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Wound suturing

…are as a rule left open. Facial bites can be sutured after careful debridement because of the cosmesis, often with antibiotic prophylaxis. Deep puncture wounds …

Central venous catheter

…in: the choice of site, the use of ultrasound throughout the puncture, and maintaining maximal barrier precautions without shortcuts. The most common serious error is…

Transcutaneous and transvenous pacing

…where the pads would go. Transvenous pacing: the relative contraindications are the same as for a central venous catheter — coagulopathy, infection at the puncture site…

Lumbar puncture

Procedurer What determines a lumbar puncture is rarely the needle itself. It is the decision whether to perform it now or after imaging, how the…

Pleural aspiration and chest drain

…Otherwise: Type Contraindication : : Absolute No safe pocket of fluid to puncture (no ultrasound verified fluid) Relative Uncorrected coagulopathy or thrombocytopenia Relative Ongoing anticoagulant treatment — plan…

Bone marrow aspiration and biopsy

…that clots before the smears are made is unusable, no matter how well the puncture went. Indications Unexplained cytopenia in one or more cell lines…

Joint aspiration

…disease. Contraindications Infection of the skin or soft tissues over the puncture site — use another approach or refrain. Bacteraemia without suspicion of joint infection (relative…

Paracentesis

…straightforward: ultrasound to find the fluid, an insertion site in the left lower quadrant lateral to the rectus sheath, and a cell count plus albumin…

Peripheral venous cannula and intraosseous access

…analysers — check locally. Contraindications Peripheral venous cannula: Infection, burns or trauma at the puncture site. An arm with an arteriovenous fistula, previous axillary clearance or…

Arterial line

…Anaesthetise the skin with a small amount of lidocaine without adrenaline (epinephrine). 3. Puncture 1–2 cm proximal to the wrist crease at an angle…

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