Easy Points: Surgery - Surgical Complication

  1. Veins used in central venous access lines
    1.Subclavian vein

    2.Internal jugular vein

    3.Femoral vein

    4.Brachial vein (Basilic & Cephalic vein)
  2. Steps used to decrease complication of central venous access lines
    • 1.Not done to all
    • patient to check the preload of the heart. (11-16cm H2O – if intubated  21 – 26cmH20) or (8-12mmHg)

    • 2.Experienced
    • personnel, proper positioning and sterile technique. 

    • 3.Not used for IV
    • medications, and should be removed once it serve its purpose

    • 4.Catheter position
    • should be check
  3. One of the common complications of central venous access using subclavian & Int. jugular
    Usually due to clinically inexperienced physicians.  
    Chest x-ray is still needed to confirm.
  4. Management of pneumothorax if patient is stable
    Observation may be adequate
  5. Treatment for pneumothorax if patient is symptomatic
    Thoracostomy tube
  6. –(the
    most common complication) result from myocardial irritability secondary to the
    guide wire placement

    –usually will resolve when the catheter or guide wire is
    withdrawn from the right heart.
    • Transient arrhythmias during catheter
    • insertion
  7. –0.2 to 1% of patients

    –mortality can reach
    50% if larger than 50 mL.

    –portable chest x-ray may be required (auscultation can’t help)
    Air embolus
  8. Treatment for air embolism
    aspiration via a central venous line 

    surgical removal of the air, or if an angiographic approach is undertaken.
  9. How do you aspirate an air embolus via a central venous line?
    • •place the patient in
    • the left lateral decubitus position and in Trendelenburg position, so the entrapped air can then be aspirated or
    • anatomically stabilized within the right ventricle.
  10. mortality rates of central venous line infection
    mortality rates of 12 to 25%
  11. Type of infection that presents
    a unique problem because of the potential for metastatic seeding of bacterial
    Staphylococcus aureus infections
  12. Treatment for Staphylococcus aureus infections
    4 to 6 weeks of tailored antibiotic therapy.
  13. Which procedure?

    the most dreaded complication is perforation.

    Perforation may occur for 1:10,000 patients
    Gastrointestinal endoscopy
  14. Increases the incidence of perforation during gastrointestinal endoscopy
    1.with biopsy (0 to 30%)

    • 2.presence of weakened tissue in the
    • wall of the intestine related
    • to an inflammatory response secondary to
    • infection (e.g.,
    • diverticulitis) or glucocorticoid use (e.g.,
    • inflammatory bowel disease).
  15. Which procedure and complication?

    diffuse abdominal pain shortly after the procedure, and then will quickly
    progress with worsening abdominal discomfort on examination.
    Gastrointestinal endoscopy, perforation
  16. Radiologic evidence of perforation due to gastrointestinal endoscopy
    –free intraperitoneal air (Chest X-ray)
  17. Treatment for perforation due to gastrointestinal endoscopy
    surgical exploration to locate the perforation

    candidate for none operative patient - does not have significant pain or clinical signs of perforation
  18. Management for perforation due to gastrointestinal endoscopy
    • (closely observed for 48 to 72 hours to detect any deterioration in clinical status. If
    • the patient remains with an uneventful course, a diet is gradually increased
    • and the antibiotics discontinued after 3 to 7 days. If the patient clinically
    • deteriorates at any time, immediate surgery is required)
  19. Indications for which procedure?
    1.removal of foreign

    2.biopsy for cancer

    3.difficult intubations

    4.delivery of
  20. Contraindications for which procedure?

    1.partial arterial
    pressure of oxygen (PO2) less than 60 mm Hg on 100% supplemental oxygen

    2.an evolving
    myocardial infarction

  21. Complications of which procedure?
    1.bronchial plugging , lobar collapse



  22. The most common complication due to bronchoscopy
    bronchial plugging
  23. Treatment for bronchial plugging and lobar collapse
    Pulmonary toilet
  24. Treatment for bleeding due to bronchoscopy complication
    Stop spontaneously, endoscopy for thermocoagulation or fibrin glue application.
  25. Indications for which procedure?
    1.Prolong intubation (most common)

    2.Provide better pulmonary toilet

    3.Head and neck trauma

    4.Head and neck malignancy
  26. Complications of tracheostomy

    2.Tracheo-innominate artery fistula (TIAFs)
  27. –rarely occur (0.3%),

    –50 to 80% mortality

    –occur as quickly as 2
    days / late as 2 months post procedure.

    –thin woman with a
    long, gracile neck.

    The patient may have
    a sentinel bleed, which occurs in 50% of these cases, followed by a most
    spectacular bleed.
    Tracheo-innominate artery fistula (TIAFs)
  28. Management of sentinel bleed
    • the patient should be transported immediately to the operating room for fiber-optic
    • evaluation
  29. Treatment for which complication?
    -Inflate the tracheostomy balloon cuff to high pressure in order to attempt compression of the innominate artery.  

