PRLS LAB Quick Facts

What is the open gloving technique?

easier, shimmy on with cuffed glove

What is the closed gloving technique?

grip and flip

What is the sterile field?

Microorganism-free area that can receive sterile supplies

below the levels of hip and above the head are out of the sterile field

Can you turn your back on a sterile field?

never

How do you set up a sterile field?

1. Adjust table to waist height, insure a dry surface.

2. Obtain all packages, inspect for tears or openings in packaging, moisture, and expiration dates.

3. Perform hand hygiene

4. Open all packages with sterile technique (open using one inch boarders and always begin by unwrapping away from body never allowing flaps to recoil on to sterile items.)

5. Don sterile gloves

What is surgical hand scrub?

scrub nails, hands and up to 1 inch above the elbow

10 strokes / 4 finger surfaces = 40 strokes / finger

What are indications for ET intubation?

work of breathing

hypoventilation

hypoxemia

cardiac arrest

surgery

What are complications of ET intubation?

-tube dislodgement

-vocal cord injury

-R main stem intubation

-esophageal intubation

Is the R or L main stem bronchi more likely to get intubated accidentally?

RIGHT

What materials are needed for ET intubation?

ETT with stylet, MAC blade, suction, tubing, bag valve mask, airway adjuncts, lubricant

What is done after ET intubation to confirm correct placement?

x ray

What position should a patient be in who is getting a central line?

trendelenberg

For central line placement, an US is used to find the _______.

internal jugular vein

What imaging is used to confirm IJV placement of the central line?

x ray

Which nare is initially used feed an NG tube into?

right

What are indication for NG tube?

-lavage / sampling

-decompression / tamponade

-nutriton

-meds

-contrast

What are contraindication for NG tube?

-facial trauma

-basilar skull fx

-nose surgery (recent)

-Zenker diverticulum

What is normal size of NG tube?

10-18 F (French)

What is infant size of NG tube?

3-8 F

What is a single lumen NG tube called?

levin

What is a double lumen NG tube called?

salam sump

What is the triple lumen NG tube with 2 balloons and 2 ports called?

Sengstaken-Blakemore

What is a quadruple lumen NG tube called?

Minnesota

What is the most commonly used NG tube?

Levin tube

__________ tube is used for drainage and feeding

levin

______________ tube is used for gastric irrigation, lavage and decompression

salem sump

_____________ tube is used for tamponade, occlusion and bleeding esophageal varies

sengstaken blakemore

How do you measure an NG tube?

nose to earlobe to xiphoid

What is the anesthetic used for NG tube placement?

5% vicious lidocare sniff and swallow

What position is the patient in for NG tube anesthesia?

sniffing (high fowler)

What are 3 ways to confirm stomach placement of NG tube?

1. auscultation (bubbles)

2. suction (stomach acid)

3. CXR (gold standard)

What is the gold standard for NG tube placement confirmation?

CXR

Should NG tube be removed quickly or slowly?

quickly

What are the 7 rights to a patient when it comes to medication administration?

Patient

Medication

Time

Dosage

Route

Site

Document

Can you mix meds in 1 syringe?

no

The first number in needle sizing is the __________ and the second number is the _________.

gauge

length

What are longer needles used for?

-____ - ___ gauge

-___ - ___ inches

oils, serums and aspiration

22 - 18

1 - 2.2

What are standard needles used for?

-____ - ___ gauge

-___ - ___ inches

general use

27 - 23

1/2 - 3/4

Are higher gauge numbers thicker or thinner?

thinner

What is the typical dose for ID injections vs IM and SubQ?

0.1 mL

0.5 mL

IM injection

-site

-angle

-muscle (UO glute, lateral thigh, midline deltoid)

-90 degrees

SubQ injection

-site

-angle

-fat (stomach, buttock, back)

-45 degrees

ID injection

-site

-angle

-skin (forearm, back)

-10-15 degrees

______ injection is for slow absorption where _____ is for fast absorption?

SubQ = slow

IM = fast

Most vaccines, B12, Depo, antibiotics, narcotics, haloperidol are administered as ___________.

IM

Insulin, live vaccines, heparin/warfarin, hormone therapy is administered as _________.

SubQ

PPD, allergy testing, local anesthetic is administered as _______.

