Practical Procedures in Anaesthesia and Critical Care

254 Pages·2010·3.22 MB·English

by  Guy Jackson

Practical Procedures in Anaesthesia
and Critical Care
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Practical Procedures
in Anaesthesia and
Critical Care
Dr Guy Jackson
Consultant Anaesthetist,
Royal Berkshire Hospital,
Reading, UK
Dr Neil Soni
Consultant Anaesthetist and Intensivist,
Chelsea and Westminster Hospital,
London, UK
Dr Christopher Whiten
Consultant Anaesthetist,
Charing Cross Hospital,
London, UK
Illustrations by
Jesse Brown

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Acknowledgments
We would like to thank the following for their permissions: Association of Anaesthetists
of Great Britain and Ireland; Diffi cult Airway Society; National Patient Safety Agency;
Portex; Resuscitation Council (UK).
Thank you also to: the microbiology and infection control departments at the Royal
Berkshire Hospital; Jesse Brown for his great illustrations and patience dealing with us;
Mark Bryant, Radiology Specialist Registrar in the Wessex Deanery, for supplying many
of the x-ray and ultrasound images; Gary Croucher for his help with photography; all the
patients who kindly consented to photography.
GJ, CW, NS
Finally, a big thank you to my wife, Georgia, and my children who put up with me during
the hours of writing!
GJ
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Contents
Abbreviations xi
Introduction xiii
Chapter 1 Basic Principles 1
Hand washing 2
Aseptic technique 7
Consent 11
Environment, safety and additional equipment 12
Ultrasound in anaesthesia and intensive care 13
Cardiopulmonary resuscitation 14
Chapter 2 Intravascular Access 21
Peripheral venous cannulation 22
Central venous access 26
Ultrasound guidance for intravenous central line insertion 30
Seldinger technique 33
Railroading 36
Internal jugular vein CVC insertion 38
Subclavian vein CVC insertion 42
Femoral vein CVC insertion 45
External jugular vein cannulation 48
Tunnelled central venous lines 50
Peripheral sites for central venous access: peripherally inserted central catheter
(PICC) lines 52
‘Special’ lines 56
Pulmonary artery catheter 56
Intraosseous needle insertion 59
Lines for haemofi ltration/dialysis 62
Dialysis 64
Arterial line insertion 66
Rapid infusion devices 68
Transducers 70
Chapter 3 Monitoring 71
‘Routine’ anaesthetic monitoring 72
12-lead ECG 73
Cardiac output monitoring 75
Intra-abdominal pressure measurement 77
Arterial blood gas sampling 78
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Chapter 4 Airway Procedures 81
Airway maintenance 82
Positioning 82
Oropharyngeal airway (aka Guedel Airway) 84
Nasopharyngeal airway 86
Facemasks 88
Laryngeal mask airways 90
Tracheal intubation 95
Oral tracheal intubation 95
Nasal intubation 101
Bougies and other intubation aids 104
ts Rapid sequence induction (RSI) 106
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t Double lumen tube insertion 111
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C Airway devices and ‘special’ airways 117
Video-laryngoscopes 118
Diffi cult intubation 120
Retrograde tracheal intubation 125
Emergency airway access 129
Cricothyroidotomy 129
Fibreoptic intubation 135
Percutaneous tracheostomy 142
Insertion of a tracheostomy 144
Changing a tracheostomy 149
Bronchoscopy 151
Ventilation 156
Mechanical ventilation 156
Chapter 5 Thoracic Procedures 163
Needle thoracostomy for chest aspiration 164
Aspiration of tension pneumothorax 164
Aspiration of pleural effusion/haemothorax 166
Intercostal drain insertion 169
Surgical chest drain insertion 169
Seldinger chest drain insertion 173
Removal of a chest drain 175
Pericardiocentesis 177
Temporary cardiac pacing 179
External temporary cardiac pacing: percussion pacing 179
External temporary cardiac pacing: transcutaneous pacing 181
Internal temporary cardiac pacing 182
Chapter 6 Abdominal Procedures 185
Nasogastric and nasojejunal tube placement 186
Nasogastric tubes 186
Nasojejunal tubes 192
Sengstaken–Blakemore and Minnesota tube placement 194
Urethral catheterization 198
Abdominal paracentesis 202
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Chapter 7 Neurological and Related Procedures 207
Local anaesthesia 208
Lumbar puncture 210
Spinal anaesthesia 214
Epidural anaesthesia analgesia 219
Epidural analgesia troubleshooting 227
Intracranial pressure monitoring 229
Index 233
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