    -If needed, remove the tracheostomy, and place a finger through the tracheostomy site in order to apply direct pressure anteriorly for compression of the innominate artery.  

    -Sterile preparation of the patient for a median sternotomy should include the assistant's hand in the operative field. 

    -Once exposed, surgically ligate the innominate artery proximally and distally to the injury. 

    -Mobilize a soft tissue flap to protect the injured tracheal site from recurrent fistula.
  30. Indications for which procedure?


    3.Pleural effusions

    Tube thoracostomy
  31. Complications for which procedure?
    1.Inadequate analgesia
    or sedation

    penetration of the pleura with formation of a subcutaneous track for the tube

    3.Lacerations to the
    lung or diaphragm

    4.Bleeding related to
    these various lacerations or injury to pleural adhesions.

    5.Slippage of the tubes
    out of position, or mechanical problems related to the drainage system.
    Tube thoracotomy
  32. •less commonly
    performed in the emergent trauma setting, but the indications
    are chiefly for the hemodynamically-unstable patient who arrives in the
    emergency department with neurologic impairment and an uncertain etiology for
    blood loss
    Peritoneal lavage
  33. Complications due to peritoneal lavage
    1.Perforation of urinary bladder (foley catheter)

    2.Perforation of the stomach and small bowel (NGT)
  34. Indications for which procedure?

    2.Pathologic diagnosis

    3.Prognostic evaluation
  35. Complications of which procedure?


    3Lymph leakage, and seromas.
  36. Major factors of wound infection
    1)Breaks in surgical technique

    2)Host parasite relationship
  37. Potential sources of contamination
    Patients themselves

    Operating room and personels
  38. Common organisms involved in wound infections
    1)Staphylococcus aureus

    2)Enteric organism (E. coli, Bacteroides, Proteus, Klebsiella, Pseudomonas)
  39. Factors involved in wound infection
    Nature of wound


    Presence of medical problems (diabetes/steroid tx)

    Duration of operations and preoperative stay in the hospital
  40. Local factors for nosocomial infections
    1.Adequacy of tissue blood supply:

    •Devitalized tissues

    •Dead space ----> hematoma, seroma

    2.Foreign bodies
  41. Systemic factors for nosocomial infections
    • 1.Age: 
    • very young (neonates) and elderly

    • 2.Obesity: poor blood supply in adipose
    • tissue

    3.Systemic illnesses:

    •Malignancy, Diabetes, Hepatic cirrhosis

    4.Medications taken (steroids)
  42. Which procedure?
    - to decrease local wound edema and to promote healing through the application of a sterile dressing that is then covered and placed under controlled suction for a period of 2 to 4 days at a time.
    Vacuum assisted closure (VAC)
  43. Reasons to apply a surgical drain
    • 1.To collapse surgical dead space in areas of redundant
    • tissue (e.g., neck and axilla). 

    • 2.To provide focused drainage of an abscess or infected
    • surgical site. 

    • 3.To provide early warning notice of a surgical
    • leak—either bowel contents, secretions, urine, air, or blood. 

    4.To control an established fistula leak.
  44. used for large contaminated wounds such as perirectal or perianal fistulas and subcutaneous abscess cavities. Suggested
    for highly contaminated wounds
    Open drain
  45. Open or closed drains?
    a.Penrose drain

    b.Wick gauze drain
  46. Management for which type of drain?
    –Twenty-four to 48 hours of antibiotic use after drain placement is prophylactic
    Closed suction drain
  47. •number one nosocomial infection, usually gram (-) bacteria (usually
  48. •Cultures with more than 100,000 CFU/ml should be treated with the appropriate antibiotics and the catheter removed as soon as possible or change every 3 days

    •Under treatment or misdiagnosis can lead to urosepsis and septic shock.
  49. Treatment for UTI
    • appropriate antibiotics and the catheter
    • removed as soon as possible or change every 3 days
  50. Causes of which complication?
    1.overwhelming pneumonia

    2.retained hemothorax

    3.systemic sepsis

    4.esophageal perforation from any cause
  51. Diagnosis for empyema
    Chest x-ray or CT scan

  52. aspiration of pleural fluid for bacteriologic analysis. (Gram's stain, LDH, protein, pH,
    and cell count are ordered)
  53. Treatment for empyema
    –broad-spectrum antibiotics

    • –thoracostomy tube is needed to evacuate and drain the infected
    • pleural fluid

    • –Video-Assisted Thoracoscopy (VATS) may also be helpful
    • for irrigation and drainage of the infection.
Card Set
Easy Points: Surgery - Surgical Complication
Surgery: Surgical Complication