irrigation fluids

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IRRIGATION FLUIDS IRRIGATION FLUIDS ARE USED TO OPEN UP THE OPERATIVE FIELD & TO CLEAR IT FROM THE BLOOD THE VOLUME OF THE IRRIGATING FLUID FLOWING PER UNIT TIME WILL DEPEND ON THE HEIGHT OF THE CONTAINER & DIAMETER OF THE TUBING SYSTEM IDEAL HEIGHT OF THE CONTAINER TO PREVENT ABSORPTION IS 50 60 CM ABOVE THE BLADDER LEVEL NORMAL ABSORPTION IS 20 ML/ MIN

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Page 1: Irrigation Fluids

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IRRIGATION FLUIDS

IRRIGATION FLUIDS ARE USED TO OPEN UPTHE OPERATIVE FIELD & TO CLEAR IT FROM THE

BLOOD

THE VOLUME OF THE IRRIGATING FLUIDFLOWING PER UNIT TIME WILL DEPEND ON THEHEIGHT OF THE CONTAINER & DIAMETER OFTHE TUBING SYSTEM

IDEAL HEIGHT OF THE CONTAINER TO PREVENTABSORPTION IS 50 60 CM ABOVE THEBLADDER LEVEL

NORMAL ABSORPTION IS 20 ML/ MIN

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DIATHERMY 

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HISTORY

1 ST DIATHRMY WAS DEVELOPED BY WILLIAM

BOVIE

1 ST USED BY HARVEY CUSHINGS IN 1926, HE

USED IT FOR REMOVAL OF A TUMOR OVER HEAD

PREVIOUS GENERATION MACHINES USED A

VACCUM TUBE SYSTEM FOR CUTTING & A SPERK

GAP GENERATOR FOR COAGULATION

NOW A DAYS ALL MACHINES GENERATE BOTH

TYPES OF CURRENT

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DEFINITION

DIATHRMY IS THE GENERATION OF HEAT IN

BODY TISSUES BY MEANS OF PASSING ANELECTRIC CURRENT

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DIATHERMY MACHINE

IT CONTAINS

- GENERATOR

- LIVE ELECTRODE

- INDIFFERENT ELECTRODE

GENERATOR : PRODUCES HIGH FREQUENCY

ALTERNATE CURRENT

IT GENERATES 300 400 WATTS OF POWERWITH A FREQUENCY MORE THAN 400 MHZ

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LIVE ELECTRODE :

IT PROVIDES ENTRY OF ELECTRIC CURRENT IN TO THE

BODY

INDIFFERENT ELECTRODE :

- ALSO KNOWN AS PATIENT PLATE

- IT RECEIVES CURRENT FROM THE PATIENTS

BODY & RETURNS TO THE GENERATOR- MINIMUM CONDUCTIVE AREA SHOULD

BE 10 Sq INCHES

- IT SHOULD BE AS CLOSE AS OPERATING

FIELD- NEVER PLACE THE PLATE NEARER TO

HEART & OVER BONY PROMINENCES

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MECHANISM OF ACTION

HIGH FREQUENCY CURRENT PRODUCED BY

GENERATOR PASSES THROUGH THE LIVE

ELECTRODE IN TO THE PATIENTS BODY &RETURNS BACK THROUGH THE INDIFFERENT

ELECTRODE TO THE GENERATOR

AT THE POINT OF ENTRY LIVE ELECRODE

PRODUCES >1000 C TEMPERATURE WHICH

GIVES THERMAL EFFECT

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EFFECTS OF DIATHERMY

CUTTING

COAGULATION/DESICCATION

FULGURATION

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CUTTING

IT IS ACHIEVED BY USING 2 5 MHZ HIGH Fq CURRENT

THE TEMPERATURE PRODUCED WILL DISINTIGRATETHE CELLS & THE TISSUE WILL BE SEPERATED

THE CURRENT IS TRANSFERRED TO THE TISSUES IN ACOTINUOUS MANNER

NO COAGULATION TAKES PLACE WHILE CUTTING

FOR IDEAL CUTTING VOLTAGE -250-280 V

POWER 50 -150 WCURRENT 0.2 0.5 A

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COAGULATION

IT OCCURS BY COMBINATION OF CELLDISTRUCTION & DENATURATION OF PROTIENS

CURRENT IS TRANSMITTED IN PULSES

FOR IDEAL COAGULATION

PULSE INTERVAL 10 100 mc Sec

PULSE WIDTH 1 - 20 mc Sec

PEAK VOLTAGE UP TO 3000 VPEAK CURRENT UP TO 2 amp

PEAK POWER OUT PUT 10 50 W

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FULGURATION

IT OCCURS WHEN SRONG CURRENT KEPT IN A

CONTACT WITH TISSUE LONG ENOUGH FOR

CHARRING TO TAKE PLACE

NEVER USED FOR HEAMOSTASIS

COMMONLY USED FOR PUV FULGURATION &

BLADDER TUMOUR DISTRUCTION.

