Bedside Procedures for General Surgeons

Abstract

This review is focused on 12 procedures that are commonly performed by general surgeons in the emergency department, critical care unit, operating room, and outpatient clinic. The review begins with eight critical care procedures: percutaneous tracheostomy, saphenous vein cutdown, percutaneous arterial cannulation, subclavian venous catheter placement by landmark technique, internal jugular venous catheter placement under ultrasound guidance, needle chest decompression, tube thoracostomy, and pericardiocentesis for trauma. Next, the diagnostic procedure of focused assessment with sonography for trauma (FAST) is described. The review finishes with three procedures that are frequently performed in the outpatient setting: temporal artery biopsy, simple abscess drainage, and muscle biopsy. Although considered basic procedures, each has its own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures as well as pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged. The figures illustrate key steps used in a number of the procedures and typical ultrasound images of the internal jugular vein during central venous catheter placement and the four standard FAST views, along with photo insets depicting appropriate ultrasound probe positioning. The tables include the lists of equipment necessary to perform each procedure. This review contains 17 figures, 14 tables, and 47 references