Common Procedures

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Procedures used to help support the patient and identify the cause of the critical problem include:

Intubation

Whenever a patient is unable to breathe on his/her own, a breathing tube is placed down the throat and into the lungs. This is called “endotracheal intubation”….or “intubation” for short. “Endo” means inside…”trachea” means windpipe. The tube is then connected to a machine called a ventilator that breathes for the patient.

Ventilator/Mechanical Ventilation

A ventilator is a machine that regulates the flow of air in and out of our bodies when we are unable to do this for ourselves. “Mechanical ventilation” is the term used when something is doing that breathing for us. Sometimes this machine is called “life support” or a “respirator”. The term “respirator” isn’t right, though, because respiration is actually the chemistry part of breathing – the exchange of oxygen & carbon dioxide that occurs deep inside the lungs at the blood vessel level. The ventilator does not do this part.

Tracheostomy

A tracheostomy is a surgical procedure that creates a hole in the neck to directly access the windpipe. “Stoma” is the Latin word for a hole and again, “trachea” is the medical name for the windpipe. It is done when someone isn’t able to breathe and needs to be mechanically ventilated for a long time. Short term versions are also sometimes needed when someone has swelling in their throat that makes the passage of a normal breathing tube difficult or impossible.

PEG tube

PEG stands for “percutaneous endoscopic gastrostomy”. It means to go through the skin (“percutaneous”) and use a camera to look inside (“endoscopic”) and make a hole into the stomach (“gastrostomy”). This is done to have food (special liquid feedings) put directly into the stomach when someone has a condition that makes them at high risk for food not going down the throat without ending up in the windpipe (“aspiration”). Aspiration is dangerous because it can cause a severe type of pneumonia.

Central venous catheterization

Central venous catheters – also known as a “central lines” or “CVCs” - are used for giving medicines and fluids and can be connected to the machines that monitor a patient. It involves the placement of a special IV that enters one of the large veins of the neck, chest or groin to thread into one of the main veins that bring blood to the heart. A variation of this is called a Peripherally Inserted Central Catheter or “PICC line” and these are typically placed into a patient’s arm and end in the same place as a regular central line. The PICC line is designed for longer-term use.

Arterial cannulation

Also known as an “art-line” or “a-line”, this is the placement of a line into an artery for measurement of blood pressure when very accurate results are needed.

Pulmonary artery catheterization

Also known as a “Swan-Ganz” catheter (or “Swan” for short), this involves placing a catheter into a large vein (like with a central line) and then threading it through the heart into the vessel that takes blood to the lungs to load up with oxygen. There is a balloon that is then inflated and it causes the catheter to wedge against the wall of a smaller vessel in the area and this can provide crucial information about heart failure and lung swelling.

Bronchoscopy

This involves the insertion into the lungs of a long, skinny, bendable tube with a camera on the end (“scope”). It can be done to look and see what might be causing a problem as well as to collect specimens that can be sent to the lab for diagnostic tests. It can also be used to remove things that are blocking an airway – such as secretions, blood or foreign objects.

Lumbar puncture

Also known as a “spinal tap”, this involves placing a needle into the spine of the lower back (lumbar region) to collect Cerebrospinal Fluid (“CSF”) from the central canal of the spinal cord. This fluid can then be sent to the lab for several kinds of diagnostic tests. The puncture can also be used to get a pressure measurement that can also be diagnostic. 

Paracentesis, thoracentesis & pericardiocentesis

“Centesis” means to use a needle to drain fluid/air from a cavity.

Paracentesis means to drain the peritoneal cavity (the empty space in the belly). This is commonly needed when someone’s liver isn’t working and their belly has filled up with fluid.

Our lungs and hearts are essentially bags inside of a second bag. If fluids or air build up between the two bags, then there isn’t room for them to expand and work properly. Thoracentesis (or “pleural tap”) means to drain the chest cavity and pericardiocentesis means to drain specifically from the bag around the heart.

Chest tube thoracostomy

If a patient has a condition where they are going to have a continued build up of fluids or air in their chest cavity, instead of doing repeated “pleural taps” or thoracenteses, a tube can be placed for drainage that stays until it is no longer needed. These tubes are typically connected to a drainage system you will see either hanging or standing at the side of the bed.