#cannulas

Oh man I HATED cannulas as a med student, although I had the opposite problem, where I would get flashback but couldn't advance and fully site the cannula.

Also apologies for the delay on replying to this, it's been a busy end of placement to get things sorted haha

My tips would be:

take your time with EVERYTHING. Make sure you've got all your equipment set up and to hand, because just slightly turning to try and pick up the blood bottles or flush or something can cause a slight movement in the needle and cause it to come out of the vein. Similarly take your time selecting the best vein and also advance the needle slowly - it's difficult to judge how deep the vein is just by palpating, especially if its in the ACF, so it's easy to get flashback but advance too far. Stop at the first sign of flashback then advance a small amount (about 1cm unless you're inserting a widebore cannula) to ensure the entire needle tip and cannula tip are in the vein, but haven't gone through the other side. Also get yourself and the patient into an optimal position. I can guarantee this helps, because the cannulas I most commonly missed are ones where I'm slightly at an angle, trying to get around stuff around the bed, or have tried to do it without the patient's arm being fully straight. Get a second pair of hands to help position the patient if they aren't able to do it themselves. It's not a failure or sign you're bad at cannulas if you have to do this, and means you're more likely to get it first time so that's better for the patient

Rest added under the cut

21:59 11/03/2019

Cannulas are those funny pieces of plastic, that continually thwart us all on a regular basis. 

However, got asked to do a cannula today on a chemo patient. One of the nurses had asked me as a favour, and I had a bit of time, so agreed to give it a go. You can only say that you’ll give it a go. 

Don’t want to brag (but want to brag a little), but I nailed it first time. 

I feel that I’ve come a long way since I first started FY1, not just with my confidence, but also with my technical skills. I can literally say to patients that I can’t remember how many cannulas I’ve done now. 

So, in that vein (lol), just thought I’d share my few tips if anyone is interested!

1. Tie the tourniquet tight enough.  Warn them that it won’t be pleasant, and it will be quite tight, but it generally does help. 

2. Prep everything before you put the cannula in. There’s nothing worse than getting the cannula in and then realising that you don’t have an octopus to attach to said cannula. Especially at the start, I liked to run through the procedure as I prepped a tray to make sure I had everything. 

3. Spend time looking for a vein. Don’t rush to stab the patient. Spend time looking for a decent vein, because you’re more likely to get it, and it’s also kinder to the patient. Explain this to the patient, and they’ll be a lot more grateful that they haven’t had an extra unnecessary needle. 

4. The best veins in order of preference:

Ones you can feel and see

Ones you can feel 

Ones you can see 

Ones you used a veinfinder for (because you’re really desperate by now)

5. Pin that vein. You have two hands; use them! Use one to anchor the vein, because especially in elderly people, veins have a tendency to wiggle away.

6. Be confident.  When you insert the needle, really be confident of your placement. You’ve spent the time looking for it, and you should be confident of your technique. 

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Planning for a tummy tuck surgery? Success starts with proper preparation. This means having all the right tools. A full abdominoplasty instruments set is essential. It ensures you are ready for every step. This guide provides a complete checklist. It details all the instruments you will need. Understanding each component is vital. It helps ensure a smooth, safe, and effective procedure. Let’s make sure your surgical tray is perfect.

Why a Complete Checklist is Essential

Imagine stopping surgery to search for a missing tool. This wastes time. It increases stress. It can even affect patient safety. A complete checklist prevents this.

Efficiency: Knowing every tool is present streamlines workflow. The surgical team works smoothly. There are no unexpected delays.

Safety: Each tool has a specific safety role. Missing one can compromise the procedure. A full set means you are prepared for every situation.

Preparedness: You are ready for any variation in the surgery. This includes unexpected findings.

Consistent Outcomes: Having the right tools ensures consistent technique. This leads to predictable, excellent results for every patient.

A complete checklist is not just a list. It is a promise of preparedness. It is a commitment to precision.

1. Incision and Initial Dissection: The Opening Steps

These instruments are used for the first cuts. They separate skin and fat layers. This begins the actual surgery.

Scalpel Handles: These hold the sharp, disposable blades. They must offer a firm, comfortable grip.

#3 Scalpel Handle: This is a slender handle. It is often used with smaller, finer blades. It provides precise control for delicate incisions. It is perfect for detailed work.

#4 Scalpel Handle: This is a larger, more robust handle. It holds bigger blades. It is used for broader, longer incisions. It provides strength for the initial cut.

#7 Scalpel Handle (Optional): This is a long, thin handle. It is often angled. It holds smaller blades. It is used for very fine, deep dissection. It helps reach tight spaces.

Scalpel Blades: These are extremely sharp. They are designed for specific cuts.

#10 Blade: This is a large, curved blade. It makes the primary, long incision. This cut typically extends across the lower abdomen. It ensures a clean, sweeping cut.

