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Institute of Surgical Research
„A” Modul – Surgical Techniques
A3. Practical Modul
Surgical interventions:
Injection, peripheral vein access;
Intravenous infusion, infusion pumps;
Suturing techniques, surgical knots, sutures
Injections
Indications:
• oral drug delivery is not possible
• drug metabolism is altered by ingestion
• quick or prolonged action
Devices:
• Syringes:
Luer: plastic, single-use, sterile
volume range: 1(tuberculin), 2, 5, 10, 20, 50, 60 ml
• Hypodermic needles:
Luer: metal + plastic tip (size: color-coded scale,
G=gauge);
„Butterfly” ;
Braunüle (needle + cannula).
Giving an injection:
may lead to infection (sterility!)
may lead to air embolism (remove air from the syringe!)
Injections 1.
Types of injection techniques:
intracutaneous
ic. into the skin layers
subcutaneous sc. into subcutaneous tissue
intramuscular im. into muscle
intravenous
iv. into vein
Injections 2.
Intravenous
Sites: forearm (v. mediana
cubiti, v. cephalica),
dorsal veins of hand and
foot.
Needles: 18-23 G
„Butterfly”:
with injection port
Braunüle:
Apply a tourniquet centrally to the vein,
puncture the vein at 30 to 45 degree angle
and in the direction of the vein, remove
tourniquet, and give the injection slowly.
Central venous catheter
Sites of punction:
1. V. jugularis interna:
medial to the pulsing
carotid artery
2. V. subclavia:
1/3 – 2/3 part of the
clavicula
Normal CVP value: 2-6 mmHg. Advantages:
- quick and high volume of infusion,
- administration of hypertonic solution/drug,
- repeated blood sampling.
Insertion of central venous catheters
1. Introduce a Braunüle into a periferal vein
2. Remove needle
3. Insert a flexible guide-wire into the central vein
4. Remove the Braunüle cannula
5. Insert – then remove a dilator cannula
6. Insert the central venous cannula, remove guide-wire
Infusion therapy
Indications: fluid and electrolyte balance,
continuous medications
nutrition
Transfusion = blood or blood components
Devices:
glass bottle/plastic bag with fluid,
sterile fluid administration set,
- spike for puncturing the bag,
- tubing, drip chamber,
- roller clamp (flow regulator)
sterile needles (Braunüle).
Infusion pumps
Infusion pumps: accurate, slow delivery of
drugs/infusions
Types:
Volumetric pumps
- long-term delivery of iv or ia infusions,
transfusions.
Syringe pumps
- small volume (iv, ia) delivery of
drugs/infusions with syringes.
Perioperative fluid replacement
Colloids
Artificial
Crystalloids
Natural
(albumin)
Isotonic:
Salsol
Ringer’s lactate
Gelatine 4% (35 kDa; Gelofusine)
Hydroxyethyl starch (HES) 6%; 130 kDa; Voluven;
6% and 10 % HES 200 kDa; HAES-sterile
Dextran 10% (40 kDa; Rheomacrodex)
Dextran 6%-os (60-70 kDa; Macrodex)
Gloving Alone (without assistance)
Holding needle holders
Mounting a needle holder and threading a needle
Interrupted: Simple suture
Interrupted: Vertical mattress suture
Continuous: Simple suture
Continuous: Intracutan suture
Continuous: Purse-string suture