Toplam Sayfa Görüntüleme Sayısı

28 Ekim 2014 Salı





This is a technique that consists in evacuating liquids and gasses intra thoracic and pleural . The drain connects the pleural cavity to a single jar ( siphonages ) or with a continuous extraction system


- Spontaneous Pneumothorax
- Purulent pleurisy
- Hemothorax
- Nécrotomie superinfected


The establishment of a chest tube designed to:
- Evacuate gas or Fluid thoracic effusions
- Perform chest washes continuously in case of empyema and pneumonia


- Drain implemented by a metal trocar MONALDI which introduces light into the pleural
  drains fine gauge which tend to clog quickly blood clots
- Trocar MONALDI
- Drains JOLLY disposable
- Sterile equipment: * sterile gauze
                             * Clamp to serve
- Antiseptics
- Sterile gloves
- Plaster
- Scissors
- Field pierced
- Local anesthetics ( Xylocaine 2% )
- Sterile syringe needle +
- Box of minor surgery
- Jar sterile graduated 3l containing an antiseptic
- Closing the jar cap crossed by two pipes in a plunging antiseptic , the other in connection with the
   Suction system
- Sterile tubing


- Explain the patient care
- Put in proper position : supine torso raised , link bars behind the head


- Make available the intubation equipment and emergency drugs
- Preparation of the suction device : * fill with saline
                                                                    * Connect with the suction source
                                                                    * Verification of operation
                                                                    * Ensure the connection with the drain pipe connected to the
                                                                       Suction system
- Sanitize the puncture
- Put a bandage and secure with tape elbows in the suction pipe
- Changing the drain suction sterile device


- Check the suction device
- Findings of the liquid and suction volume
- Take stock of outputs


- Drain Output
- Moving the drain ( emphysema s / c)
- Compressive pneumothorax
- Bleeding intercostal vascular or pulmonary
- Lung Injury
- Lesion of an abdominal organ

                                                                                                                                                                     J - R
TRACHEOTOMY OR tracheostomy


The tracheostomy is a surgical procedure which involves making a surgical opening on the front side of the trachea to establish an endotracheal tube without modification of the anatomical structures . Tracheostomy may be temporary or permanent . Breathing is through the tracheal opening but also the airway. The orifice without cannula may quit quickly.


- Maintain the freedom of the airways.
- Ensure adequate gas exchange .
- Extract effectively bronchial secretions .
- Assist patients who can not tolerate intubation .
- Allow the patient to gain greater autonomy.


- Breach of the respiratory centers without paralysis of swallowing ( mennigé state).
- Paralysis of swallowing (poliomyelitis) .
- In case of temporary or permanent laryngeal disorders ( obstructive tumor benign or malignant ) .
- Trauma of the larynx.
- Diphtheria .
- Brain tumors leading to impairment of the respiratory centers .
- Tetanus .


- 10ml syringe .
- Sterile compresses .
- Serving tongs .
- Broad-spectrum antiseptic .
- Gans sterile disposable .
- Gloves non sterile single use.
- Disposable mask .
- Cording .
- Tracheostomy cannula with sterile balloon.
- Tape or tape.
- A pair of sterile scissors .
- Local anesthetics .
- Tracheal suction equipment .
- Bean .
- Bag disposal.


The surgeon makes a horizontal incision in the patient's right under the first cartilaginous rings , the tracheal cannula with a curved mandrel or plug is inserted into this opening
After inserting the shutter is immediately removed so that the patient can breathe. The tracheal cannula is inserted and then is internally latched . Tracheal cannula was held in place by a cord gas tied around the neck of the patient.
- Humidification of the air we breathe :
* This is necessary because the natural humidification is removed by tracheotomy , we risk
    thus increasing the concentration of bronchial secretions and therefore result in an obstruction.
      * It can be achieved either by saturating the air with humidity by spraying or serum
          physiological by the tracheostomy tube .
- Aspiration of bronchial secretions :
* For this there must be a vacuum in working condition and sterile probes to soft side ports
    béquillées slightly .
      * Depression used for vacuuming should be moderate .
      * Starting after insertion of the probe into the trachea probe should never be pinched
          when suction is on.
      * The frequency of aspirations vary with the condition of the bulk of the disease but it will know that
          it not a trivial gesture.

- Change of dressing and cannula :
* If the patient is conscious, prevention care and explain the course .
* Perform a simple hand washing.
* Gather materials .
* Put on disposable gloves to avoid contact with secretions and put on a mask to avoid
   risk projection secretions.
* Remove the pads and discard.
* Clean the area around the opening of the tracheostomy with sterile gauze soaked in antiseptic
   sliding the pad under the flange of the cannula .
* Clean the flange of the cannula .
* Firmly grasp the cannula and cut the cord and discard soiled .
* Change the cord and insert the precut under the collar compresses to absorb
   flow and prevent infection.
* Remove the sterile gloves.
* Make an antiseptic wash.

- Other treatments:
* A patient can eat tracheotomy if no swallowing disorders if this is the case it is
   pose a gastric tube .
* The caregiver must not forget that the patient is aphonique and thus provide him what to write.
Monitoring will depend in part the cause of tracheotomy :
      * A temperature curve of pulse and respiration TA .
      * Observation facies and the patient's condition , cyanosis , agitation being signs of respiratory problems
      * Radiation monitoring (chest clichet ) , biological ( blood gas ) ( electrolytes ) .