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HAZARDS BURNS

- AT THE SITE OF PLATE ELECTRODE

- BETWEEN THE PETEINT & METAL OBJECTS

FIRES

-IT OCCURS DUE TO POOLS OF SPIRIT IS

IGNITED

EXPLOSIONS -IT OCCURS WHEN INFLAMABLE

ANAESTHETIC GASSES ARE USED LIKE ETHER

& CYCLOPROPANE

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CAUSES OF BURNS

POOR PATIENT PLATE CONTACT

HAIR AT THE SITE OF RETURN ELECTODE PLATE

BREAK IN THE WIRE CONNECTING THE PLATE

TO THE ELECTRO-SURGICAL UNIT

DETACHED RETUN CABLE ABNORMALLY HIGH POWER SETTING

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IRRIGATION FLUIDS

IRRIGATION FLUIDS ARE USED TO OPEN UPTHE OPERATIVE FIELD & TO CLEAR IT FROM THE

BLOOD

THE VOLUME OF THE IRRIGATING FLUIDFLOWING PER UNIT TIME WILL DEPEND ON THEHEIGHT OF THE CONTAINER & DIAMETER OFTHE TUBING SYSTEM

IDEAL HEIGHT OF THE CONTAINER TO PREVENTABSORPTION IS 50 60 CM ABOVE THEBLADDER LEVEL

NORMAL ABSORPTION IS 20 ML/ MIN

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IRRIGATION FLUIDS

NON CONDUCTIVE :

WATER

GLYCINE

SORBITOL

MANNITOL

CYTOL

CONDUCTIVE :

SALINE

RINGER LACTATE

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THE TYPE OF FLUID TO BE USED IS DEPENDENT ON TYPE

OF PROCEDURE

- FOR SIMPLE DIAGNOSTIC CYSTOSCOPY ANY OF THE

FLUID CAN BE USED WHERE CHANCE OF ABSORPTION IS

VERY LOW

- FOR NEPHROSCOPY & URETEROSCOPY WHERE DIRECT

ABSORPTION OF THE FLUID TAKE PLACE THROUGH

PYELO SINUS OR PYELOVENOUS ,SALINE OR RINGER

LACTATE IS USED

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..C ONTD ,

AN AVERAGE DEGREE OF HEMORRHAGE WILL

REQUIRE ONLY HALF OF THE MAXIMUM

AVAILABLE FLOW A LIQID OR GAS CAN BE USED FOR

IRRIGATION

IDEAL FLUID SHOULD BE CLEAR , NONIRRITATING TO MUCOSA , NON STICKY

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ADVANTAGES WITH DIFFERENT

SOLUTIONS

WATER : AS IT IS A HYPOTONIC SOLUTION ITRAPIDLY LYES RBC AND CLEAR THE VISION IN CASEOF BLEEDING

IN CASE OF BLADDER TUMOR RESECTION,TUMOR CELLS ARE LYSED BY WATER AND MAKESTHE VISION CLEAR

IT IS ALSO CHOICE OF FLUID IN CASE WHEN

ELECTRO CAUTERY IS USED

DISADVANTAGE : MAINTAINENCE OF STERILITY ISDIFFICULT

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SALINE

IT IS WELL TOLERATED BY UROTHELIUM &

ALSO WELL TOLERATED WHEN INTRA VASCULAR

ABSORPTION OCCURS

SO IT IS COMMONLY USED AS FLUID OF CHOICE WHEREFLUID ABSORPTION IS MORE

1/6 OR 1/7 HYPOTONIC SOLUTION IS USED FOR ELECTRO

HYDRAULIC LITHOTRIPSY

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RINGER LACTATE

IT IS A ELECTROLYTE SOLUTION AND CONTAIN

POTASIUM CHLORIDE , SODIUM CHLORIDE &

SODIUMLACTATE

IT CANNOT BE USED FOR ELECTRO SURGICAL

PROCEDURES

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NON HEMOLYTIC,NON CONDUCTIVE

SOLUTIONS GLYCINE :

IT IS AN AMAINO ACETIC ACID

COMMONLY USED AS 1.5 % SOLUTION

IT IS FIRST RECOMMENDED BY NESBIT & GLICKMAN IN 1848

IT HAS 200 m osm / lt WITH SLIGHTLY HYPOTONIC

ADVERSE EFFECTS :

