SURGERY

 SURGICAL AND INJECTION ADMINISTRATING VIDEO

Craniopagus twins are conjoined twins that are fused at any part of the skull, except the face, foramen magnum, skull base and the vertebral column.

The fused structures are most often the cranium, meninges, and dural venous sinuses. Brains tend to be separate; however, they may be connected by a bridge of neural tissue. The trunks and limbs are separate.

Exclusive extracranial tissues involvement needs no significant imaging evaluation; however, a CT is needed to study the osseous detail if vault fusion is present. MRI is required to study the degree of brain involvement and MR arteriogram and MR venogram are required to evaluate the status of the cerebral circulation and venous sinuses.

 

Equipment

• Needles – one of which should be a safety-engineered device;
• Syringe
• Drug for administration;
• Medicines administration chart/prescription;
• Receiver or tray to carry the drug;
• Sharps container.

Procedure

• Explain the procedure and gain consent.
• Screen the patient to ensure privacy during the procedure.
• Before drug administration, check whether the patient has any allergies.
• Check the prescription is correct, following the ‘five rights’ of drug administration, and local medicines administration policy to reduce the risk of error.
• Wash and dry hands to reduce the risk of infection.
• Assemble the syringe and needle, and withdraw the required amount of drug from the ampoule. Some medicines are available in pre-filled syringes and manufacturer’s instructions should be followed.
• Disperse air bubbles from the syringe.
• Change the needle. Doing so will ensure that the needle used for the injection is sharp, thereby reducing pain. A safety-engineered needle should be used as this reduces the risk of sharps injury.
• Dispose of the used needle in a sharps container according to local policy.
• Place the filled syringe in a tray and take it to the patient, along with a sharps bin so the used sharps can be disposed of immediately after the procedure.

• Check the patient’s identity, according to local medicines management policy.
• Position the patient comfortably with the injection site exposed. The site is influenced by the assessment of the patient, the drug and the volume to be injected.
• Check the site for signs of oedema, infection or skin lesions. If any of these are present, select a different site.
• Wash and dry hands.
• If gloves are considered necessary, following the risk assessment, these should be applied.
• Ensure the skin is clean and follow local policy on skin cleansing.
• If skin cleansing is considered necessary, swab for 30 seconds with isopropyl alcohol and allow to dry for 30 seconds.
• Inform the patient you are going to carry out the procedure. Use distraction and relaxation techniques to reduce pain if needed
• Hold the syringe and needle in your dominant hand and gently stretch the skin around the injection site using the non-dominant hand. This displaces the subcutaneous tissue and aids needle entry.
• A Z-track technique can be used to prevent backtracking and leakage from the injection site.
• Insert the needle at a 90-degree angle using a dart-like action. This prevents accidental depression of the plunger during insertion of the needle.
• Aspiration to check whether the needle is in a blood vessel is not usually necessary. Aspiration is only required when the DG site is used, which is not recommended rate of 1ml/10 seconds; this aids absorption of the drug and reduces pain.
• Wait for 10 seconds to allow the drug to diffuse into the tissue and then quickly withdraw the needle.
• Dispose of the sharps directly into the sharps bin and the syringe according to local policy.
• Ensure the patient is comfortable and wash your hands.
• Record administration on the prescription chart, as well as the administration site as repeated injections into the same site can lead to induration and abscesses.
• Monitor the patient for any effects of the prescribed medicine and any problems with the injection site.

Craniopagus twins are conjoined twins that are fused at the cranium. Conjoined twins occur in about 10–20 babies in every million births in the United States. Among this small group, cephalic conjoining, or craniopagus twinning, represents the rarest of congenital abnormalities, accounting for 2–6% of all conjoined twins. 

Additionally, conjoined twins are genetically identical and always share the same sex. The union in craniopagus twins may occur on any portion of the cranium, but does not include either the face or the foramen magnum. The thorax and abdomen are separate and each twin has its own umbilicus and umbilical cord.

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