ID

When is phlebotomy therapeutic?

PV or hemochromatosis

When is phlebotomy done with caution?

patient on anticoagulants, thrombocytopenia, hemophilia or hyperfibrinolysis

What are contraindications for phlebotomy?

-lymphedema

-AV fistula

-tattooed area

-pre-existing IV in arm

-skin infection

-sclerosed vein

-DVT

What is the best vein to use for phlebotomy?

median cubital (in AC fossa)

others-

-cephalic (hand)

-basilic (above AC fossa)

What is the typical gauge of phlebotomy needles?

25-21

What is the benefit of butterfly needle vs straight needle for phlebotomy?

butterfly is more comfortable for the patient

What is the order of color of phlebotomy tubes?

-YELLOW

-LIGHT BLUE

-RED

-TIGER TOP / GOLD

-LIGHT GREEN / CAMO

-LAVENDER/PINK/WHITE

-GRAY

What is yellow phlebotomy tube for?

whole blood

-sterile for cultures

What is light blue phlebotomy tube for?

whole blood

-coagulation studies

What is red phlebotomy tube for?

serum

-blood banking

What is tiger top / gold phlebotomy tube for?

serum

-lipids

What is green/camo phlebotomy tube for?

plasma (heparin additive)

-plasma chemistries

What is lavender phlebotomy tube used for?

whole blood (EDTA additive)

-CBC and HbA1C

What is pink phlebotomy tube used for?

whole blood

-T&S and T&C

What is gray phlebotomy tube used for?

whole blood

-glucose

What is tan phlebotomy tube used for?

plasma

-venous lead levels

What is royal blue phlebotomy tube used for?

plasma or serum

-toxicology or nutrient studies

What is black phlebotomy tube used for?

ESR

What are the proper sites for peripheral IV insertion?

-dorsum of hand

-volar forearm

-saphenous in foot

Do you want to place a peripheral IV in the most proximal or distal vein?

distal

How often should peripheral IV sites be changed to avoid infection?

96 hours

What is absorbable suture?

polyglactic (dissolvable)

-use: internal stitches

What is a nonabsorbable suture?

silk, stainless steel, nylon, polyester

-use: external stitches (need removed)

What is a monofilament suture?

single strand of material, moves easily through tissue

What is multistranded suture?

braided, stronger, higher risk of infection

What is primary intention for wound closure?

close all layers, best chance for minimal scarring

-clean

-clean - contaminated

What is secondary intention for wound closure?

close deep layers, superficial layers open. will leave wide scar and need frequent care

use when there is infection or tissue loss

What is third intention for wound closure?

deep layers closed primarily, superficial left open and then reassessed for contamination

What are the most commonly used anesthetic for sutures?

lidocaine

mepivacaine

bupivacaine

Which anesthetic has most rapid onset?

lidocaine

Which anesthetic has longest duration?

bupivicaine

Why is epinephrine used in anesthetic before suturing?

vasoconstriction to decrease BF, reduce systemic absorption of agent, shortens onset and prolongs the duration

Why is the bicarbonate buffer system used in anesthetic?

takes the sting out and increases shelf life

What body part takes the longest to heal from sutures?

foot

back

(chest, abdomen, arm, leg, hand)

What body part takes the shortest to heal from suture?

face

ear

scalp

What is square knot?

a nonslip, noose-forming knot

What is granny knot?

Two simple throws tied in the opposite direction

what is a surgeon's knot?

double-wrap throw followed by single square knot throws

What technique is used when suturing delicate structures or when the suture is too short?

instrument

What technique is used when working in small spaces?

one handed

What technique is used usually in surgery where there is tension?

two handed

Is plaster or fiberglass preferred for splinting? Why?

plaster because its more pliable and has slower setting time for molding

Should the water be warm for plaster or fiberglass casting?

plaster

What is a thumb spica splint?

What is a wrist cock up splint?

What is an ulnar gutter splint?

What is a short arm cast?

What is a sugar tong splint?

What is a sling vs sling and swathe?

Sling is just folding the arm up, sling and swathe anchors the arm to the body with a strap

What is a post op shoe?

What is ankle stirrup?

What is a long leg posterior splint?

What is a knee immobilizer?