IT IS CONVRTED TO SERINE & GLYOXYLIC ACID WITCH IN TURN METABOLISED

FINALLY TO AMMONIA AND INDUCES ENCEPHALOPATHY

IT ALSO INDUCES NAUSEA & HEADACHE POST OPERATIVELY

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SORBITAL

AVAILABLE IN 3% SOLUTION

IT IS A REDUCED FORM OF DEXTROSE

CONTRA INDICATED IN DIABETIC PATIENTS AS

IT INDUCES HYPER GLYCEMEA

OTHER SOLUTIONS :

GLUCOSE :

USED AS A 2.5 % OR 5 %

IT IS VERY STICY & INNDUCES

HYPERGLYCEMEA

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UREA :

USED AS 1% SOLUTION

IT HAS UNPLEASENT ODOR

MANNITOL :

USED AS 5% SOLUTION

IT TENDS TO CRYSTALIZE & FORMS A FILM ON

SURFASE OF INSTRUMENTS

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IRRIGATION PRESSURE

IT IS EXTREMLY IMPORTANT FOR THE ABSORPTION OF

THAT SOLUTION & THE RESULTING COMPLICATIONS

COMPLICATIONS ARE INCREASED WHEN THE PRESSURE IS

MORE THAN 60 CM OF WATER IT OCCURS WHEN THE CONTAINER HEIGHT IS HEIGHER

THAN 60 CM FROM THE BLADDER

PRESSURE IN THE BLADDER & URETHRA CAN BE LOWERED

BY CONTINUOUS FLOW-LOW PRESSURE SYSTEM BY USING

SUPRA PUBIC TROCAR DRAINAGE OR CONTINUOUS FLOW

RESECTOSCOPE

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PRESSURE IN THE BLADDER CAN BE

MONITERED BY OBSERVING THE FILLING OF

THE BLADDER

IF THE BLADDER IS PARTIALLY FILLED AND THE

POSTERIOR WALL IS SEEN TO BE PARTIALLY

COLLAPSED WITH A RESECTOSCOPE IN THE

POSTERIOR URETHRA THEN THE PRESSUREWITH IN A REASONABLE RANGE

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TEMPERATURE OF I.F

IDEAL TEMPERATURE OF THE FLUID MUST BECORRESPOND TO BODY TEMPERATURE &

SHOULD NOT BE LESS THAN ROOM

TEMPERATURE

BUBBLES IN IRRIGATION SYSTEM

BUBBLES PASSING WITH THE IRRIGANT IN TO

THE INSTRUMENT WILL DISTORT THE VISION &

EVEN CAUSES AIR EMBOLISM

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PREVENTION OF BUBBLES

IRRIGANT SHOULD BE ALLOWED TO FLOW THROUGHTHE INSTRUMENT BEFORE IT IS PASSED IN TO THESHEAT

CARE MUST BE TAKEN WHILE CHANGING THE

CONTAINER IF BUBBLES ENTER THE FIELD OF VISION THE

INSTRUMENT OR THE PATIENT IS TILTED TO ALLOWTHE BUBBLES TO FLOW AWAY FROM THEINSTRUMENT TO A HEIGHER POINT

TURN THE ENTIRE ENDOSCOPE OVER TO ALLOWTRAPPED BUBBLES UNDER THE BEAK OF THEINSTRUMENT TO ESCAPE

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DEPRESS THE OPERATORS END OF THE SCOPE

SO THAT THE PATIENT ENDIS HEIGHER ALSO ELIMINATED BY OPENING THE OUT FLOW

STOP CLOCK OR BY REMOVING THE TELESCOPE

BUBBLES IN THE URETER FILL THE ENTIRE

LUMEN & CHARECTRSTICALLY PASS TO THEHEIGHEST POINT OF THE URETER WHICH INSUPINE POSITION IS THE PORTION OF THE MIDURETER WHERE IT CROSSES THE PSOASMUSCLE

THE BUBBLES IN THIS SITUATION IS REMOVEDBY USING URETERAL CATHETERS

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CO2 AS AN IRRIGANT

VISION IS BETTER WITH CO2 THAN THEIRRIGATING FLUIDS

IN CASE OF BLEEDING BLOOD IS LOCALISED TO

THE SITE OF ORIGIN AND DONOT ALTER THEVISION

IT CAN BE USED AS OUT PATIENT SET UP

IT IS VERY CONVENIENT & NEAT TO USE WITHOUT THE SPILLS

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TUR SYNDROME SEEN IN 2% OF PATIENTS UNDERGOING TURP

CHARECTERIZED BY MENTAL CONFUSION, NAUSEAHYPER TENTION & VISUAL DISTURBENCES

IT OCCURS IF

Na CONCENTRATION < 125 Meq

GLAND SIZE > 45 gms

DURATION > 90 min

CONTAINER HEIGHT > 60 Cm TREATMENT :

TREATED BY GIVING 200 ml OF 3%

SALINE SLOWLY OVER A PERIOD OF TIME

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