TUBES

Nasogastric tube most often used ia Levine tube

Ryles tube

Identification points

·      The tube used most often has blunt end with multiple opening near the lower end which is closed.

·      The Ryles tube has a metal ball around which the tube is moulded. 

     This acts as weight for introducing the tube.

     The tube is made rubber (so that it becomes flexible) and also of transparent protex (because it may cause less irritation).

Marking of Ryles tube

The tube has four marks: mark 1when the tip enters the stomach (40 cm);
second mark 2 when the tip arches antrum (50cm);
mark 3 at 57 cm,  when it indicates the entry into the pylorus;
and mark 4 (at 65cm) indicates entry into the duodenum.

How is Ryles tube introduced?

The patient is asked to sit up. 

The tip is placed in the nose and fed in till it reaches pharynx and the patient is asked to swallow

till the tube reaches the desired mark.

Uses

·      Ryles tube is used to aspirate stomach juices in postoperative period.

·      It is also used to aspirate in cases of acute abdomen–intestinal obstruction, perforation, appendicular mass, acute cholecystitis and strangulated hernia.

·      It is also used in gastric acid-secretion tests.

·      Ryles tube is used in gastric feeding of unconscious patient.

·      It is used to perform gastric lavage.

·      It is also used to confirm the diagnosis of pernicious anaemia.

Stomach tube

Identification points

·      It is wide-bore rubber tube. 

    The tube end is rounded to allow introduction in the body without injury, the upper end has a funnel to allow pouring of lavage fluid.

·      Wash out occurs when this end is lower than the patient.

Uses

Stomach tube is used in the management of alcohol poisoning,

organophosphorus compound poisoning,

barbiturate poisoning and

opium or morphine poisoning.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com

Click on image to see detail

TUBES AND CATHETERS

TUBES, CATHETERS AND DRAINS

TUBES

Without endotracheal tubes, modern anaesthesia would be unthinkable. 

The traditional tubes of the Magill pattern are made of red mineralized rubber.

Except these, all have an inflatable cuff near the distal tip to protect the lower respiratory tract from soiling as well as providing an air-tight seal. 

Each number refers to the internal diameter of the tube in millimeters.

            These in the past have been made of rubber and recycled in practice by autoclaving. 

All these instruments and nasogastric tubes are now made of non-reactive plastic marerial and come pre-sterilized in packs. 

These tubes are all disposable and thus do not require recycling.

The tubes in use are:

·       Cuffed oral endotracheal tube

·       Uncuffed oral endotracheal tube

·       Negus tracheostomy tube

·       Chevalier-Jackson tracheostomy tube

Tracheostomy tube

Identification points of tracheostomy tube

·       It has the outer tube that is taped to the neek and always stays in the trachea.

·       An inner tube that can be taken out for cleaning.

·       An abdurator required at the time of introduction.

The Chevalier-Jakson inner tube case locked when in position.

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archiver for access and review.

Visitors that follow the site may contributions to the site.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

www.drmmkapur.blogspot.com

Click on image to see detail. 

METAL CLIPS AND STAPLERS

METAL CLIPS

Metal clips include Mitchell’s, Kifa metal clips and Cushing’s. First two are used for skin closure.

Cushings are used for vessal closure in brain surgery

Advantages of metal clips

· Apposition is better.

· Good cosmetic result is achieved.

· Less chances of infection as suture hole is not made.

Disadvantages

· It is more expensive.

· Metal clips require special instruments (applicator and extractor).

When should the clips be removed?

Clips should be removed usually at 6days, i.e. earlier than sutures ( usually removed after 8-10 days)

Staplers are being used in surgery for

Anastomosis(Colectomy-Gastrectomy)

Vessal stapling before cutting(splrnectomy adrenalectomy)

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow may post contributiond to the site.

To create consumer/provider engagement visit www.surgseminar.blogspot.com

http://bit.ly/cPTh6f

Click on image to see detail.

NEEDLES AND SUTURES

NEEDLES AND SUTURES

NEEDLES

Round-bodied needles

Used most often for suturing

Subcutaneous tissue

and muscle

All internal organs

Cutting

Cutting-edge needles have sharp edges commencing at the point

and prolonged along their shafts

to help them penetrate dense and tough tissues such as skin or tendon.

