Junior resident tips and tricks

Best practices, pro tips, and mistakes to avoid
tagged: clinical
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Your relationship with scrub tech and circulator

Functional & Stereotactic

Emergency craniotomy

Pulling drains

JP Pull slowly so you can be sure you’re not getting caught by a stitch or causing a bleed. Leave open the small wound. If oozing or trickle bleed, then consider placing a small gauze bandage. Preferable to place in red environmental hazard bag since non-trivial blood.

EVD The drain should already have been clamped before the decision was made to withdraw. CloraPrep the area. Under sterile conditions, place a 3-0 monocryl stitch to close the opening in a figure-eight. Withdraw the catheter slowly–it’s the brain! Tie off your stitch. Place catheter and bedside drain in red hazard bag.

Closing

Closing the dura. If using pericardial implant for decompressive craniectomy, lay it down so that later cranioplasty dissection doesn’t go into brain. Fit the inlay around the temporal angle before worrying about frontal/parietal layout. Don’t cheat yourself.

tagged: clinical