This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
This topic is been added in the new edition ( 26th ) of Bailey & Love. This topic covers the types, uses and also the principles of removal of a drain. Every MBBS student should be aware of drains & its uses in surgery.
This presentation is about surgical drains and the techniques of draining the surgical wounds. Advancements in the surgical drains are also discussed and mentioned.
STOMA CARE- OSTOMIES
#surgicaleducator #stomacare #ostomies #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Stoma care- Ostomies - a didactic lecture.
• I have discussed the definition, types, preparation, post-op care, stoma appliances, complications and general care of different Stomas- Ostomies
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
This presentation is about surgical drains and the techniques of draining the surgical wounds. Advancements in the surgical drains are also discussed and mentioned.
STOMA CARE- OSTOMIES
#surgicaleducator #stomacare #ostomies #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Stoma care- Ostomies - a didactic lecture.
• I have discussed the definition, types, preparation, post-op care, stoma appliances, complications and general care of different Stomas- Ostomies
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video
COLONOSCOPY- A PICTORIAL OVERVIEW
• Dear viewers,
• Greetings from “Surgical Educator”
• This week I have uploaded a video on Colonoscopy- the Lower GI Endoscopy.
• In this episode, I showed only the colonoscopic features of common pathologies in colon and rectum.
• I restricted my talk to the essential minimum that an undergraduate medical student must know about the Colonoscopy.
• I discussed about the diagnostic and therapeutic procedures you can do with the Colonoscopy.
• I hope it would be interesting and very useful to all my viewers.
• You can access this video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Central Venous Catheter Care- A Nursing skill Tse Sona
- Shared on the request of al the delegates who attended and those who couldn't attend the webinar on "CVC care- A Nursing Skill'' due to limited seats. I hope it will be helpful to all
This presentation will give an overview of what NG tube is, types of NG tube, indications and contraindications, how to insert NG tube and potential complications of NG tube
Laparoscopic cholecystectomy is the current gold standard for surgical removal of the Gall bladder, particularly in benign pathologies. Hence, it is necessary to highlight some steps to accomplish this procedure successfully while avoiding pitfalls.
Natural Orifice Transluminal Endoscopic Surgery, NOTES.
"scarless" abdominal surgery with an endoscope passed through a natural orifice (MOUTH, URETHRA, ANUS, VAGINA) then through an internal incision in the stomach, vagina, bladder or colon, thus avoiding any external incisions or scars.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. Tubes and Drains
Presenter: Dr. Annush Tha
Moderators: Dr. David Shrestha/ Dr. Dilip Baral/ Dr. Gani Alam
Department of Surgery
Pokhara Academy of Health Sciences
2077/05/01
2. Objectives
Principles of drain usage
Drain and its types
Indication/ purpose of drains
Insertion, care and Removal of drain
Complications of drains
Recommendations in surgical practice based on evidence
3. Drain
Tube or deliberate channel- to remove established or potential
collection of pus, blood or body fluid from wound or organ space
4. Principle of drain
Poiseuile law
Laminar flow rate of an incompressible fluid along a tube is
relationship of pressure gradient, radius of tube, viscosity and
length of tube
5. Classification of drain
Basis Types
Rationale Prophylactic Therapeutic
Mechanism Passive Active
Nature Tube Sheet/flat
Disposition Open Close
Location Internal External
Property Inert Irritant
6. Classification of drain
• Rationale
Prophylactic drain placement controversial
Prophylactic Therapeutic
Drain placed at end of
operation to prevent
accumulations
To evacuate an existing
collections
Placed surgically or under
radiological guidance
7. Open drains Closed drains
Drains empty directly to the exterior into
the overlying wound dressing or stoma
bag
Drains externally into sealed container
or reservoir
Increased risk of infection –ascending
along the drain
Lower risk of infection
E.g.: Corrugated drain, Penrose drain,
gauze wick drain, glove finger drain
Easy to care
Accurate assessment of fluid drainage
Penrose drain Corrugated drain Jackson- pratt drain
8. Mechanism: Active drains
• Maintained under negative pressure- High/Low
• Closed ( Jackson-pratt, hemovac drain)
• Open( Sump drain)
Advantage Disadvantage
Keeps wound dry, appose
tissues planes
Causes tissue erosion
Allows fluid drainage
against natural pressure-
pleural space
Prevent fistula closure
Blockage less
Prevent bacterial accession Hemovac drain
9. Mechanism: Passive Drain
• Drains by capillary action, pressure gradient or gravity
• No suction
• Closed ( NG tube, Foley’s catheter, T-tube, Under water seal drain)
• Open( Penrose, corrugated drain, gauge wick drain)
10. Nature of drain
Tube drain Sheet drains
Hollow tubes with multiple holes at one
end
Sheet of gutter or parallel tubes
Corrugated drain, yeates
Abdominal drain Yeates
11. Flat drains
