Essay 11- Basic surgical manipulations- puncture of abscess and hematoma. Tubes- types, indications and techniques.

what to cover for this essay

• puncture of abscess

  • what is it

  • aspiration methods

• puncture of a haematoma

  • treatment

  • aspiration methods

• tubes

• types

• examples

• complications

What is an abscess

• This is a collection of pus confined within a cavity.

• It is due to infection

• requires antibiotics and pus removal

Methods of Abscess Puncture

• Aspiration

  • For soft/fluid abscesses

  • Use large-bore needle

  • under local anaesthesia

  • Pus is aspirated (act of withdrawing the fluid)

• Incision and Drainage (I&D)

  • For superficial abscesses

  • Local anesthesia infiltrated away from tender spot

  • Small skin bleb raised → needle advanced

    → incision made

  • Pus collected for culture

  • Cavity explored using:

    • Sinus forceps (small)

    • Gloved finger (large)

Puncture of Haematoma

what to cover?

• what is it?

• treatment

What is a haematoma?

• Localised blood collection outside vessels

• due to trauma/surgery

• May be liquid (spreads) → later coagulates

• Symptoms: swelling, discomfort, discoloration

Treatment of Haematoma

Puncture aspiration:

• Area is sterilized

• Sterile needle inserted to drain accumulated blood

• Multiple punctures may be needed

• Apply pressure bandage post-procedure

Tubes in Surgery

points to cover

• purpose

• indications

• types

• examples

Purpose of Tubes

• Prophylactic: prevent fluid accumulation (e.g., bile/urine leaks)

• Therapeutic: remove existing fluid (pus, blood, exudate)

Indications

• Evacuate fluid, pus, blood, exudate

• Eliminate dead space

• Prevent or decrease infection risk

Types of Tubes

• Open Drainage

  • Fluid collects in gauze/stoma bag

  • Higher risk of infection

• Closed Drainage

  • Fluid drains into bottle or bag

  • Reduced infection risk

• Suction Drains (Active)

  • Uses negative pressure

  • Can be high or low pressure

• Non-Suction Drains (Passive)

  • Drain via gravity, overflow, pressure differences

examples of tubes

• chest tube

• t-tube

• stomach tubes

• special tube

• urinary catheter

Chest Tube

• Closed drain

• Drains pneumothorax, hemothorax, pleural effusions

• Inserted in 4th ICS

• above 5th rib

• in pleural space

T-Tube

• Inserted into the bile duct

• Drains bile postoperatively (CBD surgeries)

  • common bile duct stones (CBDS)

Stomach Tubes

Indications

• For feeding when eating is impaired

• Short- or long-term nutrition

Types

• Short-term:

  • Nasogastric (NG) tube

    • Inserted via nose → pharynx → esophagus → stomach

    • Confirm placement by injecting 5 ml air and auscultating

  • Orogastric tube

    • Inserted through mouth into stomach

• Long-term:

  • Gastrostomy tube (G-tube)

    • Direct to stomach via surgical incision (gastrostomy)

  • Jejunostomy tube (J-tube)

    • Inserted lower in abdomen → ends in jejunum

    • Used for thin liquids/powdered meds only

Special Tubes

• Dobhoff: for liquids, food, meds

• Salem tube: for GI bleeding, obstruction, ileus

• Sengstaken–Blakemore tube:

  • Has 2 balloons (gastric & esophageal)

  • Used in GI bleeding/lavage

  • Do not reinsert wire after removing!

Complications of Stomach Tubes

• Acute: aspiration, bleeding, perforation, misplacement

• Chronic: sinusitis, ulceration, perforation

Urinary Catheter

• Hollow, flexible tube

• into bladder

• to collect urine

• Made of latex, rubber, or silicone

• Indications:

  • urinary retention,

  • obstruction,

  • nerve damage

Complications of Tubes

• Sepsis (esp. with open drains)

• Failure to drain (fat/omentum blocks suction holes)

• Pressure/suction necrosis → intestinal leakage/peritonitis

• Erosion into vessels → rare hemorrhage