#15 Blade: This is smaller. It has a pointed, curved tip. It is used for finer work. This might include trimming skin around the belly button. It helps with delicate shaping.

#11 Blade: This has a pointed, straight edge. It is ideal for puncturing. It can also be used for very precise, sharp incisions. This is common for small drainage sites.

Several of each common blade size should be available. This ensures a fresh, sharp edge.

Metzenbaum Scissors: These are for fine, blunt dissection. They separate delicate tissue planes.

Straight Metzenbaum Scissors: Used for surface work. They cut soft tissue gently.

Curved Metzenbaum Scissors: More common due to versatility. They reach around structures. They aid in deeper dissection. Sizes like 7-inch or 9-inch are common. Their long, slender design helps separate skin from muscle gently. This minimizes trauma.

Mayo Scissors: These are for heavier cutting. They handle tougher tissues.

Straight Mayo Scissors: Used for cutting sutures. They also cut surgical drapes. They can trim larger sections of tissue.

Curved Mayo Scissors: Often used for cutting through dense, fibrous tissue. This includes fascia. They can resect thicker skin portions. Common sizes are 6.75-inch or 9-inch. Their robust design provides necessary cutting power.

Iris Scissors: These are very small and delicate. They have fine, sharp tips. They are used for extremely precise trimming. They handle small tissue tags. They are excellent for meticulous work. They help refine the final shape.

2. Grasping, Holding, and Manipulating Tissue: Precise Control

These tools hold, grasp, or move tissues. They provide a stable grip. This allows the surgeon to work without direct contact.

Adson Tissue Forceps: These are delicate. They have fine tips.

Adson Forceps (Toothed 1x2): Have tiny interlocking teeth. They provide a secure grip on delicate skin edges. They are vital for precise tissue handling.

Adson Forceps (Non-toothed, serrated): Have fine serrations instead of teeth. They offer a gentle grip. They are for very delicate tissues. They avoid crushing cells.

Brown-Adson Tissue Forceps: These have wider tips. They feature multiple rows of fine teeth. They provide a broad, secure grip. They are excellent for handling thicker skin flaps. They are good for adipose tissue. They distribute pressure to prevent damage.

Allis Tissue Forceps: These have sharp, inward-curving teeth at the tips. They have a locking mechanism. They provide a strong, non-crushing grip on fascia. They secure drapes to the skin. They can also hold muscle layers. They are valuable for securing deeper tissues or temporary retraction.

Dressing Forceps: These have serrated tips. They do not have teeth. They are used for handling dressings. They are for packing surgical wounds. They do not grasp living tissue directly. They ensure sterile application of materials.

Russian Tissue Forceps: These have broad, rounded, fenestrated tips. They are atraumatic. They offer a broader, gentle grip. They are useful for grasping dense tissue. They handle delicate structures. They are less likely to cause tissue injury.

Babcock Intestinal Forceps (Optional): These have a non-crushing, gentle grip. They are for delicate structures like bowel. While rare in standard abdominoplasty, they might be useful for retracting abdominal contents if deep exposure is needed in complex cases.

3. Hemostasis and Bleeding Control: Maintaining Clarity

Stopping bleeding is crucial. These instruments clamp blood vessels. This controls blood flow. This keeps the surgical field clear.

Halsted Mosquito Forceps: These are small and delicate hemostats. They have fine, serrated jaws.

Straight Halsted Mosquito Forceps: For clamping small vessels directly.

Curved Halsted Mosquito Forceps: For reaching around structures. They provide precise control over minor bleeding. They are excellent for delicate dissection.

Kelly Forceps: These are larger and stronger than Mosquito forceps. They have partial serrations on their jaws.

Straight Kelly Forceps: For clamping medium-sized vessels. Also used for general tissue grasping.

Curved Kelly Forceps: Offer better access in deeper fields. They handle more significant bleeding.

Crile Forceps: Similar to Kelly forceps. They have full serrations along their jaws. They are general-purpose hemostats. They provide a secure grip on vessels.

Rochester-Pean Forceps: These are heavy, sturdy hemostatic forceps. They have full serrations. They are used for clamping very large vessels. They are also used for grasping dense tissue. They provide a powerful, secure clamp.

Kocher Forceps: These are heavy, straight forceps. They have a strong, interlocking tooth at the tip. They provide a very secure grip. They are used for grasping tough, fibrous tissue. They can also clamp large vessels. They are often used when a firm, non-slip grip is vital.

4. Retraction for Exposure: Unveiling the Surgical Site

Surgeons need a clear view to operate safely. Retractors hold back tissues. They keep the surgical site open. This improves visibility.

Langenbeck Retractors: These are handheld retractors. They have a narrow, L-shaped blade. They come in various blade widths. They are used to pull back skin and fat edges. They can also retract muscle edges. They are useful for smaller, precise retraction. They help define the surgical plane.

