Ebook Manual of ICU procedures: Part 2

(BQ) Part 2 book Manual of ICU procedures presents the following contents: Neurological procedures (jugular venous oximetry, lumbar puncture, epidural analgesia,...), gastrointestinal-abdominal-genitourinary procedures; miscellaneous.

SECTION Neurological Procedures 32 Jugular Venous Oximetry Hemant Bhagat 33 Lumbar Puncture Bhaskar P Rao, Neha Singh 34 Epidural Analgesia Sanjay Dhiraaj 35 Cranial Burr Hole Rabi N Sahu, Kuntal Kanti Das, Arun K Srivastava 36 External Ventricular Drainage Devesh K Singh, Arun K Srivastava, Kuntal Kanti Das, Rabi N Sahu 37 Intracranial Pressure Monitoring Hemanshu Prabhakar 38 Nerve and Muscle Biopsy Sanjeev K Bhoi, Jayantee Kalita, Usha K Misra 39 Spine Immobilization in Trauma Patient Sandeep Sahu, Indu Lata 32.indd 393 24-06-2015 14:37:45 32.indd 394 24-06-2015 14:37:45 32 Jugular Venous Oximetry Hemant Bhagat INTRODUCTION Jugular venous oximetry or jugular bulb oxygen saturation (SjO2 or SjVO2) is a tool which represents a balance between the supply [cerebral blood flow (CBF)] and the need [cerebral metabolic requirement of oxygen (CMRO2)] This is achieved by locating the tip of the catheter at the jugular venous bulb which measures the jugular venous oxygen saturation using the fiber-optic sensors or by intermittent sampling of the venous sample The jugular venous bulb drains approximately two-thirds of the ipsilateral and one-third of the contralate­ ral cranial compartment Consequently, its measurement is representative of global CBF INDICATION • Acute neurological deterioration (traumatic brain injury, subarachnoid hemorrhage, etc.) • Initiation of hyperventilation for raised intracranial pressure • Status epilepticus • Neurological deterioration due to systemic illness • Prognostication following cerebral injury • Institution of barbiturate coma • As a research tool for understanding the cerebral physiology CONTRAINDICATION • • • • Coagulopathy Thrombosis of jugular veins Cervical spine injury Presence of a tracheotomy APPLIED ANATOMY The jugular venous bulb lies opposite to the anterior arch of first and second cervical vertebra as visualized on the radiograph As per the surface anatomy, the mastoid process lies at the same level The judgment for right location of catheter tip will be based on relying on these anatomic landmarks (Fig 1) The tip of the catheter should usually be placed within the jugular bulb at the same side as that of the lesion in the brain If there is a bilateral lesion of brain or no obvious 32.indd 395 24-06-2015 14:37:45 396  Section 3: Neurological Procedures Fig 1  Anatomical landmarks for retrograde cannulation of internal jugular vein lesion of brain, then the dominant jugular vein should be cannulated which is commonly the right side TECHNIQUE AND BASIC PRINCIPLES The technique for placement of jugular venous oximetry catheter consists of retrograde cannulation of the internal jugular vein (IJV) and locating the tip of catheter into the jugular bulb using the anatomic landmarks (Figs and 3) The normal values of SjO2 are 55–75% This is derived from the following formula: SjO2 = arterial oxygen saturation (SaO2; 97%–100%) – cerebral oxygen extraction (25%–45%) Decrease in SjO2 values (less than 50%) indicates one of the following: • Decreased supply (CBF) – Cerebral ischemia – Hyperventilation • Increased demand [cerebral metabolic rate of oxygen (CMRO2)] – Seizures – Fever Increase in SjO2 (more than 75%) indicates one of the following: • Decreased demand (CMRO2) – Cerebral infarction/brain death – Hypothermia – Use of sedatives • Increased supply (CBF) – Cerebral hyperemia Recording of Values Continuous Monitoring • Real time: The jugular venous oximetry catheter which uses three wavelength of light can calculate the hemoglobin value from the absorption system and allows real time continuous monitoring of SjO2 32.indd 396 24-06-2015 14:37:45 Jugular Venous Oximetry  397 • Non-real time: The SjO2 catheter which uses two wavelengths of light, the hemoglobin value has to be manually entered to calculate jugular venous oxygen solutions Though it is continuous, the values are not estimated in real time Intermittent Monitoring In the situation where central venous catheter is used intermittent venous sampling has to be done and venous oxygen saturations have to be measured by an arterial blood gas (ABG) analyzer PREPARATION The basic equipment required for its placement are as follows: • Fiber-optic catheter for monitoring the SjO2: Several catheters have been used in IJV for jugular venous oximetry The Oximetrix system uses a Fr gauge Shaw Opticath which needs to be calibrated in vivo after placement This should be recalibrated after every 12 hours of use Another Fr gauge catheter by Baxter healthcare has been used which requires recalibration only after 24–48 hours These catheters are not freely available in India We use singlelumen central venous catheter (5 Fr/5.5 Fr) for retrograde cannulation of IJV • Ultrasonography (USG) machine • Fluoroscope • Sterile drapes PROCEDURE • Positioning of patient: Jugular bulb oxygen saturation monitoring is usually done in patients with deranged intracranial physiology or/and raised intracranial pressure (ICP) So it is advised not to advocate the head-down position which may risk the increase in ICP In case of short neck it may be reasonable to use a sand bag in the interscapular region to allow extension and adequate exposure of neck Avoid extreme neck rotation which may carry risk of obstruction to the contralateral cerebral venous outflow • Preparation of skin: Disinfect the skin over the IJV with antiseptic solutions as per the hospital policy • Sterile draping of the area of interest • Use aseptic precautions to identify the IJV using a USG machine or a finder needle • Puncture the IJV with a introducer needle in the retrograde direction (Fig 2) • Insert the J tipped guidewire through the introducer needle for few centimeters beyond the needle insertion site (Fig 3) • Place the catheter over the guidewire under fluoroscopic guidance so that the tip of catheter lies over the anterior arch of C1-C2 vertebra or the mastoid process • If fluoroscope is not available then place the catheter tips estimating a length approximately measuring the distance between the skin puncture site to the ipsilateral mastoid process or till a resistance is met This can be confirmed later using the radiographs and readjusting the tip if necessary (Fig 4) 32.indd 397 24-06-2015 14:37:45 398  Section 3: Neurological Procedures Fig 2  Retrograde placement of guidewire through the introducer needle Fig 3  Retrograde introduction of catheter in internal jugular vein • Secure the catheter: The catheter should be firmly secured to the skin with the help of sutures • Aseptic dressings: The surrounding skin underlying the catheter entry point should be cleaned and covered with a sterile dressing (Fig 5) POST-PROCEDURE