Surgical Manipulations
Written by Rhiana Devadasan
10) Basic surgical manipulations in surgery. Puncture - types, indications, technique. Puncture of blood vessels and anatomical cavities. 11) Basic surgical manipulations - puncture of abscess and hematoma. Tubes - types, indications and techniques.
Surgical manipulation = a procedure that does not require incision (unlike operations). (?)
Examples of surgical manipulations
- Punctures (lumbar, sternal, abdominal, pericardiocentesis, thoracic, etc.)
- Drainages (suprapubic bladder, biliary, percutaneous abdominal, pelvic, nephrostomy, intraabdominal)
- Zond / Tubes
Ayman's examples (not in lecture)
- Cannulas (thin tube inserted into a vein or body cavity to administer medication, drain fluid or insert surgical instrument)
- Intravenous therapies (injections or infusions)
- Nasogastric tubes
- Intubations (tube into trachea to open airway or administer drugs)
- Catheters
Punctures
Puncture = the act of piercing or penetrating w/a pointed object or instrument, causing the creation of a wound.
Types of Punctures: (+indications +techniques)
- Cisternal puncture - puncture through the posterior atlanto-occipital membrane with a hollow needle inserted below the external occipital protuberance into the cisterna magna. Indications: to obtain cerebrospinal fluid analysis, or rarely to relieve increased intracranial pressure. Can be as an alternative to a lumbar puncture. Complications: subarachnoid haemorrhage and direct puncture of brain tissue (usually medulla-> respiratory arrest) are most common major complications.
- Lumbar puncture/spinal puncture - the withdrawal of CSF from the subarachnoid space in the lumbar region (usually between the 3rd and 4th lumbar vertebrae). Carried out strictly aseptic. Indications: can be diagnostics = measuring of the CSF pressure and analysis. Or therapeutic = Removal of pus or blood from the subarachnoid space, injecting sera of drugs, removing CSF to try to decrease the intracranial pressure, introducing a local anesthetic to induce spinal anesthesia.
- Sternal puncture - uses local anesthetic to remove bone marrow from the manubrium of the sternum using a sternal needle with a special guard to limit penetration depth) after applying. Indications: samples are examined for abnormal cells. Information is used in conjunction with other clinical findings and tests in diagnosis of blood disorders such as leukemia, lymphoma, multiple myeloma, and anemia.
- Ventricular puncture - uses an opening created to the brain's lateral ventricle regions. Indications: lessen intracranial pressure, administer injected medications into the brain, or collect cerebrospinal fluid.