Army-Navy Retractors: These are double-ended retractors. They have two flat blades. One blade is longer and wider. The other is shorter and narrower. They provide broad retraction. They pull back larger sections of tissue. They are very useful for deep dissection. They expose the underlying abdominal wall.

Senn-Mueller Retractors: These are double-ended handheld retractors. One end has three blunt or sharp prongs. The other end has a single, curved blade. They are used for fine, superficial skin retraction. They are good for retracting skin edges. They also hold small muscle groups. They are versatile for detailed work.

Malleable Retractors: These are bendable, flat metal strips. They come in various widths. Surgeons can shape them as needed. They are useful for adaptable, deep tissue protection. They help protect vital structures while retracting.

Self-Retaining Retractors: These retractors stay open by themselves. They do not need to be held by hand.

Weitlaner Retractor: Has multiple prongs that hook into tissue. It has a locking mechanism. It comes with sharp or blunt prongs. It frees the surgeon's hands. It provides continuous tension.

Alm Retractor: Similar to Weitlaner but often smaller. It has fine, sharp prongs. It is for very precise, delicate, continuous retraction.

Gelpi Retractor: Has sharp, curved prongs. It is used for small, deep incisions. It provides strong, focused retraction.

5. Suturing and Wound Closure: The Final Stitch

After the main work, the surgical site must be closed. These instruments help precisely place sutures. They bring tissues together for healing.

Needle Holders: These grasp and control surgical needles. They push needles through tissue.

Mayo-Hegar Needle Holder: A common, robust needle holder. It has cross-serrated jaws. It provides a strong, secure grip on needles. It often has a locking mechanism. It is suitable for most suturing needs. It handles medium to large needles well.

Crile-Wood Needle Holder: A more delicate version. It has finer jaws. It is used for smaller, more delicate needles. It is ideal for fine suturing in plastic surgery. Its precision allows for neat, meticulous stitches.

Webster Needle Holder: Even more delicate. It is used for very fine sutures. Common in micro-surgery or intricate skin closure. It allows for extreme precision.

Skin Hooks: These have single or double prongs. They can be sharp or blunt. They are used for very gentle retraction of skin edges. They provide tension. This helps achieve precise alignment during closure. They minimize trauma to delicate skin.

Suture Scissors: These scissors are specifically for cutting suture material. They have sharp, pointed tips. Some have one sharp blade and one blunt blade. This helps cut the suture cleanly. They ensure a neat trim of the suture ends.

6. Suction, Drainage, and Aspiration: Keeping It Clean

Fluids like blood, fat, and tumescent solution collect during surgery. These instruments efficiently remove them. This maintains a clear view.

Suction Cannulas/Tips: These are tubes with openings. They connect to suction tubing.

Frazier Tip: Fine and angled. Used for precise suction in small areas. It handles small amounts of fluid.

Poole Tip: Has multiple holes. Used for high-volume suction. It prevents clogging. It efficiently removes fat and fluid.

Adson Suction Tip: A general purpose suction tip. It is versatile for various fluid removal needs.

Suction Tubing and Connectors: This sterile tubing connects the suction tip to the collection canister. It is flexible. It allows for efficient fluid transport. Connectors ensure a sterile, secure connection.

Collection Canisters: These are sterile containers. They collect all aspirated fluids. They connect to a suction pump. The canister often has volume markings. This allows the surgical team to measure fluid loss accurately. It is crucial for monitoring patient safety. They securely contain biohazard materials.

7. Ancillary, Marking, and Support Instruments: The Essentials

These tools do not cut or grasp. But they are vital for organizing. They ensure sterility. They help with pre-operative planning.

Towel Clamps (Backhaus): These have pointed, curved tips. They lock to hold surgical drapes firmly. They prevent drapes from shifting. This keeps the sterile field intact. They also hold tubing or cords.

Sponge Holders (Foerster): These have ring handles. They hold surgical sponges securely. They are used to absorb blood and fluid. They keep the surgical field dry. Several should be available for continuous use.

Skin Markers: These are sterile pens. They draw precise lines on the patient's body. They mark incision lines. They outline areas of skin removal. They ensure accuracy in planning.

Rulers: Stainless steel rulers are used for accurate measurements. This helps plan the surgery precisely. Flexible rulers can conform to body curves.

Sterilization Trays/Containers: These protect instruments during sterilization. They organize them for quick access. They ensure instruments remain sterile until needed. They are crucial for instrument longevity.

Scalpel Blade Removers: These are small, safe devices. They help remove used scalpel blades safely. They prevent accidental cuts to staff. They are essential for safety protocols.

Syringes (various sizes): Used for injecting tumescent fluid or local anesthetic. If fat grafting is combined, larger syringes are used for fat collection and injection.

Blunt Trocars/Cannulas (if liposuction combined): If liposuction is part of the abdominoplasty, specific blunt cannulas are used to harvest fat.

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