INSTRUMENTS

1. Ryle’s Tube Insertion

Definition:
Ryle’s tube insertion is the procedure of introducing a nasogastric tube (Ryle’s tube) through
the nose into the stomach for diagnostic or therapeutic purposes.

Indications
• Gastric decompression (intestinal obstruction, paralytic ileus)
• Gastric lavage (poisoning)
• Enteral feeding in unconscious or dysphagic patients
• Aspiration of gastric contents
• Administration of drugs

Contraindications
• Basilar skull fracture
• Severe facial trauma
• Esophageal varices or strictures
• Recent nasal surgery

Procedure
1. Explain procedure and obtain consent.
2. Position patient in high Fowler’s position.
3. Measure tube length (nose → ear lobe → xiphisternum).
4. Lubricate tube and insert through nostril gently.
5. Ask patient to swallow water while advancing tube.
6. Advance up to measured mark.

Confirmation of Placement
• Aspirate gastric contents and check pH (<5 suggests gastric placement).
• Inject air and auscultate over epigastrium (whoosh test).
• X-ray chest/abdomen (most reliable method).
Complications
• Misplacement into trachea
• Aspiration pneumonia
• Nasal bleeding
• Esophageal injury

2. Rubber Catheter
A rubber catheter is a flexible tube made of soft rubber used for temporary drainage of urine
from the urinary bladder. It is commonly used for short-term catheterization.
Types
• Straight (Nelaton) catheter – for intermittent catheterization
• Foley’s catheter – self-retaining catheter with balloon
Sizes
• Measured in French (Fr) scale
• Adults: 14–18 Fr (commonly used)
Indications
• Acute urinary retention
• Monitoring urine output
• Pre-operative bladder emptying
• Collection of sterile urine sample
Contraindications
• Suspected urethral injury (blood at meatus, pelvic trauma)
• Urethral stricture

Procedure of Rubber Catheterization

Preparation
• Explain procedure and obtain consent
• Maintain strict aseptic precautions
• Position patient (supine; male – legs slightly apart, female – lithotomy position)
 • Clean genital area with antiseptic
Steps
1. Lubricate the catheter with sterile lubricant.
2. Hold penis at 90° (male) or separate labia (female).
3. Gently insert catheter into urethra.
4. Advance until urine flows.
5. Allow complete drainage of urine.
6. Remove catheter slowly (if straight catheter).
o If Foley’s, inflate balloon with sterile water after urine appears.

Complications
• Urinary tract infection (UTI)
• Urethral trauma
• Hematuria
• False passage

[Link]
A nebuliser is a medical device that converts liquid medication into a fine mist (aerosol) so
that it can be inhaled directly into the lungs.
Types
• Jet nebuliser – uses compressed air/oxygen
• Ultrasonic nebuliser – uses high-frequency vibrations
• Mesh nebuliser – uses vibrating mesh technology
Common Drugs Used
• Bronchodilators (e.g., salbutamol)
• Anticholinergics (ipratropium)
• Corticosteroids (budesonide)
• Hypertonic saline

Nebulisation
Nebulisation is the process of administering medications through a nebuliser in the form of
inhaled mist.
Indications
• Bronchial asthma
• COPD
• Acute bronchospasm
• Pneumonia with wheezing
• Upper airway obstruction
Procedure
1. Explain procedure and reassure patient.
2. Place patient in sitting or semi-Fowler’s position.
3. Add prescribed drug and normal saline to nebuliser chamber.
4. Attach mask/mouthpiece and connect to oxygen/compressor.
5. Instruct patient to breathe slowly and deeply through mouth.
6. Continue for 5–10 minutes until mist stops.
7. Clean and dry equipment after use.

Advantages
• Direct drug delivery to lungs
• Rapid onset of action
• Fewer systemic side effects
Complications
• Tremors
• Tachycardia
• Dry mouth
• Infection if equipment not cleaned properly
[Link]-Flow Nasal Cannula (HFNC)
Definition
High-Flow Nasal Cannula (HFNC) is an advanced oxygen delivery system that provides
heated, humidified oxygen at high flow rates (up to 60 L/min) through a special nasal
cannula to patients with respiratory distress.

Components
• Air–oxygen blender
• Flow meter (up to 60 L/min)
• Heated humidifier
• Heated circuit tubing
• Wide-bore nasal cannula

Indications
• Acute hypoxemic respiratory failure
• Pneumonia
• COVID-19 infection
• Acute exacerbation of asthma/COPD
• Post-extubation support
• Pre-oxygenation before intubation

Mechanism of Action
• Delivers precise FiO₂ (21–100%)
• Provides high flow to meet inspiratory demand
• Washes out nasopharyngeal dead space
• Generates mild positive airway pressure (PEEP effect)
• Improves oxygenation and reduces work of breathing

Procedure
1. Explain procedure and position patient upright.
2. Set prescribed FiO₂ and flow rate.
 3. Ensure humidifier chamber is filled with sterile water.
4. Place nasal cannula properly in nostrils.
5. Monitor oxygen saturation, respiratory rate, and comfort.