CARE • Follow-up for the correct location of the tip of catheter • Asepsis of the catheter and the underlying skin 32.indd 398 24-06-2015 14:37:45 Jugular Venous Oximetry  399 Fig 4  Radiograph of placement of jugular bulb oxygen saturation catheter in internal jugular vein (white arrow) and catheter tip at the level of anterior arch of first cervical vertebra (black arrow) Fig 5  Securing the skin entry point of catheter with sterile dressing COMPLICATION/PROBLEM • Catheter misplacement: This can occur in the form of placement of catheter tip either proximal to the jugular bulb This can be prevented by using the fluoroscope during the catheter positioning (Fig 6) • Inadvertent puncture of carotid artery and arterial cannulation can occur USG-guided catheter placement can avoid this complication • Catheter migration: Catheter migration can occur from its position area giving erroneous readings (Fig 6) This can be prevented by properly securing the catheter at the skin entry point Follow-up radiograph will help in early recognition and management of catheter migration • Extracranial contamination of venous sample: Extracranial contamination of venous sample can occur when the catheter tip is below the jugular bulb or when venous sampling is done very fast This can be prevented by ensuring 32.indd 399 24-06-2015 14:37:46 400  Section 3: Neurological Procedures Fig 6  Radiograph of catheter tip malposition below the jugular bulb (black arrow) correct placement of catheter tip and sampling the venous blood a rate less than mL/minute • Relatively insensitive to brainstem and cerebellar lesions as these areas contribute little to cerebral venous outflow • Catheter blockage: Whenever intermittent sampling is done via a venous catheter there is a possibility of its lumen being blocked This can be prevented by continuous flushing of the catheter lumen with heparin added saline using keep the vein open (KVO) mode of the syringe infusion pumps • Catheter-related sepsis: Through data is scarce, there is a theoretical possibility of introducing bloodstream infection Prevention should aim at placement of SjO2 catheter under strict aseptic precautions and maintaining a sterile dressing and aseptic handling throughout the days of indwelling catheter ACKNOWLEDGMENT I gratefully acknowledge the contribution of Dr S Saranya Vishnumathy for the sketch and thankful to the residents of neuroanesthesia for helping me in acquiring rest of the figures SUGGESTED READING Andrews PJD Jugular venous oximetry Eur J Anaesthesiol 1998;15:61-3 Gopinath SP, Robertson CS, Constant CF, Hayes C, Feldman Z, Narayan RK, et al Jugular venous desaturation and outcome after head injury J Neurol Neurosurg Psychiatry 1994;57:717-23 Schell RM, Cole DJ Cerebral monitoring: jugular venous oximetry Anesth Analg 2000;90:559-66 Tisdall MM, Smith M Multimodal monitoring in traumatic brain injury: current status and future directions Br J Anaesth 2007;99:61-7 32.indd 400 24-06-2015 14:37:46 33 Lumbar Puncture Bhaskar P Rao, Neha Singh INTRODUCTION Lumbar puncture in intensive care unit (ICU), otherwise known as spinal tap, involves insertion of a needle intrathecally, either to obtain cerebrospinal fluid (CSF) for diagnostic studies for varied life-threatening conditions or to instill some drug as a therapeutic measure Being invasive in nature and that too in close proximity to spinal cord and numerous nerves, there is always a possibility to develop iatrogenic neurological complications leading to significant postprocedure morbidity Thus, it is prudent to obtain the very knowledge of proper anatomy, indications, contraindications and management of procedure-related complications for all involved in patient care Although, it is still considered a blind procedure, inclusion of ultrasound for the identification of the pertinent intervertebral space can definitely alter the safety issues associated with the technique, especially in patients with difficult landmarks.1,2 INDICATION Lumbar puncture is essential in the diagnosis of varied infective and noninfective conditions in ICU patients These conditions can be broadly classified into acute, non-acute and supportive situations Similarly, it is often utilized or extremely useful as a therapeutic measure for various conditions enlisted below Diagnostic Acute Conditions • Suspected central nervous system (CNS) infections • Clinical suspicion of subarachnoid hemorrhage not supported by computed tomography (CT) scan3,4 • To diagnose and differentiate bacterial and viral meningitis in symptomatic patients Non-acute Conditions • Idiopathic intracranial hypertension (pseudotumor cerebri) • Carcinomatous meningitis 33.indd 401 24-06-2015 10:07:50 402  Section 3: Neurological Procedures • • • • Tuberculous meningitis Normal pressure hydrocephalus Central nervous system syphilis Central nervous system vasculitis Supportive Conditions (Non-diagnostic but Still Useful) • Multiple sclerosis • Guillain-Barré syndrome • Paraneoplastic syndromes Therapeutic • Intrathecal administration of chemotherapy • Intrathecal administration of antibiotics • Injection of contrast media for myelography or for cisternography CONTRAINDICATION There is no absolute contraindication to perform lumbar puncture except for patient refusal But, there are many conditions where this procedure is relatively contraindicated where it can be weighed for the benefits against the risks These are: • Suspected raised intracranial pressure • Coagulopathy/thrombocytopenia • Epidural abscess • Cardiovascular instability • Respiratory instability • Local infection • Vertebral anomalies, etc.5-9 APPLIED ANATOMY Procedure of lumbar puncture requires an intimate understanding of the functional anatomy of the spinal column, spinal cord and spinal nerves along with their surface markings The vertebral column consists of 33 vertebrae: seven cervical, twelve thoracic, five lumbar, five sacral and four coccygeal segments (Fig 1) The part of the body of concern during lumbar puncture is lumbar vertebrae, which along with other vertebrae forms a hollow ring-like structure to accommodate and provide a protective enclosure for the spinal cord The ring is formed anteriorly by the vertebral body, laterally by the pedicles and transverse processes, and posteriorly by the lamina and spinous processes The spinal cord lies inside the spinal canal being covered by three layers or membranes, namely dura mater, arachnoid mater and pia mater Dura mater is the outermost layer, followed by the arachnoid mater, and the pia mater The space between pia mater and arachnoid membrane is known as subarachnoid space, containing CSF Besides these, as the needle passes into the subarachnoid space, the following ligaments come across: supraspinous ligament (connecting the tip of the spinous 33.indd 402 24-06-2015 10:07:50 Index Page numbers followed by f refer to figure, t refer to table and fc refer to flow