Daily NotesTuesday, 11/18/14 In the context of Breast CA genetic screening the cost is $3-4K Then the patient has to counseled about the results Feeding tubes It is not uncommon for them to leak Stomach fills up with food and the pressure increases They can be loose and wiggle around, enlarging the fistula Calots node A lymph node located in Calots triangle Cystic duct Cystic artery Hepatic duct? Remember the Sx that Dr. Chun help with: Aberrant hepatic artery, the right hepatic artery was in the place of the cystic duct Drains Used for two reasons: Treatment (active): left in as long as needed Prophylaxis Look at volume of drainage When deciding when to take it out, why was it put there? Is it there for a potential problem that is no longer going to be an issue The longer a drain is left in the greater the chance for infection In the graph below think of the population size as the bacterial population size Types Closed E.g., Blake/JP JP: Jackson-Brat Old name that is no longer accurate but is still used Open E.g., Penrose We put in a Penrose drain for the 95 year-old-man with a perirectal abscess All drains get plugged Fluid may leak out around the insertion point if the drain is plugged Plugged drains cannot be unplugged When pulling a drain think about the volume of the fluid still in the space and the volume of fluid still being produced, will not having a drain cause a problem? What type of drainage? Pus, bile, ect.? Drain care Hydrogen peroxide, alcohol, betadine Alcohol hurts Betadine dyes the skin Hydrogen peroxide is Dr. Chuns favorite Is the site infected or is it inflamed Inflammation will be well demarcated Infection will be poorly demarcated