Common surgical

procedures:cvp,chest
tube,spc,banding
Muhammad aniq bin anhar
1)cvp
 Central venous line is a
special IV line inserted into
large vein in the body
definition
Central venous pressure
reflects arterial
pressure ,similar to
measuring jvp clinically
Indications
• Monitoring of the central venous pressure
• Major procedure involving large shift of fluid/loss
• Long term medications
• Parenteral nutrition
• Need for frequent intravenous access
• Dialysis
• Poor peripheral venous access
 Infection at site of insertion

contraindications Coagulopathies

Newly inserted pacemaker wires

 • Wash hands
• Prepare iv flush
• Prepare pressure tubing
• Monitor patient
procedure • Obtain appropriate equipment
• 15-25 degree position
• Flush ports
• Obtain cxr post procedure
 Arterial puncture with hematoma

A-V fistula
Complications
of central Hemothorax,pneumothorax
venous
cannulation Air embolism

Catheter/wire shearing
Complications of
cathether presence

• Thrombosis/thromboembolism
• Infection,sepsis,thromboembolism
• Arrtyhmias
• hydrothorax
2)Chest tube
• Indication
• contraindication
• Equipments
• Preparation
• complication
definition
• Insertion of tube into pleural cavity to drain:
-air,blood,bile,pus
indication
indication contraindication
pneumothorax coagulopathy
hemothorax Pulmonary/pleural adhesions
Pleural effusion Skin infection over sites
pleurodesis Pulmonary bullae
equipments
• Chest tube drainage device with water seals
• Chest tube with appropriate size
• Suction source and tubing
• Sterile gloves
• Lidocaine(analgesics)
• Syringes
• Needles,blades,sutures
• Pneumothorax set
 Site of insertion

• For pneumothorax
-mostly at 4th and 5th
intercostal space in the
anterior or midaxillary lines
positioning
 steps

• Local anaesthesia,confirm location

• Skin incision with selected blades
• Dissect into pleural cavity through subcutaneous tunnel using medium sized Kelly’s clamps
• Locate pleural cavity-use your finger for digital exploration
• Add more analgesics
• Use large Kelly clamps to open spaces
 steps

• Measure the distance between apex of lung and incisions

• Using Kelly clamps as a guide,Insert tube posteriorly and laterally
• Both distal end of chest tube should be clamped first before chest tube inserted into
pleural space
• Close incision wound,fixed the tube
• Connect tube to underwater sealed bottle
• Securing sutures:
-using simple interrupted stitches on each side of chest tube

Advantages:
-tight closure of skin incision
-Prevents dislodge
 • Drainage decreased to little or none
• The air leak has disappeared

Indication of • The patient is breathing normally without

respiratory distress
removal of • Breath sounds are at baseline

chest tube • Fluctuations in the water seal chamber have

stopped
• Chest x-ray shows lung reexpansion with no
residual air or fluid in the pleural space
spc
 • A form of urinary diversion,in which a
self retaining catheter is placed into the
definition bladder via the suprapubic region via
the suprapubic region for purpose of
draining the urine
 Failed urethral catheterizations

Ruptured urethra

Urethero-cutaneous fistula
indications
Periurethral abscess

Chronic retention in neurogenic bladder

steps
• Prepares the bladder area with iodine and cleaning solutions
• Locate bladder gently
• Use local anesthesia
• Make incisions
• Pull catheter until the tip is right below cannula leval
• Insert cystofix
• Removes outer side
• Insert foley catheter
• Inflates balloon
• Stitch area
• Dressing with gauze
 Surrounding
Hematuria
organ injury

Catheter
complications blockage
Dislodgement

infection
Spc care at home
Clean area around catheter with
soap and water at least one-
Wash your hands before you
time every day. Wash area with
handle the catheter
soap and water after every
bowel movement

Keep drainage bag lower than Empty drainage bag when its is
your bladder full or at least every 8 hours
 • Done every 4-10 weeks
• Occur on:
When should -individual scheduled basis
it be changed? -as needed for signs of degradation,balloon
breakage,malfunction,bypassing of urine or
irreversible blockage
banding
• Hemorrhoid banding,treatment method for hemorrhoids that don’t
respond to home treatment

• Minimally invasive technique

• Not for grade 4 hemorrhoids

 components
-rubber band
-banding set
-anoscope
 Inability to
risks Infection Bleeding
pass urine
procedure
• Anoscope inserted into anus
• Hemorrhoid grasped with instrument
• The devices places rubber band around base of hemorrhoids
• -hemorrhoid will fall around one week time by itself