Advantages
• Better tolerated than non-invasive ventilation (NIV)
• Improved patient comfort
• Reduced need for intubation (in selected cases)

Complications
• Nasal dryness or discomfort (rare due to humidification)
• Delayed intubation if not monitored properly

[Link] Bag
Definition
An AMBU bag (Artificial Manual Breathing Unit), also called a Bag-Valve-Mask (BVM)
device, is a hand-held device used to provide positive pressure ventilation to patients who
are not breathing or have inadequate respiration.

Components
• Self-inflating bag
• One-way (non-rebreathing) valve
• Face mask
• Oxygen reservoir bag
• Oxygen tubing

Indications
• Cardiac arrest
• Respiratory arrest
• Apnea
• Severe respiratory distress
 • During CPR
• Pre-oxygenation before intubation

Procedure
1. Place patient in supine position and ensure airway patency.
2. Attach oxygen supply (10–15 L/min) to reservoir.
3. Position mask over nose and mouth using E-C clamp technique.
4. Squeeze bag gently to deliver breath (1 breath every 5–6 seconds in adults).
5. Observe chest rise to ensure effective ventilation.

Advantages
• Simple and portable
• Can deliver high concentration of oxygen
• Useful in emergency situations

Complications
• Gastric distension
• Aspiration
• Barotrauma
• Inadequate ventilation if poor mask seal

[Link] Bag
Definition
A urine bag (urinary drainage bag) is a sterile collection device attached to a urinary catheter
to collect and measure urine output.

Types
• Leg bag – small, strapped to thigh; used for ambulatory patients
• Bedside drainage bag – larger capacity (1500–2000 mL) for bedridden patients
• Urometer bag – measures hourly urine output accurately (used in ICU)
Indications
• Continuous bladder drainage
• Monitoring urine output (ICU, post-operative cases)
• Urinary retention
• Neurogenic bladder
• Prolonged immobilization

Components
• Sterile collecting bag
• Graduated measurement markings
• Drainage tubing
• Non-return (anti-reflux) valve
• Outlet tap for emptying

Care and Maintenance

1. Maintain a closed drainage system.
2. Keep bag below bladder level to prevent backflow.
3. Avoid kinking of tubing.
4. Empty bag regularly using clean technique.
5. Record urine output accurately.

Complications
• Catheter-associated urinary tract infection (CAUTI)
• Backflow of urine
• Blockage of tubing
• Skin irritation (with leg bag)
[Link]
Definition
A defibrillator is a life-saving medical device that delivers a controlled electrical shock to
the heart to restore normal rhythm in life-threatening arrhythmias.

Indications
• Ventricular fibrillation (VF)
• Pulseless ventricular tachycardia (VT)
• Cardiac arrest

Types
• Manual defibrillator – used in hospitals by trained personnel
• Automated External Defibrillator (AED) – gives voice prompts; used in public
places
• Implantable Cardioverter Defibrillator (ICD) – implanted in high-risk patients

Principle
The electrical shock depolarizes all myocardial cells simultaneously, allowing the natural
pacemaker (SA node) to regain control and restore normal sinus rhythm.

Procedure (Manual/AED)
1. Confirm cardiac arrest and start CPR.
2. Attach defibrillator pads to chest (right upper chest & left lateral chest).
3. Analyze rhythm (automatically in AED or manually).
4. Deliver shock if indicated (e.g., 200 J biphasic).
5. Resume CPR immediately after shock.

Complications
• Skin burns
• Myocardial injury (rare)
• Arrhythmias (if improperly used)
Syringe
Definition
A syringe is a medical instrument used to inject fluids into the body or withdraw fluids (such
as blood) from the body.

Parts of a Syringe
• Barrel – hollow cylindrical tube with graduation markings
• Plunger – fits inside the barrel to create suction or pressure
• Tip – connects to needle (Luer lock or slip tip)
• Needle (if attached) – sharp hollow tube for injection

Types
• Disposable plastic syringe
• Insulin syringe
• Tuberculin (TB) syringe
• Glass syringe (rarely used now)

Sizes
• 1 mL, 2 mL, 5 mL, 10 mL, 20 mL, 50 mL etc.
• Insulin syringe: 40 IU or 100 IU

Uses
• Administration of drugs (IM, IV, SC, ID)
• Drawing blood samples
• Flushing IV lines
• Irrigation procedures

Precautions
• Maintain strict aseptic technique
 • Use correct size syringe and needle
• Do not reuse disposable syringes
• Dispose in puncture-proof sharps container

Complications
• Infection
• Needle-stick injury
• Pain or hematoma at injection site

[Link] syringe
An insulin syringe is a small, calibrated syringe specifically designed for the accurate administration
of insulin in diabetic patients.

Parts
• Barrel – marked in insulin units (not in mL)
• Plunger – for drawing and injecting insulin
• Needle – fine, short needle (usually 28–31 gauge)
• Cap – protects sterility

Types
• U-40 syringe – for U-40 insulin (40 units/mL)
• U-100 syringe – for U-100 insulin (100 units/mL)
(Important: Use matching syringe for the insulin concentration.)