chart A Abdominal aortic aneurysm 368 closure 556 collection 586 ultrasound image of 544 compartment syndrome 323, 520, 558 content 560f reapproximation anchor system 556 wall, tube migration into 504 Abnormal bleeding 110 ABRA application to open abdomen schematic illustration of 558f Abscess collections 586 Absolute contraindications 30, 78 Access site puncture 545f Accessories traps 138 Accidental line dislodgement 296 mediastinal entry 274 Acidosis 133 Adam’s apple 79 Aerodigestive tract, applied anatomy of 487f Aerosol drug delivery 200 factors 201 factors affecting delivery of 201 therapy 200 Air bubbles 525 Air embolism 296 aspiration of 246 Air embolus 258 Air leaks 198 Airway adjunct like OPA, need of 15 Airway adjuncts 8, 11 Airway bleeding 50 Airway manipulation 103 Airway obstruction, acute 78 Airway prevention 508 Airway resistance 133 Airway, dryness of 198 Airway, loss of 112 Alanine aminotransferase 701 Alveolar proteinosis 147 Alveolopleural fistula 184 Index.indd 703 Ambesh T-dagger 107 T-trach dilator 96f T-trach kit 96f T-trach technique 92, 94 Ambulatory drains 171 patients, difficult in 250 Amylase concentration 535 Anaphylaxis 685 Anatomic variation 246 Anatomical landmark entry point selection with 410f marking of site in relation with 578f Anesthesiologists, American Society of 255 Anesthetized patient fiberoptic intubation in 57 Angiography catheter guided cricoids manipulation 482 Anticipated difficult intubation 49 Anticoagulant/coagulopathy 477 Anticoagulation therapy 336 Antifog solution 65 Antimicrobials 639 Antisialagogue 55 Anti-Trendelenburg position 553 Anuria 598 Aorta, thrombosis of 297 ARDS, baby lung in 211 Arrhythmias 126, 147, 259 Arterial blood gas 214 analysis 191 analyzer 397 machine 305 sampling 298 Arterial blood sampling 298, 303 equipment needed for 303 Arterial cannula 302, 307f parts of 303f Arterial cannulation 298, 300t, 305 equipment for 303 Arterial oxygen saturation 214 Arterial placement 243 Arterial pressure waveform interpretation of 300 Arterial pseudoaneurysms 273 03-07-2015 16:19:25 704  Manual of ICU Procedures Arterial puncture 272 sampling by 303 technique of 304f Arterial waveform 301f analysis 377 different types of 302f Arteriovenous access fistula 609f fistula 591, 603, 604f grafts 604, 605f Artery puncture 258 Artificial airway 204 Asbestosis 147 Ascitic fluid protein concentration 535 aspiration of 533f Asepsis 302 Aseptic dressings 398 precautions 305 Aspartate aminotransferase 701 Aspergillus 147 Aspiration high-risk of 188 pneumonia 131 pneumonia 518 risk of 198 Asthma 150 Atelectasis 218 lobar 130 Atypical mycobacteria 147 Axillary vein 247, 250 Azygos veins 277 B Backache 412 Bacteremia 268, 549 Bacteria 147 Bag valve mask 5, 20 Bag-mask ventilation Bailey’s maneuver 32 Balloon dilatation percutaneous tracheostomy kit 98f facilitated percutaneous tracheostomy 109 facilitation technique 92, 98, 108 rupture 321 tipped 361 Barbiturate coma, institution of 395 Barotrauma 60, 113 Basal skull fracture, suspected 477 Baseline liver function test 696 Basilar skull fracture 18 Beck’s triad 338 Berman II intubating airway 58 Berylliosis 147 Index.indd 704 Bicaval view, modified 318f Bier’s block 386 Bilateral peripheral vascular disease severe 368 Bilevel positive airway pressure 190 Bilirubin concentration 535 Biopsy gun shaft 630f showing, side view of 627f Bite block/mouthguard 138 Bladder cancer, history of 574 pathology, medical history of 521 surgery, recent urethral 563 syringe advanced in 579f Bleeding 144, 182, 412, 459 diathesis 91, 133, 164, 336 disorders 586 disorder 18, 455 uncontrolled 368 episodes 89 Blocked chest tube 183 Blood components 674, 684t adverse reaction due to 684 bag identification check 679 inspection of 680 basic properties 674 bedside handling of 678 specific issues 681 transfusion 237 Blood culture bottle 670f Blood gases 231 Blood pressure 232, 374 monitoring 313 Blood sampling 667, 686 technique and basic principles of 68 Blood stream infections 244f Blood transfusion 674 Blood-borne pathogens, transmission of 692 Bloodstream infection 258, 266, 661 Blue rhino 94 Bone marrow aspirate 617 aspiration needle 617 biopsy 617 needle 617, 623f piece 623f examination, adjunct equipment for 619f Bougie 22f Bowel diseases, severe/active inflammatory 586 gangrene, suspected 553 perforation 344, 535 stoma (ostomy) 587 Bradycardia 27 Brain heart infusion 669 Brainstem herniation 412 Breathe sound, examination 231 03-07-2015 16:19:25 Index  705 Bronchitis 150 Bronchoalveolar lavage 71, 146 Bronchopleural fistula 130, 184 Bronchoscopy 129 cart, typical 137f use of 102 using NIPPV 140 using non-invasive positive pressure ventilation 142f Bronchospasm 145 severe 219 Bronchostenosis 130f Buried bumper syndrome 503 Burr hole, site of 432 C Calcium alginates 639 Cancer pain 415 Cannula 582f Cannula into bladder Foley catheter through 582f Cannulation, local infiltration 306f Carbon dioxide detector 65 Carcinoembryonic antigen level 535 Carcinomatous meningitis 401 Cardiac arrest 17, 30, 126, 188, 232, 382 Cardiac arrhythmias 144, 200, 219, 519 Cardiac complications 297 Cardiac dysrhythmia’s 232 Cardiac pacing 353 Cardiac perforation 320, 344, 365 Cardiogenic pulmonary edema 187 Cardiopulmonary resuscitation 216, 250, 280 Cardiorespiratory monitoring 427 Cardiovascular instability 402 C-arm fluoroscopy 539f Carotid artery puncture 248 Catheter 440, 564, 570f associated urinary tract infection 662 definition of 662 based on lumen of 251 blockage 400 choice of 251 connect drainage bag to 571f damage 267, 428 different types of 590f embolus 258 fixation of 425, 572 flow rate of 251 fracture 321 function, assessment of 549 insertion, day of 591 knotting 259, 320 length of 251, 270 magnified, epidural catheter with 421f malpositioning 259, 267 migration 399, 597 Index.indd 705 misplacement 399 related bloodstream infections 254, 259, 296 related sepsis 400 removal 445, 549 routine changing of 572 site selection 264 specimen 672 technique 529, 532 threading of 424f tip, malpositioning of 274 tracing after 316f types of 251, 270, 589 with sterile dressing securing skin entry point of 399f Catheterization difficulty in 571 duration of 564 Central line-associated bloodstream infection 663 definition of 663 surveillance for 663 Central nervous system 55, 401 infections 401 syphilis 402 vasculitis 402 Central venous cannulation less preferred sites for 250 Central venous catheter 246, 250, 268 tunneling of 268 Central venous pressure (CVP) 246, 312, 322 monitoring 288 Cerebral blood flow 373, 395 Cerebral edema 323 Cerebral hyperemia 396 Cerebral infarction/brain death 396 Cerebral ischemia 396 Cerebral perfusion pressure 438 Cerebrospinal fluid 401, 418, 431 flow of 436 rhinorrhea 18 Cerebrovascular accidents 497 Cervical instability 62 Cervical spine fracture or instability 210 injuries 62, 395 manual in-line stabilization of 465 Chamber pacemaker, single 