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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