DRILLING

Although we have many kinds of probes and different places to use them, we basic
ally hold this class in the polls bladder, rectal and gastrointestinal. Importan
t is the correct definition of the probe and catheter, which are often used for
similar functions. Probe is defined as a tube is introduced into the body channe
l, natural or not to recognize her status, extract or introduce some kind of mat
ter. In the definition of catheter are: tubular instrument that is inserted into
the body to remove fluids, enter blood, serum, drugs and perform diagnostic inv
estigations. Catheterization When the urine can not be eliminated naturally, mus
t be drained artificially through tubes or catheters that can be introduced dire
ctly into the bladder, ureter or renal pelvis. The bladder catheterization is th
e introduction of a probe or catheter into the bladder, which can be performed t
hrough the urethra or through the suprapubic, and aims at removing the urine. It
s main indications are: obtaining aseptic urine for examination, bladder emptyin
g in patients with urinary retention, in preparation for surgery and even after
surgery to monitor urine output and hours unconscious patients, for the determin
ation of residual urine or with neurogenic bladder lacking an adequate sphincter
control. The Catheterization can be said with relief, when there is withdrawal
of the probe after bladder emptying, or delay, when there is a need to stay the
same. In those polls delay, the bladder is not full or contracts to be emptied,
losing over time, some of its tone and leading to the inability of muscle contra
ction detrursor, so before the removal of urinary catheter, training with closin
g and opening of the probe intermittently, should be performed for the preventio
n of urinary retention.
Catheter to relieve bladder Probes delay of two and three-way roads when there i
s a need for a probe delay, it is imperative to use a closed system of drainage,
which consists of a probe or indwelling catheter, a tube connection and a colle
ction bag that can be emptied through a drain valve, all to reduce the risk of i
nfection (illustration below).
The risk of infection is inherent in the procedure, bacterial colonization occur
s in half of patients with probe delay for two weeks and almost all patients aft
er six weeks of polling. Known
that the urinary tract infections account for one third of all hospital infectio
ns, and that in most cases there was an invasive urinary tract procedures such a
s micro-organisms can gain access to the urinary tract through the urethra at th
e time of probing through the thin liquid layer to the external urethral probe a
nd through the inner light of the probe after contamination. This infection rate
is so even with the obedience of all the precepts of a good technique for bladd
er catheterization. Suprapubic bladder drainage - is performed by inserting a ca
theter after an incision or puncture in the suprapubic region, which is surgical
ly prepared, and the catheter is then connected to a closed drainage system. Its
main indications are patients with urinary retention, urethral obstruction not
amenable to catheterization in patients with prostate cancer or in patients with
plegias, ie when there is need for chronic use of the probe. There are several
advantages of suprapubic drainage: patients are able to urinate earlier, is more
comfortable than a probe of trans-urethral delay, allows the patient greater mo
bility, ease of exchange of the probe and mainly presents a lower risk urinary t
ract infection. The disadvantage is to be a surgical method.
Suprapubic bladder drainage
TYPES OF PROBES or catheter - range of designs and materials, according to the t
ype of poll, whether relief or delay. For surveys of relief, the most used are t
he probe NELATON; for polls delay probes have two-way, as Foley (figure below) o
r three-way bladder washing.
PROCEDURE - for the necessary materials: sterile pack containing: cuba kidney, f
enestrated field, tweezers, gauze, ampoules of distilled water, 10 ml syringe an
d tank rounds, and also: urinary catheter, sterile gloves, bottle with an antise
ptic solution (polyvinylpyrrolidone) bag, plastic container for urine collection
and lubricant (sterile xylocaine). We should start a guide to patient needs and
techniques. After proper washing of hands, you should gather all the material n
eeded for the procedure.€The isolation of patients in rooms
Community is human. How to best position is for women to gynecological and men i
nto the supine position with legs apart. After opening the package catheterizati
on, sterile gloves. In women, perform antisepsis in the pubic area, labia and pu
t field fenestrated; dehisce the labia and urethral meatus to antisepsis, always
towards the anus, urethra, taking into consideration that the hand in contact w
ith this area is contaminated and not should return to the field or probe. Inser
t the probe in the lubricated urinary meatus up to check the output of urine. If
a Foley catheter, inflate the balloon up with distilled water, following the vo
lume identified in the probe. Connect the extension, to fix the probe and to gat
her material. If a probe of relief, waiting to empty the bladder and immediately
remove the probe. In men, after antisepsis of the pubic region, takes place the
same in the penis, including the glans with a circular motion, and the passage
of the catheter, it pulls itself up by introducing the probe slowly. Delay in bl
adder catheterization, with the closed drainage system, one must observe some ru
les for reducing the risk of urinary tract infection: never raise the collection
bag above the bladder; thorough cleaning twice a day around the urethral meatus
, never disconnect the drainage system closed, and the exchange system should b
e conducted every seven days in every woman and man in 15 days, or in the presen
ce of inflammatory signs. Poll GASTROINTESTINAL The passage of the probe tract i
s the insertion of a tube of plastic or rubber, flexible, mouth or nose, whose o
bjectives are:
1. 2. 3. 4. 5. 6.