SUTURES

Absorbable

Catgut(plain) (98% collagen) suture for small vessals

Catgut(chromic) treated in cromic bath blood vessall ligation and internal organn

Polyglycolic acid Synthetic polymers uses similar to catgut

Nonabsorbable

Silk

Linen

Cotton

Synthetic nylon ethilon

Metal wire

 

Any questions be sent to drmmkapur@gmail.com

All older posts are stored in archives for access and review.

Visitors that follow can contributions to the site.

To create consumer/provider engagement visit

http://bit.ly/cPTh6f

www.surgseminar.blogspot.com

Click on image to see detail.

NEEDLE HOLDERS

NEEDLE HOLDERS

Needle holders are modified box joint-locking forceps designed to hold curved needles.

The surgeon should thus be able to manipulate the needle with ease during suturing.

Since the function of needle holders is to grasp needles,

The instruments look like artery forceps also it has additional features, which are as follows:

· Serration at the tips to prevent slipping of needle.

· Shafts with rings for thumb and fingers.

· Locking device.

Fine needle holders are damaged by large needles,

and small needles are damaged by large needle holders.

Te varieties in use are as follows:

· Mayo needle holder

· Gillies needle holder

· Naughton-Morgan needle holder

· Kilner needle holder

· Mayo-Hegar needle holder

Micro vascular needle holder

Identification

· They have shorter blades as compared to a haemostatic forceps.

· Blades are serrated in both directions to enable a firm grip on needle.

· There is a catch for long-term holding.

· The blade can be straight or curved.

Needle holders are commonly used in surgery to hold a needle with its suture.

Where to hold the needle with a needle holder?

· Just behind its mid point, which gives maximum advantage in curving action.

 

Any questions be sent to drmmkapur@gmail.com

All older post are stored in archives for access and review.

To create consumer//provider engagement visit www.surgseminar.blogspot.com 

http://bit.ly/cPTh6f

Click on image to see detail

 

CRUSHING CLAMPS

Crushing clamps

When is GI re-section required?

Re-section of bowel is required in cases of gangrene of the bowel (which may be caused by strangulation, thrombosis) or cancer.

The special instruments required are

·       Crushing clamps

·       Non-crushing clamps.

Crushing clamps

Crushing clamps are generally used with an objective to crush the muscle coat of the bowel thus obliterating the vascular supply.

These crushing clamps thus have

·       Blades that are heavy and strong

·       Blades of parker-Kerr are curved and of Lang-Stevenson are straight

·       Loops for finger

·       A catch for gradual crushing.

Identification points

·       The instrument is heavy.

·       The jaws appose closely.

·       These occlude lumen and vessels.

·       These are used on the segment that is removed from the body.

These clamps are of three types:

(a)    Payr’s smaller crushing clamp

(b)   Payr’s smaller clamps

(c)    Parker-Kerr’s crushing clamps.

Identification points

·       Payr’s gastric crushing clamps have heavy blades and handle.

·       The joints are 4 and these double the force of action of the blades.

·       The jaws have longitudinal serrations.

·       The jaws are long so as to reach from lesser to greater curvature of stomach.

Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review.
Visitors that follow may post contributions to the site.
To create consumer/provider engagement visit www.surgseminar.blogspot.com
http://bit.ly/cPTh6f
Click on image to see detail.

GASTRIC AND INTESTINAL CLAMPS

INTESTINAL CLAMPS

These clamps are large tissue forceps with the primary function of occluding the bowel lumen

These non crushing clamps cause no permanent damage to the bowel

They when applied prevent spillage of bowel content during surgery.

They also occlude the blood vassals,and no bleeding occurs.

Manipulation of the bowel is easy and anastomosis of bowe is possible/

The varieties in use are:

Doyans

Kockers

Lane

Lane twin anastomosis clamp

Any questions be sent to drmmkapur@gmail.com

All earlier posts are stored in archives for access and review.

Visitors that follow may post contributions to the site.

To introduce consumer/provider engagement visit www.surgseminar.blogspot.com

http://bit.ly/cPTh6f

Click on image tosee detail