1. Stomas

2. Ostomy: A surgical opening made into the bowel to allow for the elimination of stool.
Stoma: The part of the bowel or urinary system visible on the abdomen
Colostomy
Indications:
Colon cancer
Diverticular disease.
Truma
Hirschurprung's disease
Anorectal malformations
High anal fistula
Description:
The stoma is light pink in color, moist and has no feeling and has less wrinkled.
Situated on the left side of the abdomen below the waistline.
Flat with skin.
Its content is solid and brown.

3. iliostomy

4. Indications:
IBD
Description:
Usually on the right side of the abdomen.
The output will be soft to liquid greenish in color.
more dark pink to red and more wrinkled
Complications (for both):
Anatomical: para-stomal hernia, stricture of bowel, bowel prolapse.
Functional: decrease absorption of nutrients, increase in secretions of intestine (become 6 liters) which may leak outside and cause skin irritation and ulceration.

5. Central venous line

6. Neck (internal jagular)
Chest (subclavian)
Groin (femoral)
Types:
Tunneled catheter
Implanted port
peripherally inserted central catheter, or PICC line
Indications:
Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid balance
Long-term Intravenous antibiotics
Long-term Parenteral nutrition especially in chronically ill patients
Long-term pain medications
Chemotherapy
Plasmapheresis
Dialysis

7. Complications:
Pneumothorax (for central lines placed in the chest); the incidence is thought to be higher with subclavian vein catheterization. In catheterization of the internal jugular vein, the risk of pneumothorax can be minimized by the use of ultrasound guidance.
Infection: Staphylococcus aureus and Staphylococcus epidermidis sepsis (highest in femoral)
Air embolism
Hemorrhage
Arrhythmia may occur during the insertion process when the wire comes in contact with the endocardium

8. Foley's Catheter

9. Indications: Insertion "completely aseptic technique": Take a consent
Clean the perineum
Lubricate & insert it all the way, to know its in the bladder u'll see the urine coming out
Inflate the balloon & pull it until u feel a resistance (balloon at the bladder neck)
Then fix it to the thigh
Indications:
Diagnostic:
Urine output monitoring
To collect urine specimen
Study anatomy of the urinary tract (ascending cystourethrogram)
Therapeutic:
Acute urinary retention
Chronic obstruction causing hydronephrosis
Intermittent bladder decompression for neurogenic bladder
Chronically bed-ridden patients for hygiene
Inject chemotherapy

10. Contraindications:
Urethral injury
Complications:
Trauma (bleeding, urethral rupture)
Urethral stricture
UTI
Types:
Rubber: for < 3 weeks, change it every 3 weeks
Silicon: stay up to 3 months but more expensive
Usually there are 2 lumens: 1 for drainage of urine & 1 for balloon inflation

11. NasoGastric Tube

12. Inserstion:
Take a conset
Put patient in 45o, neck extended
Ensure that patient doesn’t have nasal blockage or bleeding
Lubricate the tube with xylocane Jel
Insert, when patient feels Gag reflex ask him to swallow
Ensure its in the stomach(flush with 50cc air & auscultate epigastric area)
Tube is marked:
Mark 1: in the Eso.
Mark 2: Gastro-eso junction
Mark 3: in the stomach it between mark 2 & mark 3
Mark 4: in the duo.

13. Indications:
a)Diagnostic:
patient presenting with melena to know if there is UGIB
esophagio-tracheal malformation (Eso. Atresia)
small bowel enema
Toxicology
b)Therapeutic:
Feeding
Decompression (intestinal obstruction, vomiting)
Complications:
Trauma
Necrosis of nostril (epistaxis)
GERD

14. Sengstaken-Blakemore tube:

15. Is an oro- or nasogastric tube used occasionally in the management of upper gastrointestinal hemorrhage due to bleeding from esophageal varices when bleeding can't be contolled by medications.
It is passed down into the oesophagus and the distal balloon is inflated in the stomach. Distension of the proximal balloon is used to stop bleeding from the varices.
It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications.

16. Endoscopic Retrograde Cholangiopancreatography (ERCP)
ERCP showing dilated CBD with multiple filling defects (CBD stones)

17. Indications:
Diagnostic:
Diagnosis of possible tumor at the ampulla
Assessment of chronic pancreatitis
Diagnosis of possible pancreatic tumor
Biliary disease with jaundice or abnormal liver function tests
A dilated biliary tree on ultrasonography
Therapeutic:
Biliary duct stone extraction or lithotripsy
Placement of stent
Endoscopic sphincterotomy of the sphincter of Oddi
Ampullary balloon dilatation
Complications:
Pancreatitis
Ascending cholangitis
Perforation (duodenum)
Bleeding

18. In cholangiogram we are looking for:
Filling defect (stone or tumor)
Stricture (benign: inflammatory, malignant: cholangiocarcinoma)
Dilatation (intra or extra)
Leak of contrast

19. Double J stent

20. Indications:
to relieve obstruction (benign or malignant), adjunct to stone therapy (ESWL), for ureteral instrumentation, management of urine leak after trauma
Complications:
dislocation, infection and blockage by encrustation

21. Done By: Dana Saud ALEssa Best wishes ;)