Surgical Bed Side Procedure New 2017 2018

BED SIDE
PROCEDURES
Dr. Hiwa Omer Ahmed
Professor in Metabolic and Bariatric Surgery
Tuesday,
November 27,
2018
surgery
2
Not like any other branch of medicine
Diseases
Accidents
Advice
Drugs
operations
Tuesday, November 27, 2018

Operations
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Bedside procedures
Operative room procedures
To help patients either with

Diseases
Or
Accidents

Bedside procedures
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To help deficient function of that

System
To do the function of affected system
To correct the abnormal state physiology and

anatomy

General precautions
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Check indication
Check the file
Check the patient
Inform consent
Check equipments

Fundaments
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Introduce your self
Tell the patient what you are going to do
Put the patient in suitable

position
Do suitable exposure

Procedure
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Anesthesia
Disinfection
Steps of the procedure
Completion of the procedure
Post_procedure
Instructions
managements

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ABCDEF
Specially in emergency surgical
conditions , the care of the
patient must be organized.
This simply expressed as
ABCDEF

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1. A:
AIRWAY
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Endo-Tracheal Entubation
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ET
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TRACHEOSTOMY

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Airway
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TRACHEOSTOMY

Definition
Tracheostomy is an operative procedure that creates a
surgical airway in the cervical trachea

INDICATIONS
1. To bypass obstruction
2. Neck trauma
3. Subcutaneous emphysema
4. Palpable fractures (eg, mid-face, hyoid, thyroid,
cricoid, mandible, midface)
5.Tumor
6.Bilateral vocal cord paralysis
7. Edema
*Trauma
*Burns
*Infection
22 *Anaphylaxis Tuesday, November 27, 2018
* Indicated to provide a long-term route for
mechanical ventilation in cases of respiratory failure
(not enough oxygen in)
* To provide pulmonary toilet

Inadequate cough due to chronic pain or weakness
,aspiration and the inability to handle secretions.
* Prophylaxis (as preparation for extensive head and

neck procedures and the convalescent period)

COMLICATIONS
* Airway obstruction and aspiration of secretions
(rare).
* Bleeding.
* Damage to the Larynx
* Infection
* Air trapping in the surrounding tissues or chest. In
rare situations, a chest tube may be required
* Scarring of the airway or erosion of the tube into the
surrounding structures (rare).
*Impaired swallowing and vocal function
* Scarring of the neck

Cricothyroidotomy

cricothyroidotomy
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27

28

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Indications
* Intubation is not possible via the oral or nasal route
* Need to avoid neck manipulation
(e.g. basal skull /cervical spine injury or fracture)
* Severe maxillofacial trauma
* Oedema of throat tissues preventing visualisation
of the cords
(e.g. angioneurotic oedema, anaphylaxis, burns,
smoke inhalation)

*Severe oropharyngeal
/tracheobronchial haemorrhage
* Foreign body in upper airway
* Lack of equipment for endotracheal intubation
* Technical failure of intubation
* Severe trismus/clenched teeth
*Masseter spasm after succinylcholine

Compared to an emergency tracheostomy,
1. quicker
2. asier to perform
3. associated with fewer complications.
There are three techniques:

* Needle
* Intubation (with purpose-built kits)
* Surgical

Contraindications
1. availability of a less invasive means of securing
the airway
2. Patients <5 years old (needle technique may be
used but formal tracheostomy is preferred)
3. Laryngeal fracture
4. Pre-existing or acute laryngeal pathology
4. Tracheal transection with retraction of trachea into
mediastinum
5. Anatomical landmarks obscured by gross
haemorrhage/surgical emphysema etc.

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2.B;
Breathing
central
local Tuesday, November 27, 2018
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CXR; Pneumothorax
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CXR; Haemothorax
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Chest wall injuries
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CT Insertion

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3. C
Circulation
Circulation
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Bleeding
Dehydration
Starvation
Malnutrition

IV line
Optimal
On the non dominant arm
Away from joint
In straight vein
Away from burn, infection
Better in upper limb
IV canulla
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IV infusion set
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Scalp vein canullation
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UV cannulation
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Peripheral iv central cannula
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CVP line
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central lines

1.Measurement of CVP
2. to deliver larger volumes of irritating solutions, such as
antibiotics, blood products, parenteral nutrition media,
and sclerosing chemotherapeutic agents.
3.If patients need prolonged IV access,
4.when peripheral access cannot be achieved;
however, in an emergency situation, an intraosseous

needle is probably the primary choice according to
Pediatric Advanced Life Support (PALS) guidelines.