359f Chandy’s maneuver 39 Chemotherapy 237 infusion of 246 intrathecal administration of 402 Chest and abdominal wounds 210 Chest drain, insertion of 173 Chest injury, severe 118 Chest pain 610 Chest physiotherapy 218 Chest trauma 415 03-07-2015 16:19:25 706  Manual of ICU Procedures Chest tube dressing 181 Chevalier Jackson’s paper 80 Chills 610 Chin lift, jaw thrust 15 Chylothorax 259, 274 Ciaglia blue rhino 104 multiple dilator percutaneous tracheostomy kit 94f multiple-dilator technique by 92, 93 percutaneous tracheostomy 95f Seldinger technique multiple-dilator technique by 93f Cisternography 402 Citrate dialysate 607 Claustrophobia 188 C-MAC showing glottis, screen of 69f video laryngoscope, using 68 various components of 69f Coagulation disorders 133 Coagulopathy/thrombocytopenia 395, 402, 416, 575 severe 269, 299 uncontrolled 436 Cocked biopsy gun 628f Coma 118 Combined balloon dilatation 98 Compartment syndrome 287 Computed tomography 552 midline shift of 448 Conduction abnormalities 320 Cone-cannula separation 101f Congestive cardiac failure 586 Congestive heart failure 675 Constipation 428 Copious secretions 50, 188 Coronary artery laceration 344 Cranial burr hole 430 Craniofacial trauma 62 Cricoid pressure (Sellick’s maneuver) Cricothyroid membrane 82f, 86f incision, dilation of 85 location of 51f palpation of 84 Cricothyroidotomy 78 Cricothyrotomy 26 Critical care ventilators 189 Crush injury, severe 387 Cryo-poor plasma 675, 683 Cryoprecipitate 675 Cuff pressure 110 Cuffed tubes 121 Cytomegalovirus 147 D Dandy point 432, 440f Datura stramonium 200 Index.indd 706 Deep vein thrombosis 250, 365 Dementia/poor personal hygiene 587 Dermatomal distribution 417f Diabetic neuropathy 387 Diagnostic bronchoscope, typical 136f Diagnostic paracentesis 527 Diagnostic thoracentesis 153 Dialysate fluid 603 composition of 604t Dialysis 608 access 603 apparatus 601 associated ascites 586 circuit, parts of 601f filters 609f machine 609f, 610f parts of 602f Diastolic pressure 301 Dicrotic notch 301 Differential cell count, interpretation of 151 Differential leukocyte count 534 Difficult intubation 26 history of 49 Difficult vascular-access algorithm 242 Digital ischemia 297 Dilatation method, single 92, 94 Direct cannulation 299 Directed cough 223, 227, 228f Disequilibrium syndrome 610 Dissection through rectus abdominis muscle 593f Disseminated intravascular coagulation 616, 682 Disseminated intravascular coagulopathy 268 Distal cuff 43 Distal femoral IO insertion site 282f Distal femur 282 Distal tibia 282 Distal tibial IO insertion site 283f Diverticulitis, frequent episodes of 587 Diverticulitis/diverticulosis, acute 586 Donor platelet concentrates, single 675 Double back maneuver 492f Double dandy point 432, 441f Double lumen endotracheal tube placement 71 Double lumen tube 71, 72, 72f, 76t 121 type of 73 Drainage and collecting system 441 Drainage catheters 539 Dressing kit 637f Dressing materials 640t Dressing, various types 639f Drill trajectory 443 Drug distribution, monitoring of 427 Drug poisonings 586 Drugs coated catheter 251 03-07-2015 16:19:25 Index  707 Dry powder inhalers 201 Dry tap 162 Dual chamber pacemaker 360f Dysarthria 46 Dyselectrolytemia 519 Dysphagia 46 Dysrhythmias 344 E Ear pain 46 Ear-sternal notch position 15 Edema 118 Electrolytes imbalance 446 Emergency procedure 120 Emergency surgical airway management 90 Emergency tracheostomy 120 Emergency vascular access during resuscitation 288 Empty syringe after pushing saline bolus 524f Encephalitis 447 Endobronchial intubation 27 Endobronchial hemorrhage 320 Endocarditis 321 Endogenous infections 658 Endoscopic (Seldinger) method 493f Endotracheal intubation 17, 26 Endotracheal tube 18, 21f, 31, 35, 49, 63, 65, 129, 148, 204, 214, 223 End-stage renal disease 585 End-tidal carbon dioxide 45, 138 Enteral feeding 477 Eosinophilic pneumonia 147 Epicardial wires 357, 361 Epidural abscess 402, 428 Epidural analgesia 415, 419 drugs administered for 418 technique and basic principles of 417 Epidural catheter, migration of 427 Epidural hematoma 428 Epidural needles 420 Epidural space, anatomy of 416f Epithelium 637 Erector spinae 221 Esmarch bandage, method of 389f Esophageal intubation 27 Esophageal lead 361 Esophageal stricture 478 Esophageal surgery 71 Esophageal tracheal combitube (ETC) 26 Esophageal varices 477 Esophagogastroduodenoscope 40, 499 Ethylenediamine tetra-acetic acid 161 Ewald tube 516 Exit site cuff erosion 597 Expiratory positive airway pressure 150 Exposed health care worker management of 700fc Index.indd 707 Exposed person, management of 697fc Extracorporeal membrane oxygenation 216 Extracranial contamination of venous sample 399 Extra-peritoneal segment different variations of 589f Extravasation syndrome 287 Eye irritation 198 Eyepiece 51 Ez-io insertion technique 286f Ez-io system (vidacare) 280f F Facemask, measuring scale for 195f Facial trauma, severe 477 Facilitate weaning 90 Faciomaxillary deformity 188 injuries 188 surgery 188 Failed tracheal intubation False passage insertion 89 Fantoni’s translaryngeal tracheostomy technique 99f Fasciotomy 386 Faulty setup 50 Febrile nonhemolytic transfusion reaction 684 Femoral artery catheters 663 Femoral vein 247, 310 femur—branches of 277 Fenestrated tubes 121 Fiber gelling dressings 639 Fibrinogen replacement 682 Flail chest 118, 187 Fluid administration of 288 administration set 323 analysis, interpretation of 534 bolus and drugs, administration of 288 filled system 450 imbalance 446, 519 localization of 155 Flush device 323 Foley catheter 525, 564, 570f, 581f parts of 565f Foley’s urinary catheter 522 Forceps, use of 84f Foreign body 63 larynx 118 removal 131 Fowler’s position 516, 516f Frank hemoptysis 219 Frank-Starling law 371 Fresh frozen plasma 675 Fresh intra-abdominal surgery 586 Funnel-shaped stomach tube 514f 03-07-2015 16:19:25 708  Manual of ICU Procedures G Gas density 203 Gas exchange 212 Gas exchange, alterations in 135 Gastric balloon 509f Gastric bleeding 477 Gastric contents, aspiration of 518f Gastric decompression 498 Gastric dilatation 198 Gastric distension 188, 477 Gastric irrigation 512 Gastric lavage 477, 512 Gastric mucosal lesions 498 Gastric pH, assessment of 477 Gastric ulcer 504 Gastric wall tumors 498 Gastrocolic fistula 504 Gastroesophageal junction 509f Gastrointestinal endoscopy 499 Gaucher’s disease 615 Gel facemask 192f Genital edema 597 Glasgow coma scale 118, 435, 468 coma with 188 score 448 Glidescope assisted NGT placement 482 Glidescope video laryngoscope 66f Glottis, edema of 78 Glucose concentration 535 Glycopyrrolate 65 Goalposts’ method 296 Graft-versus-host disease transfusion-associated 686 Great saphenous vein, distal tibia 277 Griggs’ technique 92, 97, 98, 105 Gross hematuria 575 Guidewire (Seldinger) technique 300 Guidewire dilating forceps (GWDF) method 97 Guidewire passed, ultrasound image of 546f Guidewire technique 588 Guidewire tube thoracostomy 