decompress the stomach to remove gas and fluids to diagnose motility administer
medicines and foods to treat an obstruction or a site with more bleeding gastric
contents for analysis
TYPES OF PROBES - We will emphasize that the most used are the nasogastric tubes
, and the most used for decompression, suction and irrigation (washing): Levin,
simple gastric Salem, Miller-Abbott and others, for food and drug administration
: Levin, nutriflex, Dobhoff and to control bleeding from esophageal varices: Sen
gstaken-Blakemore. Probe Levin - has a single lamp, manufactured with rubber or
plastic, with openings located near the tip, the circular marks contained at spe
cific points of the probe serves as a guide for insertion (Figure 1) gastric pro
be simple - is a naso- radiopaque gastric clear plastic, equipped with two lamps
, used to decompress the stomach and keep it empty. Dobhoff probe - probe freque
ntly used for enteral feeding, and has a characteristically heavy and flexible t
ip (Figure 2) Probe Nutriflex - has 76 cm long with a heavy spike of mercury to
facilitate insertion. Sengstaken-Blakemore probe - a probe is used specifically
for the treatment of bleeding from esophageal varices, and has three lights with
two balloons, and a light to inflate the gastric balloon and one for the esopha
geal balloon. Sonda Miller-Abbott - is of two lights, one for introduction of me
rcury or air in the balloon at the end of the probe and the other for aspiration
.
Figure 1
PROCEDURES
Figure 2
1. instruct the patients about the procedure
2. handwashing 3. gather the material and lead to the patient, probe, beaker wit
h water, 20 ml syringe, gauze, water soluble lubricant (xylocaine jelly) tape, s
tethoscope and gloves. 4. position the patient in supine or Fowler 5. measure th
e length of the tube: the tip of the nose to the base of the ear and down to the
end of the sternum, scoring with a strip of adhesive tape 6. Apply oropharyngea
l anesthetic spray to facilitate the transition and suppress the gag reflex. 7.
doping of approximately 10 cm. initial probe of a substance soluble in water (KY
gel), introduced in one nostril, and after the introduction of part-oiled, flex
ing the neck so that the chin toward your chest. Request for the patient to make
swallowing motions during the passage of the probe through the esophagus, notin
g if it is not in the oral cavity. 8. introducing the probe to the brand of tape
. 9. fix the probe, after confirmation of their placement.
Fixing PROOF OF CORRECT POSITIONING
1. Hearing test: Place the diaphragm of the stethoscope at the time of the patie
nt's stomach and quickly inject 20 cc of air through the probe, and the right th
ing is to hear the characteristic noise. 2. Content aspiration: aspirate with a
syringe gastric contents and determine its pH.€The pH of gastric contents is ac
idic (about 3) of intestinal aspirate is less acidic (approximately 6.5) and the
inhaled breath is alkaline (7 or more) is also confirmed the correct positionin
g, if we check with the aspiration remains food. 3. Bubbling test: Place the tip
of the probe in a beaker with water, and if bubbles occur, is a sign that is in
the trachea. 4. Verification of signals: Importance for signs such as coughing,
cyanosis and dyspnea.
Rectal catheter The most important use of the rectal probe is for bowel cleansin
g, which has as its purpose: to eliminate or avoid bloating and flatulence, faci
litating the elimination of feces, remove blood in cases of melena and prepare t
he patient for surgery, examinations and treatment of the intestinal tract. PROC
EDURES
1. guide the patient 2. material preparation: lining, petroleum jelly or xylocai
ne jelly, toilet paper, bedpan, Screens, rectal probe, gauze, serum catheter and
gloves.
3. 4. 5. 6. 7. 8.
wash hands and wear gloves to adapt the solution prescribed rectal probe and ser
um catheter to place the patient in the Sims lubricate about 10 cm of the probe
away from the glutes with vaseline and insert the probe in the case of enema, op
en equipo , let the liquid drain, close the catheter and after completion, remov
e the probe and refer the patient to the bathroom or put it into a bedpan.