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CPSS: Chest Tubes and Arthrocentesis
Summer II 2011
36
Medical
Graduate
06/20/2011

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Cards

Term
What are the indications for a chest tube placement?
Definition
Drainage of hemothorax or large pleural effusions
Drainage of large pneumothorax
Prophylactic tx of pt with chest trauma
Flail chest segment or severe pulmonary contusion
Term
What are the contraindications for a chest tube placement?
Definition
Infection over insertion site
Uncontrolled bleeding
Term
Size of chest tube for adult or teen male?
Definition
28 - 32 Fr
Term
Size of chest tube for adult or teen female?
Definition
28 Fr
Term
Size of chest tube for a child?
Definition
18 fr
Term
Size of chest tube for a newborn?
Definition
12 - 14 Fr
Term
What should you obtain before a chest tube placement?
Definition
Informed consent, pre-procedure x-ray
Term
Where is the skin incision with a chest tube made?
Definition
midaxillary and anterior axillary lines over a rib that is below the intercostal level selected for chest tube insertion (fifth intercostal space - nipple line!!)
Term
Where does the intercostal vessels and nerve path run in the chest? How does this affect the chest tube placement?
Definition
Inferior portion of the ribs; Place chest tube on anterior portion of rib
Term
What areas need to be numbed?
Definition
Infiltrate skin, muscle tissues, and right down to pleura
Term
What blade size do you use to make an incision for a chest tube? How long should the incision be?
Definition
10 blade (or 11); 4 cm long overlying the rib
Term
What tool should be used to bluntly dissect a tract in the subcutaneous tissue by intermittently advancing the closed instrument and opening it? How far do you carry this blunt dissection to?
Definition
Kelly Clamp; continue until intercostal muscle is reached
Term
After tract is made with a Kelly clamp, what should you do? Why?
Definition
Palpate the tract with a finger; make sure that the tract ends at the upper border of the rib above the skin incision
Term
What can indicate 'entry into pleural space'?
Definition
rush of air or fluid should occur
Term
Once the tract is made all the way into the pleural space, what should be done? Why?
Definition
Use a sterile, gloved finger to appreciate the size of the tract and to feel for lung tissue and possible adhesions
Term
When advancing the chest tube, what direction should it be advanced in?
Definition
continue to advance the chest tube posteriorly and superiorly
Term
Before securing the chest tube in place, what should you look for? Why?
Definition
look for a respiration-related swing in the fluid level of the water seal device to confirm correct intrathoracic placement
Term
What type of suture material should be used to secure the chest tube? What type of stitch should be used?
Definition
0 or 1-0 silk or nylon suture is used to secure the chest tube to the skin, central vertical mattress stitch with ends left long and knotted together can be placed to allow for sealing of the tract once the chest tube is removed.
Term
What gauze should be placed directly around chest tube and skin incision?
Definition
Petrolatum (Vaseline) gauze
Term
How should the emerging chest tube be secured? Why?
Definition
Strap the emerging chest tube on to the lower trunk with a "mesentry" fold of adhesive tape

avoids kinking of the tube as it passes through the chest wall. It also helps reduce wound site pain and discomfort for the patient
Term
How can you prevent puncturing the spleen or liver?
Definition
Make sure to insert between 5th and 4th ribs (nipple line
Term
What is the purpose of arthrocentesis?
Definition
Aspiration of a joint for diagnostic and/or therapeutic reasons
Term
What are the indications for arthrocentesis?
Definition
undiagnosed mono- or poly-arthritis with an effusion
suspected infection
suspected crystalline arthritis
joint effusion after trauma
Term
What are the contraindications of arthrocentesis?
Definition
Overlying cellulitis, wound, bacteremia
Suspected infected joints should not be given steroid injections
Neuropathic joint (Charcot joint)
Coagulopathies
Uncontrolled DM
Prosthetic joints
Inaccessible joints
Term
How many injections can be given in a year?
Definition
Max three
Term
What are the reasons for injecting a joint?
Definition
reduce inflammation
Term
What are the indications for injections?
Definition
Osteoarthritis
RA
Gouty arthritis
Synovitis
Bursitis
Tendonitis
Muscle Trigger points
Carpal Tunnel Syndrome
Term
What are the contraindications to injections?
Definition
Adjacent osteomyelitis
Bactaremia
Hemarthrosis
Impending joint replacement surgery
Infectious arthritis
Joint prosthesis
Osteochondral fx
Periarticular cellulitis
Poorly controlled DM
Uncontrolled bleeding d/o
Term
After a joint injection, how long should the pt avoid strenuous activity?
Definition
24 to 48 hrs
Term
What are the local SE of a joint injection?
Definition
pain, flushing, swelling
Term
At what location should you inject a knee?
Definition
Mark 1 fingerbreadth above + lateral to the superior-lateral of patella
Term
What are the rotator cuff muscles?
Definition
Supraspinatus
Infraspinatus
teres minor
Subscapularis
Term
What is the proper location for a glenohumeral injection?
Definition
sulcus between head of humerus and acromion
Term
What is the proper location for an AC joint injection?
Definition
At slight depression where clavicle meets acromion
Term
What is the proper location for a sub-acromial injection?
Definition
Insert inferior to acromion at lateral shoulder
Term
How effective is an elbow epicondyle injection?
Definition
very effective in the short-term, but does not last longer than 6 weeks
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