• Flat drain with multiple perforators – connected to tubing system
• Inner wall of flat segment has ribs – prevents from kinking and
collapsing
• Use:- Plastic and reconstructive surgeries
12. Sump drain
• Double lumen, radio opaque
• 1st lumen- suction of gastric
contents
• 2nd lumen- blue extension open to
room air to maintain continuous
flow of atmospheric air into
stomach
• Controls the amount of suction
pressure on tissue/organ and
prevents blockage
• Reduces amount of tissue damage
13. Pigtail drain
• Removes unwanted fluid from organ, duct or abscess
• Inserted under radiological guidance
14. Disposition
External Internal
Open externally outside body wall Placed internally within luminal organs to create a
route or to connect two luminal organs
Fluid channeled from deepest part of cavity to
exterior
Diverts retained fluid from primary drainage site
/area distal to body passage or cavity to bypass
obstruction
E.g.: ventriculo-jugular shunt, ventriculo-atrial shunt,
Dj stents
16. Indication/ Purpose Of Drains
Therapeutic – remove fluid/pus/gas
• Abscess cavity
• Seroma
• Pleural fluid
• Acute urinary Retention
Palliative- to allow diversion of body fluids/bypass luminal
obstruction
• Advanced Ca oesophagus
• Hydrocephalus
Access route- to body space or cavity
• Percutaneous nephrolithotomy,
17. Diagnostic- injection of dye/contrast about underlying cavity or
fistula to reach diagnosis
• Biliary fistula
• T-tube cholangiogram for retained gall stones in common bile duct
Prophylactic-
prevents post operative complications arising from fluid collection in wound
cavity
Promote tissue appostion
Post thyroidectomy
Thoracotomy
Monitoring- of fluid volume and quality
Gastrointestinal bleeding
Urinary Catheterisation
18. Drain insertion
Exteriorized via shortest , safest route and through a stab wound not
through the surgical incision
Reach deepest and most dependent part of the cavity or wound
Placed lower than the incision site
Appropriate size and length of drain
Secured at exit to prevent migration of drain-
Silk, safety pin, drain clip, adhesives
Tubing free of kinks, debris, clots—free drainage
19. Securing the drain
A Modified Technique for Securing Drains to the Skin.
Mura S1 , Guarneri GF1 , Parodi PC1 1. Department of Plastic and Reconstructive
Surgery, University of Udine, Udine, Italy.
Different ways of securing drain
20. Drain Care
• Is the patient well?
• Drain secure?
• Signs of infection, excoriation, peritubal leakage at skin site?
• Tube kinked/ clogged/ damaged?
• Drain connected properly?
• Quality and quantity of drainage fluid?
• Change in nature or volume of effluent?
• Vacuum suction working or not?
21. Drain Removal
• Drain has lived up to its function
• Remove drain with steady gentle traction (avoid sudden jerks)
• Release suction prior to removal
22. Complications and prevention
• Tissue reaction and necrosis
• Hemorrhage
• Source of infection- increase with prolonged drain
placement
• Bowel herniation- if complicated by infection
• Drain entrapment- due to fibrosis
• Fluid and electrolyte loss-high output
• Migration of drain- not secured properly
• Erosion of viscera- in peritoneal cavity without well defined
abscess cavity
23. Evidence based findings
Routine NG drainage after abdominal surgery not recommended
Delay return of gastrointestinal function a/w drain( time to passage of flatus)
NG use –Acute gastric dilation, GOO, Small bowel obstruction, NG feeding
Colorectal surgery-
Drain only if anastomotic leak
Avoid Prophylactic drainage
Appendiectomy
Despite of severity ( gangrenous or perforated or uncomplicated appendicitis)
drain placement a/w increased wound infection and faecal fistula
24. Cholecystectomy
Drain A/w increased wound infection
Avoid in simple cholecystectomy (lap or open)
Hepatic Rection
Subphrenic collection and bilomas m/c complication of liver resection
Drain placement a/w increased risk of infection if collection occurred
Drain failed to detect post operative leakage and hemorrhage
T-tube drainage for CBD exploration following choledocholithotomy
Operative time and postoperative stay longer if t-tube placed
25. Upper gastrointestinal surgery(DU perforation, Gastrectomy)
No difference in incidence intraabdominal collection
Drain a/w increase in complication(10%) and intestinal obstruction(3%)
Pancreatic surgery
Increase (rate of complications and number of interventions for collections)
a/w drain
26. Therapeutic Drainage
Percutaneous drainage under image guidance ( USG or CT) for
symptomatic post operative collection with signs of infection is
recommended for treatment.
27. Take home message
• Drain play important role in management of preoperative, operative
and postoperative patients
• Appropriate drain for appropriate time
• Prophylactic use of drain in various surgeries not recommended
• Therapeutic percutaneous drainage under radiologic guidance for
symptomatic postoperative collections with signs of infection
28. References
• James A. caton ,Dileep N. Lobo.The use of drains in Gastrointestinal
surgery, Recent Advances of surgery.31 Edition
• JG M, EA A. Surgical drains: what the resident needs to know. Nigerian
journal of Medicine. 2008 Jul;17(3).
• Durai R, Mownah A, Philip CN. Use of drains in surgery: a review.
Journal of perioperative practice. 2009 Jun;19(6):180-6.
• SRB’s manual of surgery