167, 174 Guiding catheter 104 Guillain-Barré syndrome 402, 497 H Head injury 17, 447 Headache 610 severe 448 Heart rate 232, 374 Heat exchangers 110, 203 Hematuria catheter 565 Hemodialysis 598, 599, 601 anticoagulation 607 intolerance 586 blood flow rates in 600t Index.indd 708 Hemomediatinum 259 Hemophilia 616 Hemostat clamp 507 Hemostatic agents 138 Hemothorax 162, 258, 273, 344 Hepatic encephalopathy 448 Hepatic failure 586 Hepatic laceration 344 Hepatic necrosis 297 Hepatitis B surface antigen 700 Hepatitis B virus 691, 694, 700 Hepatitis C virus 690, 691, 694, 701 lower prevalence of 588 Hepatorenal space 160f Herpes simplex 147 Histiocytosis-X 147 Histoplasma 147 Hoarseness 274 Horner’s syndrome 274 Host factors 202 Human immunodeficiency virus 691, 694 hepatitis b virus 690 hepatitis c virus 678 Humeral IO insertion site 283f Humidification 110 Humidifier, use of 208 Hybrid therapies 600 Hydrocephalus 447 Hydrogel 639 Hydrothorax 597 Hyperalimentation 246 Hyperbaric oxygen 642 Hypercatabolism, severe 586 Hyperglycemia 297 Hypersensitivity pneumonitis 147 Hypertension 219, 232, 297 Hyperthermia 586 Hyperventilation 396 Hypoglycemia 297 Hypotension 112, 219, 232, 428, 520, 535, 610 Hypothermia 396, 519, 586 Hypovolemia 301, 416 Hypoxemia 144, 219 Hypoxemic respiratory failure 187 Hypoxia 59, 112, 520 Hypoxic brain injury 447 I IABP balloon pressure waveform analysis 378 normal 379f Iatrogenic pneumothorax 164 ICP monitoring different techniques of 449t ICP monitoring, various sites of 449f ICU bronchoscopy 140f ICU intubation 58 03-07-2015 16:19:26 Index  709 ICU-acquired infection 658 ICU-acquired infection, surveillance of 658 Ideal position 43 Ideal square-wave waveform 326 Identification, localization of 155 Idiopathic intracranial hypertension 401 Illustrate “safe triangle”, diagram to 165f Imaging-guided techniques 626 Inadvertent occupational exposure 691 Incision 173 Indwelling catheter 341 Infection 89,162, 250, 287, 321 Infection over insertion site 299 Infection/osteomyelitis 434 Infectious complications 182 Infectious disease 146, 147 Infective complications 412 Inferior vena cava 289 Inflammatory myopathy 454 Inflating balloon 571f Initiating bag, equipment required for 7f Innumerous complications 484 Inotropes, administration of 288 Inserting indwelling catheter, steps of 342f Insertion cord 52 depth of 291 failure 112 for UAC, depth of 291 for UVC, depth of 291 needle, misplacement of 112 Inspiratory positive airway pressure 150, 190 time 191 Intercostal artery laceration 162 drain placement 175f drainage bags 169 drainage tube 168 space, anatomy of 166f tube, insertion of 177f Interface injury—facial 198 Intermediate cutaneous nerve 455 Intermittent hemodialysis 599, 600 Intermittent open system irrigation 513 Intermittent positive-pressure ventilation (IPPV) 247, 269 Internal jugular vein (IJV) 247 anterior approach for 248f International normalized ratio 527 Interstitial lung disease 147 Interventional radiology room 539f Intestinal ischemia 210 perforation 297 Intraperitoneal segment different variations of 589f Intra-abdominal hypertension 520 pressure 210, 520 pressure monitoring 323, 520 pressure trace 525f Index.indd 709 Intra-aortic balloon pump 367, 371, 372, 374b, 663 arrangement of 370f arterial waveform 377f augmentations 379f console 369f counterpulsation 367 display screen 376f function of 370f position 375f complications of 382t counterpulsation 381t effect of 372f various waveforms of 380f Intracerebral hemorrhage 323, 447 Intracranial pressure 133, 210, 322, 416, 437, 461, 447, 448 effects of 437 monitoring 323 Intractable angina 415 Intraoperative bleeding 390 complications 126 Intraosseous (IO) access 276 needle 277f Intraperitoneal hemorrhage 535 Intraspinal epidermoid tumors 413 Intravascular hemolysis, acute 684 Intravascular pressure monitoring 322 Intravenous access 20 Intravenous cannula 237 Intravenous drug delivery 237 fluid administration 237 regional anesthesia 386 Intravesicle IAP measurement equipment required for 522 Intravesicle IAP monitoring equipment, setting up 522 Intubate 67 patient, bronchoscopy in 139 Intubation care bundle management 28 injury 129 Invasive ventilation in copd weaning from 187 IO needle, removal of 286 Ischemic reperfusion injury 390 Ischemic stroke 447 Isolated limb perfusion for 386 Itching 610 IV cannula, universal color coding for 240t IV cannulation, steps for 243f veins of foot used for 239f J Jamshidi bone marrow biopsy needle 618f aspiration needle 278f disposable intraosseous infusion needle 279f 03-07-2015 16:19:26 710  Manual of ICU Procedures Jejunal feeding tube 488 Jet nebulizer and compressor 202f Jet ventilation, provision of 83f Joint replacement surgeries 386 Jugular vein cannulation, anatomic landmarks for 311f thrombosis of 395 venous oximetry 395 J-wire insertion 103 K Kantrowitz cardiovad (KCV) components of 383f Keen point 432 Kidney injury, acute 598 Kiesselbach’s plexus 18 Kocher’s point 432, 439, 442, 443 located 439f Kussmaul’s sign 338 L Laboratory testing 533 drained fluid for 161 Laryngeal framework, injury to 126 Laryngeal function, visualization of 63 Laryngeal mask airway 14, 19, 26, 30, 42f, 43f, 57, 65 cuff deflated into spoon shape 41f dorsal view of 31f grasped like pen 42f insertion 30 insertion in prone position 34 positioned at laryngeal inlet 33f sizes 34 supreme 39f Laryngeal stenosis 120 Laryngectomy 486 Laryngoscope blades, different types 20, 22f Laryngoscopic view of glottis 19f guided LMA insertion 34 Laryngospasm 145, 519 Laryngotracheal stenosis 113 Layers traversed during spinal needle insertion 405f Leak testing 52 Legionella 147 Leukemias, acute 615 Leukocyte depleted platelet concentrates 675 Life-threatening hypoxemia 188 Ligament of Treitz 486 Lignocaine 65 jelly 568f toxicity 145 Limb occlusion pressure 387 Linton-Nachlas tube 507, 507f Index.indd 710 Liver using, ultrasound image of 628f Longitudinal plane, widening of 85f Lubricating jelly 138 Lucilia sericata 642 Lumbar puncture 401 Lumen tubes, single 121 Lundberg waves, characteristics of 448t Lung collapse 130 Lung compliance, decrease in 134 Lung entrapment 184 Lung expansion, failure of 184 Lung fissures, surface marking of 166f Lung injury, acute 211 Lung resection 71 Luschka, foramina of 436 Lymphocyte differential count 151 Lymphoproliferative disorders 615 M Macocha score 23 Magendie, foramina of 436 Magill forceps 22f, 508 Male urethra, anatomy of 564f Malecot catheter 539 detached, stiffener of 548f Malignant arrhythmias 188 Malnutrition, severe 586, 597 Mandibular fracture 62 Manual hyperinflation 223, 227 Manual in-line stabilization 463 Manubrium—internal mammary 277 Marking identified site 157 Mask holding 11 technique of 12f two-hand technique of 13f Mask interface 188 ventilation equipment required for 7f Mass median aerodynamic diameter 201 Maxillofacial disorders or surgery 486 Maxillofacial injuries 78 Mcgrath