Capacity
• 0.3 mL (30 units)
• 0.5 mL (50 units)
• 1 mL (100 units)
Procedure of Insulin Injection
1. Wash hands and check insulin type & expiry.
2. Roll cloudy insulin gently between palms (do not shake).
3. Draw required units of insulin into syringe.
4. Choose site (abdomen preferred; also thigh, arm).
5. Clean site with spirit swab.
6. Pinch skin and inject subcutaneously at 45°–90°.
7. Withdraw needle and do not massage site.

Advantages
• Accurate dosing
• Less painful due to fine needle
• Easy self-administration

Complications
• Hypoglycemia (due to overdose)
• Lipodystrophy (if site not rotated)
• Local infection

9. IV set
Definition
An IV set is a sterile disposable device used to administer intravenous fluids, medications, or
blood products directly into a patient’s vein.

Parts of an IV Set
• Spike – pierces IV fluid bottle/bag
• Drip chamber – allows visualization of fluid drops
• Air vent – for glass bottles
• Tubing – carries fluid to patient
• Roller clamp – regulates flow rate
 • Injection port – for adding medications
• Connector – attaches to IV cannula

Types
• Macrodrip set – 10, 15, or 20 drops/mL (used for adults)
• Microdrip set – 60 drops/mL (used for children, precise control)
• Blood transfusion set – with filter

Procedure
1. Wash hands and maintain aseptic precautions.
2. Close roller clamp.
3. Insert spike into IV fluid bottle/bag.
4. Fill drip chamber halfway.
5. Open clamp to prime tubing (remove air).
6. Connect to IV cannula.
7. Adjust flow rate as prescribed.

Uses
• Fluid replacement
• Drug administration
• Blood transfusion
• Electrolyte correction

Complications
• Air embolism
• Phlebitis
• Fluid overload
• Infection
[Link] vein set
Definition
A scalp vein set, also called a butterfly needle, is a small-gauge winged infusion device used for
venipuncture, especially in infants and patients with fragile or difficult veins.

Parts
• Short fine needle (23–25G commonly)
• Two flexible “butterfly” wings
• Transparent tubing
• Connector (Luer lock/slip tip)

Indications
• Pediatric venipuncture (especially scalp veins in infants)
• Difficult venous access in elderly
• Blood sampling
• Short-duration IV therapy

Procedure
1. Maintain aseptic precautions.
2. Select suitable vein (scalp vein in infants, hand veins in adults).
3. Clean site with antiseptic.
4. Hold wings between fingers and insert needle at 10–15° angle.
5. Confirm blood flashback.
6. Secure needle and connect to IV line or syringe.

Advantages
• Better control due to wings
• Less painful (small gauge)
• Useful for fragile veins

Complications
• Hematoma
 • Infiltration
• Infection
• Vein collapse

[Link]’s catheter
Definition
A Foley’s catheter is a flexible, self-retaining urinary catheter with an inflatable balloon at
its tip, used for continuous drainage of urine from the urinary bladder.

Parts
• Drainage lumen (for urine flow)
• Balloon lumen (for inflation)
• Inflatable balloon (5–30 mL capacity)
• Drainage port
• Inflation port (for sterile water)

Sizes
• Measured in French (Fr) scale
• Adults: 14–18 Fr commonly used
• Pediatric: smaller sizes (6–10 Fr)

Indications
• Acute or chronic urinary retention
• Monitoring urine output (ICU, post-operative)
• During major surgeries
• Neurogenic bladder
• Prolonged immobilization

Procedure
1. Explain procedure and obtain consent.
 2. Maintain strict aseptic precautions.
3. Position patient appropriately (supine).
4. Clean genital area with antiseptic solution.
5. Lubricate catheter and insert gently into urethra.
6. Advance until urine flows.
7. Inflate balloon with sterile water (usually 10 mL).
8. Connect to urine bag and secure catheter.

Complications
• Catheter-associated urinary tract infection (CAUTI)
• Urethral trauma
• Hematuria
• Blockage

[Link] Water
Definition
Distilled water is purified water obtained by the process of distillation, where water is
boiled into steam and then condensed back into liquid, leaving impurities behind.

Process of Preparation
1. Water is heated until it boils.
2. Steam rises and leaves dissolved salts, minerals, and impurities behind.
3. Steam is cooled and condensed into a separate container.
4. The collected condensed water is distilled water.

Properties
• Colorless, odorless, tasteless
• Free from dissolved salts and microorganisms
• Low electrical conductivity
• Neutral pH (approximately 7)
Uses in Medical Field
• Preparation of injections and IV fluids
• Cleaning and sterilizing medical instruments
• Laboratory procedures
• Dilution of medications (as prescribed)
• Filling autoclaves and humidifiers

Advantages
• Highly pure
• Free from contaminants
• Safe for laboratory and pharmaceutical use

Limitations
• Not suitable for direct IV injection unless sterile and labeled for injection
• Lacks essential minerals (not ideal for regular drinking)