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VENOUS CUT DOWN

Introduction
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Venous cut down is an emergency procedure that is

potentially life saving.
It is taught in the ATLS (Advanced Trauma Life
Support) course, and might often need to be
performed by the inexperienced in severely ill trauma
patients. It is one of the few modern
surgical procedures in which speed is a crucial factor
due to the presence of hypovolemic shock.
An important drawback is the difficulty in
cannulation of the vein. We describe simple
modifications in the conventional technique that make
the procedure safer and faster.
CONTRAINDICATIONS
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Coagulopathy or bleeding diathesis

Vein thrombosis
Overlying cellulitis

65

The great saphenous vein at the ankle is commonly
used for the procedure; although other sites are also
66 available. After isolation of the vein in the usual
manner, a loop of thread is passed under the vein
as shown below
The apex of the loop is then divided.

67

68
Then Suture the skin

Secure the catheter
Dress the wound
The complications of venous cut
69
down
are
Cellulitis
haematoma
phlebitis
perforation of the posterior wall of the vein
venous thrombosis and nerve and arterial

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Peripheral intravenous central

catheters

Although the lines are placed
peripherally, usually in the antecubital or
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superficial saphenous vein, the distal tip
remains in a large central vein.
PICC lines are indicated in children who

require intermediate-term IV access for
prolonged home or hospital therapy,
, PICC placement should be attempted as

soon as the need for intermediate-term
access is apparent.
72
Umbilical artery
catheters and umbilical
vein catheters

73 Useful in the first few days of life.
The umbilical vein can be used for access
during the first 5-7 days but is rarely used
beyond 7 days.
Both and UACs and UVCs can be used: UAC
is used for blood pressure monitoring, and
UVC is used for central venous pressure
monitoring.

74
DF
D:
To diagnose dysfunction of kidney
Circulation
Treatment as rehydration
F:
To follow up the function of organs
To find the cause of a feature
Urinary Catheterization

Introduction
The ability to insert a urinary catheter is an essential skill
in medicine.
Catheters are sized in units called French, where one

French equals 1/3 of 1 mm. Catheters vary from 12
(small) FR to 48 (large) FR (3-16mm) in size.
They also come in different varieties including ones

without a bladder balloon, and ones with different
sized balloons - you should check how much the
balloon is made to hold when inflating the balloon
with water!
Universal precautions
Gloves must be worn while starting the Foley, not only to
protect the user, but also to prevent infection in the
patient. Trauma protocol calls for all team members to
wear gloves, face and eye protection and gowns.
INDICATIONS
•Dx
Sampling of urine
Filling before US
Cysto,urethrograms
Urine collection, critical

Short Term Therapeutic
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pelvic operations
acute urinary retention
instillation of drugs
short term diversion

80 Long term Therapeutics
unressectable Ca bladder
Neurogenic Bladder
prolonged urinary toilet
patient preference after failure of Mx, Sx

Contraindications
Foley catheters are contraindicated in the presence of
*urethral trauma.

Removal of a catheter
* early in the morning so that if micturition
Procedures;
1.attach a syringe to the orifice to the balloon and
draw back on the plunger to suck out the water or
saline in the balloon and then gently pull the
catheter out.

If the balloon will not empty
2.try being more gentle with traction on the plunger

of the syringe as excessive pressure may have
collapsed the tube so that water will not flow.
3. Try instilling another 1 or 2 ml of water to unblock

any adhesions.
4.Try wiggling and rotating the catheter whilst pulling

the plunger.
4.Cut the catheter a little way outside the urethra. It

may be necessary to insert a safety pin through it
5.If the balloon remains rigid, it may be possible to
locate and puncture is by digital examination and
use of a prostatic biopsy needle.
6. It may be possible to overinflate the balloon and

burst it. If this is done is should be followed by
cystoscopy as to ascertain that no pieces are left in
the bladder.
Ether should not be used. Ether is very irritant to the

bladder. The boiling point of diethyl ether is 34.6º.
Therefore, when it is brought up to body
temperature it boils with an enormous expansion
and increase in pressure. causes an explosion

Complications
The main complications are

* tissue trauma
* infection.
The alternatives to urethral catheterization include

suprapubic catheterization and external condom
catheters for longer durations.