- Sudden Death in the very rare introduction may occur especially during aspirations in tetanus .
- Trigger cough reflex during the insertion of the cannula : remove the cannula and ask the patient to
   to qq . of inspiratory and expiratory movements.
- Accidental decannulation due to inadequate fixation.
- Stenosis of the trachea and vocal cord paralysis ( nerve damage reccurents ) .
- Bronchial irritation and exacerbation of the hole due to tracheal aspiration of secretions and
   inadequate care .

VIII - Conclusion :
Tracheotomy is almost always benign early intervention that could save bcp . life , it is still necessary that the post-op care and monitoring. is level so as not to lose the patient the benefit of the tracheotomy. J - R


Venous approaches rely on a complex system of channels , arteries, capillaries and heart . Veins drained blood to the heart . There are 2 types of veins
- Receptive veins which plays a passive role in the return circulation .
- Propelling veins which circulates back managed by gravity.


 The patient should be informed of the technique he will undergo .
 Ensure comfort to gain his cooperation.
 The operator must comply with hygiene by washing hands , skill and knowledge.


- ADVANTAGES: - implemented in a vessel of large caliber and therefore a larger and faster throughput
                                 for a faster effect of drugs .
                              - Allow the measurement of PVC.

- DISADVANTAGES: - risk of injury and bleeding arteries and adjacent veins.
                                       - Risk of perforation.

( See courses in medicine SI )


Take a venous access is an important technique that should be taken into consideration so it will avoid incidents and accidents that may occur to avoid complications .


        J - R


 This is a method of exchange between two solutions , blood and a liquid called dialysate through a semipermeable membrane synthetic .
Hemodialysis is performed using a device called a generator that produces the dialysis fluid or dialysate and a filter called a dialyzer or artificial kidney
It aims to prevent and correct the manifestations of uremic syndrome and its complications and to maintain homeostasis ( maintenance of normal value for different physiological constants , eliminate excess water , to overcome kidney failure and purify the blood of toxic waste, some toxic drugs.

- For the dialysis equipment :
* Capillary dialyzer fibers disposable.
* Bottles of saline .
* CC syringe 20 to increase the level of the expansion rooms.
* Heparin according to medical prescription.
* Extracorporeal circuit : arterial line and venous line .
* Bicarbonate.
Acetic acid * .
* Sterile compresses .
* Antiseptic.
- For connection :
* Needle arteriovenous fistula.
* Four clamp.
* Tray containing sterile hemodialysis : - two masks.
                                                                     - A waterproof field.
                                                                     - Sterile disposable gloves.
                                                                     - Boulle sponge for the patient's hand .
                                                                     - Sterile gauze .
                                                                     - Hypoallergenic tape .
                                                                     - Withers decontaminated and cleaned.
                                                                     - Antiseptic.
                                                                     - Tube for examination.
- To disconnect :
* Disposable gloves sterile and non- sterile.
* Mask .
* Sterile gauze .
* Antiseptic.
* 2 syringes of 5 CC .
* 2 10 CC syringes .
* 0.9% saline .
* 5 CC syringe containing heparin e .


- Ensure cleanliness arm fistulized or support arm of the shunt.
- Take the weight before to assess weight relative to the weight lost on the checklist .
- BP and pulse after a rest.
- Take the patient's temperature .
- Place the patient supine elevated bars.

- Select the puncture which must be no closer than 6 inches to avoid recirculation.
- Sanitize the area of puncture on the arm and place the sterile field.
- Insert the needle into the blood arterial shunt but in the direction of blood flow and venous needle
  above the venous shunt.
- Fix 2 needles with hypoallergenic tape.
- The needles used must first be rinsed with saline.
- Turn on the blood pump .
- After stabilization , check: * 200A blood flow 300 ml / min
                                                   * Venous pressure
                                                   * Depression, and the conductivity of the dialysate flow
- Turn on the pump heparin.
- Check the TA and FC.
- Stop the heparin pump 1-15 minutes before the end of the dialysis session and measure the remaining content and
   note on the control sheet .
- Stop the blood pump and clamp the tubing and the arterial needle
- To empty the blood circuit by remaining saline.
- Keep the arm elevated patient.
- Ranger, clean and sterilize equipment .


1 / BEFORE :

- Weigh the patient and check for digestive disorders.
- Take the patient's temperature .
- Examine the fistula pain inflammation or edema.
- Rinse all the dialyzer with saline to avoid serious namely shock accident.
  Anaphylactic , back pain .....
- To monitor the performance of the generator.
- Check pump heparin.
- Check the pressure at the bubble trap .


- Monitor BP and HR at least 3 times to detect in time the beginning of voltage drop.
- Monitor the facies of the patient.

3 / AFTER :

- Monitor the appearance of the dialyzer and verify the absence of clotted blood.
- Weigh the patient and take his TA .
- Take his temperature.
- Establish a long-term monitoring for vascular aging was found mainly in
   chronic patients.
- Pre joint pain were noted in the wrist of the vertebrae.