
 Absolute contraindications (in all settings, including emergent)
1. Cannot open mouth
2. Complete upper airway obstruction
 Relative contraindications (in the elective setting)
1) Increased risk of aspiration :
 Prolonged bag-valve-mask ventilation
 Morbid obesity
 Second or third trimester pregnancy
 Patients who have not fasted before ventilation
 Upper gastrointestinal bleed
2) Suspected or known abnormalities in supraglottic anatomy
By: Emtenan AlSahafi
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4-Endotracheal tube:

 USES:
1. Anesthesia (general anesthesia)
2. Comatose pt in ER (GCS 8 or less)
3. Contusion of the lung, paradoxical
movement of the lung due to
multiple rib fracture.
 complication:
1. Infection
2. Tracheal necrosis
3. Displacement (during movement of the pt), therefore it cause collapse.
 Contraindication
3) Obstruction of the upper airway due to foreign objects
4) Cervical fractures
5) Mandibular fractures
6) Esophageal disease
7) Laryngeal edema
8) Thermal or chemical burns

5- Oxygen Mask and its types:

A ) A nasal cannula consists of a
flexible tube that is placed under the
nose. The tube includes two prongs
that go inside the nostrils. A nasal
cannula delivers oxygen
concentrations of 22% to 50% with
flow rates from 1 to 6 L/min
through the cannula
 Used : to deliver low levels of oxygen to the patient
 Complication: nasal dryness

By: Emtenan AlSahafi

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 B) A face mask that covers the nose
and mouth :
1- simple face mask :
Uses :To deliver oxygen
concentrations of 40% to
60% with flow rates from 6
to 10 L/min
2- Nonrebreather face mask:
Uses :A nonrebreather mask with reservoir bag
allows a higher FiO2 to be administered. It can
deliver oxygen concentrations of 60% to 95%
with flow rates from 10 to 15 L/min. When using
a nonrebreather mask, do not allow the reservoir
bag to deflate. If it does deflate, the patient is
likely to breathe in large amounts of exhaled
carbon dioxide.

- Tracheostomy tube:
 USES:
1. Upper airway obstruction
2. Maxillofacial injuries.
3. large tumors of the head and
neck
4. acute inflammation of head and
neck
5. Surgery to the head and neck.
6. In patient with risk of aspiration.
7. In patient need for long term mechanical ventilation.
 COMPLICATION:
Early :
1) Pneumothorax.
2) Hemorrhage.
3) Subcutaneous emphysema.

By: Emtenan AlSahafi

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 Intermediate:
1. Erosion of brachiocephalic artery.
2. Infection
Late:
1. Stenosis.
2. Collapse of tracheal ring.
 Contraindication:
No absolute contraindication.

-Proctoscope:
 Uses: : to inspect the rectum and lower colon
a) Diagnostic:
1) Bleeding per rectum
2) Hemorrhoids
3) Anal &rectal polyps
4) Carcinoma of the anal canal & rectum
5) Anal canal and rectal injuries
6) Fistula in ano
b) Therapeutic:
1. Band ligation of hemorrhoids
2. Cryo hemorrhoid therapy
3. Polypectomy
4. Laser and infrared-coagulation of hemorrhoids
 Complication: Usually, NO complication
 Contraindication:
The procedure may not be performed without anaesthesia in painful
conditions of the anal canal.

By: Emtenan AlSahafi

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-Fogarty catheter:
 Uses:
a type of balloon-tip catheter used to remove thrombi and emboli from blood
vessels “arterial embeloctomy”

 Complication:
1) intimal lesions, which can lead to
another thrombosis.
2) Dissection or rupture of the vessels
3) Causing cholesterol embolism from
atherosclerotic plaques

By: Emtenan AlSahafi

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