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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_848_Библиотеки_им_академика_М_И_Перельмана
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KEHR’S TTUBE
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Chapter 8: Tubes
43
alient Features
S
Available in sizes No. 12, 14, 16, 18
There is a short horizontal limb (inserted into common
bile duct) and a long vertical limb which is brought
outside the skin.
ses
U
Placed in CBD following choledocholithotomy
Placed in CBD following repair of bile duct injury
May be used as stent following repair of ureteric injury
Used as stent in choledocho–jejunostomy/choledocho-
duodenostomy anastomosis.
emoval
R
Perform a T-tube cholangiogram on 8-10th postoperative
day
If it is normal, T-tube is clamped overnight and removed
next day if patient has no problem (Usually no biliary leak
occurs due to contraction of brous tract).
44
Section 2: Non-Metallic Surgical Objects
FLATUS TUBE
alient Features
S
It is a stout, red rubber tube with a conical lower end
Lower end has an opening and the tip is rounded and
smooth
Additional side openings present
Other end of the tube is meant to pass atus and feces.
ses
U
To relieve gaseous distention of large bowel in post-
operative cases
To relieve sigmoid dilatation in cases of sigmoid volvulus.
ethod
M
Make the patient lie in left lateral position with knee on
chest position
Lubricate atus tube with lignocaine jelly and insert in
rectum for 5”-7” without forcing it.
Chapter 8: Tubes
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TRACHEOSTOMY TUBE
ese are the tubes that are inserted directly into trachea through a surgically created stoma in the neck region.
45
alient Features
S
Consists of an outer tube and an obturator (introducer)
Outer tube- has anges/wings to secure it in place
Obturator- has a smooth round tip which helps in the
introduction of outer tube into the trachea
Have a gentle curve
These tubes may be cued or uncued
Radiopaque blue line for X-ray visualization.
Soft low pressure cu dynamically adjusts the pressure
at the point of contact during the breathing cycle.
Thus minimize the risk of tracheal trauma and other
complications.
Pilot balloon with non-return valve facilitates the cu
ination and deation.
ses
U
For intermittent positive pressure ventilation
To provide a denitive airway in patients with
¾ Upper airway obstruction
¾ Major head injury with low GCS
¾ Oro-facio-maxillary injuries
¾ Impaired pharyngeal or laryngeal reexes.
ey Points
K
Dierence between cued and uncued tubes
Cued tube Uncued tube
Balloon like
structure
Used in Ventilated
Risk of aspiration Low High
Tracheal
complications
Present on the
outer tube
patients
Tracheal stenosis
Ulceration
Pressure necrosis
Absent
Non-ventilated
patients/children
Less common
46
Section 2: Non-Metallic Surgical Objects
TRANSURETHRAL RESECTION SET TUR SET
alient Features
S
“Y” shaped set for endoscopic irrigation
Has three thumb operated clamps
One end with exible latex tubing for easy connection to
endoscope
Other end has two spikes that insert into two dierent
irrigating solution.
ses
U
Used in various endoscopic surgeries like TURP (Trans-
urethral resection of prostate), URS (Ureteroscopic
retrieval of stone) to irrigate the endoscope for proper
vision.
Drains
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ABDOMINAL DRAIN KIT (ADK)
Chapter
9
alient Features
S
Soft and smooth catheter with large atraumatic eyes for
ecient drainage
Radiopaque line throughout its length
ADK bag has markings so as to calculate the output
Specially designed foldable handle on bag suitable for
bedside hanging.
ey Points
K
Drain is placed in most dependent spaces of peritoneal cavity in supine position namely Morrison’s pouch (Hepatorenal space) and
pelvis (Pelvic cavity).
ses
U
Specially designed for postoperative abdominal drainage
To drain pus in cases of perforation peritonitis, pyoperito-
neum, ruptured appendicular abscess especially if general
condition of the patient is low and surgery cannot be done
immediately.
48
Section 2: Non-Metallic Surgical Objects
ROMOVAC SUCTION DRAIN
alient Features
S
Has following parts
¾ Bellow unit with connector
¾ Connecting tube with clamp and “Y” connector
¾ Curved needle with matching catheter
¾ Spare perforated catheter.
ses
U
Most commonly used drains in surgeries where collection
is expected postoperatively like incisional hernia,
modied radical mastectomy, large lipomas
Minivac (smaller version of Romovac) is used to drain
collection after enucleation of broadenoma or large
lipomas.
dvantages
A
Contents can be measured
Minimal soakage around wound
Secondary infection less likely as it is a closed system
Can drain collections from non-dependent areas due to
negative suction pressure.
isadvantages
D
Expensive
Tubes can get blocked.
ey Points
K
Always place it in dependent position
Remove if not draining for at least 48 hours
Bring it out of skin by separate incision.
Chapter 9: Drains
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INTERCOSTAL CHEST DRAIN (ICD)
49
alient Features
S
Intercostal chest drains may be with or without trocars
Trocar made of steel with a pointed end for piercing
intercostal muscles and parietal pleura
Cannula made of plastic with large smooth drainage eyes
for ecient drainage
Markings provided at 5, 10, 15 and 20 cm from distal tip to
help ascertain depth of penetration
Proximal end tted with tapered connector for easy
connection to drainage bottle
Sizes available – FG 12, 16, 20, 24, 28 and 32.
ses
U
Used in following conditions:
¾ Pneumothorax
¾ Pleural eusion
¾ Hemothorax
¾ Empyema thoracis, etc.
omplications
C
Pain
Lung injury
Injury to intercostal nerves and vessels
Thoracic/abdominal viscera trauma.
50
Section 2: Non-Metallic Surgical Objects
CORRUGATED RUBBER DRAIN
alient Features
S
Has corrugations which provide passage for draining the
collections from desired sites.
ses
U
Placed in scrotum postoperatively in hydrocele surgery to
drain out collection
To drain blood, pus, bile, following some surgeries like
breast abscess, laparotomies, etc.
To preserve stitch lines by draining out collection from a
dierent site with the help of drain.
isadvantages
D
Contents cannot be measured
Can cause secondary infection
Can get blocked
Vacuum cannot be applied.
Drip SetS
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PEDIATRIC CHAMBER
Chapter
10
alient Features
S
Clear, soft, cylindrical and calibrated volume chamber
Chamber injection port allows medication to be injected
into the chamber
Chamber vent allows air to enter the chamber through
hydrophobic membrane
Available burette sizes- 110 ml, 150 ml
1 ml = 64 drops
Has Murphy’s chamber which can regulate number of
drops falling per minute.
ses
U
Especially used for neonates and infants where strict
regulation of IV uid administration is required.
52
Section 2: Non-Metallic Surgical Objects
INTRAVENOUS DRIP SET (IV DRIP SET)
alient Features
S
Precision moulded drip chamber with sharp spike for
smooth penetration
Smooth, exible, kink resistant tubing made of non-toxic
medical grade PVC granules
Sterilized with ETO gas
Single use, non-toxic, non-pyrogenic, and sterile
Available in three sizes – 10, 15, 20 gtt/ml (e.g. 10 gtt/ml
means 10 drops = 1 ml).
ses
U
Used for routine IV administration of uids/drugs.
PARTS
Spike/Pivot: Part that pierces the IV uid bottle.
Drip chamber: Prevents air from entering venous
circulation.
Fluid lter: To remove impurities in IV uid.
Infusion tubing: Connects drip chamber to injection
site.
Regulator: Regulates ow of uid to be administered
to the patient.
Injection site: Soft tubing near patient’s end.
Needle with its protector cap: To pierce the IV uid
bottle to prevent negative pressure inside the bottle.
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