video laryngoscope 67f Mean arterial pressure 213, 302, 325, 438 Mechanical upper airway obstruction 117 Mechanically ventilated patients 150, 203, 205 Medications, administration of 288 Medicine, administration of 477 Meningitis 323, 447 Metabolic demand Metabolic myopathies 454 Metallic tracheostomy tube 121 Metered dose inhalers 200, 201 demonstration of 206f Methicillin-resistant Staphylococcus aureus 661 Mid tracheostomy 120 03-07-2015 16:19:26 Index  711 Mid-esophageal bicaval view 318f Mini tracheostomy 120 Minimal contact mask 193f Minimum dose heparin 607 Minor surgical procedures over hand 386 Mitochondrial cytopathies 454 Modified Paine’s point 441f Moisture exchangers 110, 203 Morbid obesity 49, 50, 91, 498 Morbid obesity/body size limitations 587 Motor function, bromage scale for 427 Mucous membranes, contact with 694 Murphy’s eye 113 Muscle biopsy 454, 455, 457, 456f sample handling 459 cramps 610 injury 390 choice of 455 Muscular dystrophies 454 Mycobacterium tuberculosis 147, 411 Mycoplasma 147 Myelodysplastic syndrome 615 Myelography 402 Myeloproliferative disorders 615 Myocardial contractility 301 Myocardial infarction, acute 133, 219, 354 Myocardial ischemia 59 Myocardial oxygen supply 371 N Nasal intubations 17, 18 Nasal mask, measuring scale for 195f Nasal pharyngeal airway Nasal polyp 18 Nasal ulcerations 198 Nasogastric tube 63, 477, 479f, route of 478f Nasojejunal tube 486 endoscopic insertion of 494 Nasopharyngeal airway 21f size, adequacy of 10f Nasopharyngeal tumor 478 Nasotracheal intubation 26, 56 additional preparation for 55 Nausea, vomiting 428, 477, 610 Nebulizer, steps for use of 207, 201 Neck flexion 482 lateral neck pressure 482 Necrotizing enterocolitis 289, 297 Needle and stylet 407f advancement of 424f cricothyroidotmy 80, 81 in urinary bladder 579f recapping is medical sin 692f stick injury 241f technique 528, 530 Index.indd 711 Needle-stick injury 690,693 fc Nerve biopsy 454, 455, 456 sample handling 459 Nerve injuries 259, 390 selection of 455 Neurogenic bladder 521 Neurological deterioration, acute 395 disease 118, 416 examination results, change in 520 Neuromuscular blockade 334 diseases No-heparin hemodialysis 607 Nonalimentation indications 498 Non-cardiac conditions 309 Non-chronic obstructive lung disease 647 Noncompliant pressure tubing 323 Nondistended, nonpalpable bladder 574 Nondominant hand, use of 82f Non-expanding lung after placing chest tube 185f Nonimaging-guided techniques 626 Noninfectious disease 146, 147 Non-invasive ventilation 150, 187, 208 complications of 198 contraindications of 188 machine 191 modes of 190 setting up of 196 support, types of 189 technique and basic principles of 188 using full facemask 190f using helmet interface 194f using nasal mask 193f using total facemask 194f weaning from 198 with facemask in child 192f Non-invasive ventilation-assisted bronchoscopy 188f Non-nucleoside reverse transcriptase inhibitor 697 Non-rebreathing mask 20 Non-target catheterization or puncture 550 Nonthrombotic occlusion 266 Non-traumatic amputations 386 catheters 605 Nosocomial pulmonary tract infection 232 Nostril, selection of 481 Nucleoside reverse transcriptase inhibitor 697 O Obesity hypoventilation syndrome 190 fatty abdomen 587 Obstructive ileus 416 sleep apnea 187, 190 Oliguria 520, 598 unexplained acidosis, mesenteric ischemia 323 03-07-2015 16:19:26 712  Manual of ICU Procedures On-site microbiology laboratory, role of 659 Open and clean airway 14 fractures of leg 387 pericardiocentesis 338 Operative tube thoracostomy 167, 172 equipment needed for 167f Operator unfamiliar with equipment 63 Opioids, allergy to 416 Optimal technique for delivering MDI 208 Oral anticoagulants 419 cavity finger manipulation of NGT 482 intubations 17 Orofacial bleed, maxillofacial trauma with 63 Oropharyngeal airway 20f size, adequacy of 9f Oropharyngeal surgery 486 Oropharyngeal tumors 486 Oxygen saturation 133, 313 Oxygen source 20 Oxygen tubing, attachment of 83f cerebral metabolic requirement of 395 supply of 15 Oxygenation, failure of P Pacemaker setting 362 spike 364f Paceport PAC 356 Pacing mode 361 Pacing rate 361 Pain service, acute 427 Palliative care 643 Pancreatitis 415, 586 Papilledema 448 Paracentesis 527 Paragonimus westermani 147 Paralytic ileus 415 Paramedian incision 592f Paraneoplastic syndromes 402 Paratracheal structures 126 Paroxysmal supraventricular tachycardia 354 Partial inflation technique 34 Particle crush technique 623 Patil fiberoptic airway 58 PCD, equipment needed for 542f PD catheter removal, indication of 596 Peak end expiratory pressures 520 Peak systolic pressure 300 Peel-away cannula technique 262 PEG tube endoscopic removal of 503f removal of 503 removal, techniques of 503 size of 499 Pelvic trauma 521 Penis with thumb, closing tip of 569f Index.indd 712 Pentax-AWS, using 67 Percussion 222 technique for child 226f Percutaneous catheter drainage 537 dilatational tracheostomy 90, 120 step of 105f, 106f, 107f, 108f drainage 538 catheters, types of 540f endoscopic gastrostomy 497 injury 694 needle aspiration 338 nephrostomy 539 technique 595 tracheostomy methods classification of 92 Performance test (preuse check) 40 Pericardial drain, insertion of 341 Pericardial effusion, pathophysiology of 337 Pericardial tamponade 258 Pericardiocentesis 336 steps of 341f Periodic training 692 Perioperative registered nurses association of 387 Peripheral and central arterial waveforms 301 Peripheral circulation 373 Peripheral liver parenchyma biopsy gun shaft in 629f Peripheral vascular collapse due to shock 276 Peripheral vascular disease 586 severe 299, 387 Peripherally inserted central catheters 261 Peritoneal dialysis 210, 585f, 587, 591 catheter placement 585 preferred in patients with 586 Peritoneal leaks 586 Peritonitis 535 Peritubal leak 184, 185 Periurethral abscess 574 Periwound skin, condition of 636 Persistent leak of ascitic fluid 535 Persistent PEG site infection 503 Pharmacological preparation of patient 55 Phlebitis 266 Phlebostatic axis leveling to 332f transducer level to 334f transducer position above 334f Phlebostatic point transducer position below 334f Phrenic nerve injury 274 Physiologic basis for mobilization 648 Physiotherapy technique manual hyperinflation with 229 Pigtail catheter 540 Pinna, behind top of 440f Planned biopsy site 455 03-07-2015 16:19:26 Index  713 Plasma components 675 Plasmapheresis 246 Platelet concentrates 677t Pleura, surface marking of 166f Pleural cavity 168f Pleural effusion 164 identification of 156f Pneumocystis jirovecii 147 Pneumonia 661 Pneumopericardium 344 Pneumothorax 112, 133, 144, 161, 163, 198, 247, 258, 344 Poiseuille’s law 251 Polycystic kidney disease 591 Polydioxanone suture 560 Polytetrafluoroethylene 604 Polyvinyl chloride 291 Ponsky pull technique 498, 501f Poor cardiac function 586 Poor home hygienic conditions 587 Poor peripheral venous access 246 Portable bilevel pressure devices 190f