SURGERY

1. 3-way foley catheter(latex/silicon)

a) Parts and function of catheter:

 Bladder opening
 Balloon : inflated in the bladder to hold catheter in place
 Balloon port : to inflate and deflate balloon with fluid
 Urine drainage port: to drain urine from bladder
 Irrigation port: for medication or irrigation of normal saline
b) Size: the size is the diameter measure in French unit(Fr). Size ie 10Fr.
c) Indication /contraindication/complication
INDICATION CONTRAINDICATION COMPLICATION
Therapeutic:  Urethtral injury  Ascending
 Perioperative  Suspected urethral injury: infection
monitoring of u/o  Inability to void  Urethral
 Acute urinary retention  Unstable pelvic fracture trauma
 Incontinence  Blooad at meatus  Urethral
 Fluid management of  Scrotal hematoma stricture
patient  Perineal echymosses
 Irrigation of bladder  High riding postate
after surgery
 Also used as
gastrostomy tube
Diagnostic:
 Urine for culture
 Urodynamic studies
 Cystourethrography-
instilll contrast
retrogradely

2. Nasogastric tube

Salem sump
Levin tube(one lumen) tube(double lumen)

Levin tube Salem sump

 single lumen  double lumen,
 suction & feeding radiopaque
 1st lumen: suction of
gastric cintents
 2nd lumen: blue
extension(pig tail)
open to room air to
maintain continuous
flow of atmospheric
air into stomach
 suction
Measuring NG tube
insertion

a) Parts:
 Proximal end(outer)
 Distal end(inner)
b) Indication & contraindication &complication
INDICATION CONTRAINDICATION COMPLICATION
 Decompression of  Severe facial and  Epistaxis
stomach d/t neck fractures  Erosions in
IO,p.ileus,UGIB  Esophageal varices nasal cavity
 Analysis of gastric  Bleeding disorder and
content  hx of gastric by pass nasopharynx
 Drug surgeryknown  Esophageal
administration(fine esophageal stricture penetration
bore tube)  Intracranial
 Enteral feeding insertion
 aspiration
 c) how to know measure for insertion ?
 from tip of nose across cheekbone to tip of ear to bottom of
xiphisternum
 roughly 40cm from nose
d) how to check correct placement?
 Syringing the air down the tube while listening for bubbling over
epigastrium
 Aspirate from tube – using pH paper if tested pH <4 (only useful if
patient isn’t taking PPI/antacids) Aspirating gastric content turn
litmus blue to red
 CXR- in stomach below diaphgram

3. T-tube

a) Indication:
After removal of gallbladder(cholecystectomy) or a portion of bile
duct(choledochostomy)
b) Vertical limb (cross head) placed
in CBD while the horizontal limb
is connected to a bile bag
c) Time of removal: After 10 days
d) Therapeutic use:…………………

4. Sengstenken BlackmoreTube
 a) Indication: to control esophageal bleeding
b) complication :
 ischemic necrosis of esophageal mucosa
 aspiration pneumonia
c) function of each lumen:
 Esophageal balloon: inflate esophageal balloon
 Esophageal aspiration: aspirate saliva and prevent aspiration
pneumonia
 Gastric balloon: inflate gastric balloon
 Gastric aspiration: decompress the stomach content
d) How to inflate the balloon:
 Esophageal balloon: Connect to the BP set and inflate with pressure
30-40mmHg
 Gastric balloon: Inflate with 200 ml water for injection (give
approximately 60 mmHg pressure)
 Deflate esophageal balloon 8 minutes every 5 hours (reduce risk for
esophageal necrosis)
 Reduce pressure in esophageal balloon to 25mmHg by 12 hours
 Do not left the tube for more than 24 hours.

5. STOMA

Loop ileostomy

End ileostomy
Loop colostomy
 a) DEFINITION:surgical procedure that involves connecting part of bowel
onto the anterior abdominal cavity
b) Examination of stoma:
 Site
 Caliber:twin/wide
 Number of lumens
 Functionaing/healthy
 Color/surface
c) Stoma
RUQ:
- Defunctioning transverse
colostomy: two lumens but not
spouted, flushed to skin
instead.
RLQ:
- Usually spouted. Small bowel
contents are irritant: stands
clear of skin
- End ileostomy: after total
colectomy
- Loop ileostomy: temporary
defunctioning
d) Complications:
METABOLIC
Renal calculi
Electrolyte imbalance
 Bag: contents,
surrounding skin
 Any parastomal hernia
 Inspect perineum
LUQ:not usually, but if so, for same reasons as
LLQ:
- End colostomy
- Double-barrelled
- Loop
LLQ:
- End colostomy: resection of
rectum/sigmoid/Hartman’s/AP
resection
- Double-barrelled: after procedure if
unsafe to join but distal end long
enough to be brought to surface
- Loop: apex of sigmoid brought to
surface
ANATOMICAL
Parastormal hernia
Prolapse ileostomies
Parastormal deformities