Condom catheter
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NG TUBE

1. DIAGNOSTC
* to drain gastric contents
*assessment of GI bleeding
*obtain a specimen of the gastric contents
*decompress the stomach
*Administration of radiographic contrast to the GI
tract

2. THERAPUTIC
* Administration of medication
Drainage
* lavage in drug overdosage or poisoning.
* In trauma settings, NG tubes can be used to aid in
the prevention of vomiting and aspiration
* MANAGEMENT of GI bleeding.
* NG tubes can also be used for enteral feeding
initially.
* Comatose patients have the potential of vomiting

during a NG insertion procedure, thus require
protection of the airway prior to placing a NG tube
* GASTRIC Irrigation before operation

CONTRAINDICATONS
Absolute contraindications
Severe midface trauma
Recent nasal surgery
Relative contraindications
Coagulation abnormality
Esophageal varices or stricture
Recent banding or cautery of esophageal varices

Alkaline ingestion
During insertion
ask the patient to speak. If the patient is able to speak,
then the nasogastric tube has not passed through the
vocal cords and/or lungs.
The nasogastric tube may coil in the nasopharynx or

oropharynx. If this occurs, or if the tube is difficult to
pass in general, try curling the distal end and
partially freezing it in a cup of ice so it temporarily
holds its curled shape better.
Another option (only in patients who are paralyzed) is to

place 2-3 fingers through the patient’s mouth into the
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oropharynx. Tuesday, November 27, 2018
Before removal kink the
tube

PERITONIAL LAVAGE

INDICATIONS
Blunt trauma to the abdomen is a major component of
traumatic injury and can be deadly.
Blunt trauma can occur during falls, motor vehicle
accidents, or severe blows to the abdomen

Often it is difficult to determine if an intra-abdominal
injury has occurred in a blunt trauma victim.
In many cases, the decision about when to perform an
exploratory laparotomy surgery is not straightforward.
The procedure used to determine whether blunt trauma
victims require surgery is diagnostic peritoneal lavage (DPL).
Using local anesthesia, the surgeon makes a small incision in
the abdomen just below the umbilicus.

A catheter is introduced through the incision into the
abdomen. Saline is infused into the abdomen
through the catheter, and then removed. If blood is
present in the saline after removal, it is highly
probable that there is a serious intra-abdominal
injury.

Newspaper method
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Positive DPL
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 Food particles
 Bile
 Bacteria
 feces
 RCB more than 100000/cmm
 WBC more than 500/cmm
 Amylase more than 175IU/L

FNAC

Expanded FNAC
 flow cytometry,
 immunohistochemistry

Needle types 25-18

New; pistol with needle

Slides

Originally for breast masses

NOW from skin to deepest viscera

Thyroid

Intra-buccal lesions

Tongue lesions

 PROCEDURE
This technique uses a thin
needle to obtain a sample
of cells from an
abnormality such as a
lump

Procedure conti.
 FNA was performed using a 10-20 cm3 disposable
syringe attached to a 22-gauge needle. The needle
was allowed to move back and forth into different
parts of the tumour site several times before
withdrawal.

FIXATION & STAINING
The two different methods of staining

and fixation are,
1.air dried MGG stains
2.wet fixed Pap smears
FNAC + US

FNAC + CT

FpNAC + MRI

Friable tumors & cysts

RESULTS
1. Traumatic
2. Pus
3. Reactive hyperplasia
4. Lymphocytosis
5. Lymphoblast
6. Sq.C.C.
7. Adenocarcinoma

118
F
As part of follow up you see the patient in
time to check and remove the sutures
Nose 3 days
Face and scalp 5 days
Abdomen 7 days
Lower limb, back 10 days

Removal of sutures

Surgical Bed Side Procedure New 2017 2018

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BED SIDE

Professor in Metabolic and Bariatric Surgery

Not like any other branch of medicine

Tuesday, November 27, 2018

Operative room procedures

To help patients either with

Tuesday, November 27, 2018

To help deficient function of that

To do the function of affected system

To correct the abnormal state physiology and

Tuesday, November 27, 2018

Tuesday, November 27, 2018

Introduce your self

Tell the patient what you are going to do

Put the patient in suitable

Tuesday, November 27, 2018

Tuesday, November 27, 2018

Tuesday, November 27, 2018

Tuesday, November 27, 2018

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* To provide pulmonary toilet

* Prophylaxis (as preparation for extensive head and

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There are three techniques:

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