Portal hypertensive gastropathy, severe 498 Portal vein thrombosis 297 Positive end expiratory pressure 8, 50, 150, 224, 310, 664 Possibility of renal transplantation in near future 586 Post-biopsy paresthesia and sensory loss 459 Post-bariatric surgery 477 Post-bronchoscopy fever 145 Post-craniotomy 323 Post-dural-puncture headache 412 Posterior approach for internal jugular vein cannulation 249f Posterior iliac crest site 619 Posterior rectus sheath, dissection of 593f Posterior superior iliac spine 616 Posterior tracheal wall, laceration of 112 Post-exposure counseling 692, 699 Post-exposure prophylaxis 692, 697, 701 for hepatitis 699 for HIV 696 Post-extubation failure in COPD patients 187 Postirradiation of bladder 521 Postspinal headache 427 Post-tracheostomy tube placement 109 Post-transfusion purpura 686 Postural drainage 223, 229 PRBCS, types of 675 Preadolescent children 91 Precautionary immobilization 463 Predialysis 608 Preexisting infection or malignancy 90 Preexisting tracheomalacia 91 Pregnancy 575 women with third trimester of 586 Preintubation 28 Index.indd 713 Preoperative marking of abdomen 591f Pressure applied using screwing motion 285f Pressure hydrocephalus, normal 402 Pressure measurement 328 Pressure monitor 323 Pressure transducer 322, 323 system set-up 328 technique and basic principles of 323 with flush device 324f Pressure tubing 325 Pressure ulcer pathophysiology of 631 stage 636 treatment of 636 various grades of 633f various stages of 633t Pretracheal fascia 123f Previous abdominal surgeries 587 Previous radiation therapy 269 Previous surgery at tracheostomy site 91 Primary hemorrhage 126 Primary spontaneous pneumothorax 163 Primary survey and resuscitation 467 Priming tubing 329 Problems and troubleshooting 15 Product water for hemodialysis 603 Prognostication following cerebral injury 395 Prolonged air leak 184 Prone positioning 210 Proning, various steps of 216f Pro-seal laryngeal mask airway all sizes of 38t parts of 36f Pro-seal LMA 35 Prostacyclin regional anticoagulation 608 Prostate and lower urologic surgery 521 Prostatitis, acute 574 Prosthetic ileofemoral grafts/iliac artery stents 368 Prosthetic valvular disease 586 Protect upper airway 188 Prothrombin time 540 Proximal tibia 280 IO insertion site in children 281f popliteal vein 277 Proximal vascular injury, suspected 269 Pruritus 428 Pseudomonas aeruginosa 412 Pseudotumor cerebri 401 Psychotic disorders, severe Pull technique 500 Pulling Snap-tab, activation of 326f Pulmonary arterial hypertension, severe 133 Pulmonary artery catheter 309, 356 Pulmonary artery occlusion pressure 317 Pulmonary capillary wedge pressure 317, 322 Pulmonary diseases 118 Pulmonary edema 219, 598 03-07-2015 16:19:26 714  Manual of ICU Procedures Pulmonary embolism 391 Pulmonary hemorrhage 147 Pulmonary infarction 321 Pulmonic valvular stenosis 310 Pulse contour analysis 298 Pulse pressure 301 variation (PPV) 298 Puncture needle 314f, 542f Puncture technique 303 Push technique 501 Pyrogen reaction 610 Q Quincke’s needle 407f R Racheostomy tube 214 Radial artery insertion puncturing skin 306f techniques of 299 Radial nerve at wrist superficial cutaneous branch of 455 Random donor platelet concentrates (RDP) 675 Red blood cell 674, 675, 681 components 676t units 678 Re-expansion pulmonary edema 162, 182 Refractory congestive heart failure 586 Refractory hyperkalemia 598 Refractory metabolic acidosis 598 Renal function, monitoring of 563 Renal insufficiency 297 Renal replacement therapy, modalities of 599 Respiration, muscles of 220 Respiratory arrest 17, 188 Respiratory depression 428 Respiratory distress syndrome acute 148, 647 severe acute 210 Respiratory failure 3, 118 due to obesity hypoventilation syndrome 187 in immunocompromised patients 187 Respiratory instability 402 Respiratory monitoring 231 Respiratory muscle weakness 218 Respiratory rate (RR) 224 Retrograde cannulation, anatomical landmarks for 396f Retroperitoneal bleed 250 Reverse osmosis plant 603f Reverse Sellick’s maneuver 482 Robinson catheter 565 Rotahaler, demonstration of 207f Russell introducer technique 498, 502, 502f Index.indd 714 S Scalenes 220 Scalp incision 443 Sclerosing encapsulating peritonitis 597 Scoop stretcher 467f method/maneuver 465 use of 466 Screw single dilators 95f Sedation, level of 427 Sedatives, use of 396 Seizures 396 Seldinger technique 80, 87, 167, 532, 538, 541 modified 262 Seldinger’s method 93 Self-inflating bag, parts of 8f Sellick’s maneuver 5, 28 Semi-Fowler position 516 Sengstaken-Blakemore tube correct position of 510f fixation of 510f modified 507, 508f Sensory analgesia dermatomal distribution of 417 dermatomal level of 427 Sepsis 3, 268, 321, 549 airway infection 232 uncontrolled 368 Septicemia 365 Serratus anterior 221 Shaking 222, 227 Shunt system malfunction 436 Sickle cell disease 387 Silicosis 147 Skin incision and dissection 103 at marked site 580f Skin injury 390 Skin preparation 264 Skin sterilization 173 Skull fractures 486 Slough 637 in wound 638f Small skin incision, placement of 158 Soybean casein digest 669 Space-occupying lesions 323 Special oral airways 58 Spinal board 466 Spinal cord injury 460 Spinal needle insertion technique 410f Spine board 471 application, logrolling of 471f stabilization 468f Spine deformity 416 Spine immobilization contraindication of 461 during imaging 470 in trauma patient 460 03-07-2015 16:19:26 Index  715 Spontaneous bacterial peritonitis 533 Spontaneous breath 203 Spontaneously breathing patient 149 bronchoscopy for 140 Square wave test 326 Staphylococcus aureus 412, 442, 445, 642, 659 Sterile container, assembly of 149f Sterilization/disinfection 45, 52 Still’s disease 50 Stoma care 110 Stomach pumping 512 Stomach tube 515f Stomal erosion or infection 113 Stomal granulation 112 Stomal infection 112 Straddle lift and slide method/maneuver 463 technique 464f Streptococcus salivarius 412 Stridor 62 Stroke volume 374 variation 298 Strongyloides 147 Stump neuromas 459 Stylet 21 cook disposable intraosseous infusion needle with 278f Magill’s forceps, bougie 20 Subarachnoid hemorrhage 435, 447 Subarachnoid injection 427 Subclavian vein (SCV) 247 Subcutaneous emphysema 79, 112, 182 Subcutaneous tunnel, creation of 594f Subglottic stenosis 62 Suction 138, 224, 229 inserting catheter without negative pressure 231f machine and catheters 20 withdrawing suction catheter with negative pressure 231f Superficial peroneal nerve at shin 455 Superior sagittal sinus 436 Superior vena cava 310 syndrome 246 Supplemental feedings 498 Suprapubic specimen 673 Sural nerve after dissection 457f Sural nerve below lateral malleolus 455 Sural nerve on posterior lateral ankle, distribution of 456f Surgical cricothyroidotomy 84f Surgical emphysema 127 Surgical site preparation 432 Surgical tracheostomy 117, 125f Surveillance systems 658, 659 Suspected fungal infections 129 Suspected viral 129 Sutured fixation 265f Index.indd 715 Sutureless fixation 265f Swan-Ganz bipolar pacing catheter 357f Swan-Ganz catheter 311 Swivel adapter 138 with central orifice 136f Sylvius, aqueduct of 436 Systemic arteriovenous fistula 182 Systemic illness neurological deterioration due to 395 Systemic vascular resistance 374 Systolic pressure variation 298 T Tapered dilator technique, single 92, 94 Temporary abdominal closure methods advantages of 557t disadvantages of 557t Therapeutic paracentesis 527 Thermodilution paceport PAC 357f Thermodilution pacing PAC 356 Thoracentesis 153 Thoracic aortic aneurism, repair of 71 Thoracic squeezing 228f Thoracic surgery 415 Thoracoscopic pericardial drainage 338 Thoracoscopy 71 Three-bottle collection system 170f Thromboangiitis obliterans 299 Thrombocytopenia 133 severe 269, 616 Thromboembolism 365 Thrombosis and subsequent embolism 296 Thrombotic thrombocytopenic purpura 683 Thrombus formation 266, 321 Thumb insertion technique 34 Thyroid cartilage 79, 79f immobilization 84 laceration of 89 Thyromental distance 49 Touch (imprint) smear 623 Toxoplasma gondii 147 Trachea stabilization of 85 surgical anatomy of 119f Tracheal dilatation 104 Tracheal disruption 79 Tracheal injury 78, 113 Tracheal necrosis 127 Tracheal stenosis 127 Tracheal tube misplacement 112 Tracheal walls 124f Tracheoesophageal fistula 113, 127, 128, 130 Tracheoinnominate artery fistula 113 Tracheostomy 26, 117 anatomy relevant to 91f types of 120 with speaking valve 121 03-07-2015 16:19:26 716  Manual of ICU Procedures Tracheostomy tube insertion of 86f placement of 85 size, selection of 121 type of 121 widening of 85f Tract, creation of 176f Tranquil tracheostomy 120 Transbronchial biopsy 144 Transcutaneous pacing 356 Transducer 253f Transducer and pressure monitoring 302, 322 Transducer housing 323 Transducer preparation 328 Transducer system, concepts of 324 Transesophageal echocardiography 317 probe 63 Transesophageal pacing 358 Transfixion technique 300 Transfused red cells delayed hemolysis of 686 Transfusion of blood adverse reaction due to 685t Transfusion reaction, acute 684 Transient blindness 448 Transient cranial nerve palsies 413 Translaryngeal technique (retrograde) 92, 99 Translaryngeal tracheostomy 99 Transmission risk pyramid due to different viruses 691f Transparent dressing 426f Transparent films 639 Transthoracic pacing 358, 361, 246, 355 Transvenous pacing leads 355f Trapezius 221 Trapped lung 164, 185 Trauma 118, 435 Traumatic amputations 386 Traumatic brain injury, severe 323 Traumatic complication 495 Traumatic foreign body inside oral cavity 78 Traumatic pneumothorax 164 Traumatic urethral disruption 574 Trendelenburg position 553 Triglyceride concentration 535 Trismus 62, 78 Trocar technique 538, 543 Trocar tube thoracostomy 167, 180 Trocar with cannula 581f Tube displacement 112 and blockage 127 Tube malposition 181 Tube placement, confirmation of 518f Tube position, confirming 180 Tube thoracostomy 163, 163 Tubeless method 515 Tuberculous meningitis 402 Tumor 118 Index.indd 716 mass occluding left main bronchus 130f necrosis factor 601 Tunneled catheters 605 Two-bottle drainage system 170f U Ugly scar 113 Ulcer, multiple sites of 632f Ultrasound beam 156f Ultrasound guidance technique 529 Ultrasound probe 406f alignment of 629f vertical placement of 407f Ultrasound-guided central venous cannulation 251 Ultrasound-guided cricothyroidotomy 80, 88 Ultrasound-guided internal jugular vein cannulation 256 Ultrasound-guided procedure 257 Ultrasound-guided technique 533 Umbilical arterial catheter and umbilical venous catheter 288 Umbilical arterial catheterization 288, 295 depth of 293f Umbilical catheter size based on birth weight 291t Umbilical catheters 289 Umbilical vascular catheterization 288 Umbilical vein catheterization 288, 294, 295f, 297 depth of 292f Umbilical vessels 294f applied anatomy of 290f Unanticipated failed intubation 49 Uncooperative patient 50, 563 Uncorrectable coagulopathy 537 Uncuffed tubes 121 Underdamped system 328f Underwater seal bag, chest tube 178f Undrained pneumothorax 219 Universal precautions material 11f Unprepared airway 50 Unstable angina 133 Unstable arrhythmias 133 Unstable cervical spinal injuries 90, 486 stabilization of 469f Unstable spine patient logrolling technique in 464 Upper airway anatomy 19f Upper airway obstruction 17 Upper esophageal aortic arch 319f Upper extremity veins diagrammatic representation of 262f Upper gastrointestinal (GI) bleeding 188 Upper GI bleed, balloon tamponade in 506 Uremia, severe 133 03-07-2015 16:19:26 Index  717 Uremic encephalopathy 598 Uremic pericarditis 598 Urethral catheterization 563 Urethral mucosal trauma 572 Urethral stricture 563, 574 Urinary bladder anatomical position of 575f Urinary retention, acute 563 Urinary tract infection 572, 661 Urine acute retention of 574 sampling 671 USG-guided lumbar puncture 405 V VAC therapy application of 561 sponge of 561f Vaccination 691 Valve mechanism, appropriateness of 15 Valvular damage 320 Vascular injury 390 tourniquet for 386 Vasoactive medication 322 Vasoactive substances, infusion of 246 Vasospasm and lower limb ischemia 297 Vasovagal syncope 162 Venopuncture at carotid triangle 273f Venous cannulation central venous catheter 246 peripheral 237 peripherally inserted central catheter 261 Venous puncture 271 Ventilated patients manual chest physiotherapy in 218 Ventilation 13, 103 catheter, placement of 100f failure of mode of 203 Ventilator parameter 231 Index.indd 717 Vertebral anomalies 402 Vertebral column showing vertebral body 403f with nerve roots 462f Vessel perforation 296 Vibration 222, 227 using both hands 227f Video laryngoscope 62, 65 Vocal cord bilateral abductor paralysis of 120 palsy 63, 118 Vomiting, severe 448 von Willebrand factor (von Willebrand disease) 683 W Walls of artery, anatomy of 238f Warmed saline 65 Water-soluble lubricant 507 Waveform during ICP monitoring 447f Wedge method 623 Well-evidenced indications 187 White blood cells 412, 527 Whole blood cell 674 components 676t Working channel port 52 Wound fillers 639 Wound infection 127 and dehiscence 459 Wrong transducer positioning 525 Z Zeroing transducer 523f to atmospheric pressure 331, 331f ZN-stain adenosine deaminase activity 535 Z-track technique 530, 532 for seldinger technique 533 of needle insertion 532f 03-07-2015 16:19:26 ... Table 1  Depicting color coding of the different size of lumbar puncture needles Size (in gauge) Color 18 Pink 19 Beige 20 Yellow 21 Green 22 Black 25 Orange 26 Brown 27 Gray • Stylet (prevents unintended... (Fig 6) 34.indd 421 24 -06 -20 15 14:38:39 422   Section 3: Neurological Procedures A B Figs 5A and B  (A) Epidural kit; (B) Epidural tray Fig 6  Prepping and draping 34.indd 422 24 -06 -20 15 14:38:39... correct location of the tip of catheter • Asepsis of the catheter and the underlying skin 32. indd 398 24 -06 -20 15 14:37:45 Jugular Venous Oximetry  399 Fig 4  Radiograph of placement of jugular bulb