Lumbar Puncture needles (16, 18, 20 guage)

Indications -

meningitis, encephalitis diagnosis

Myelopathy to rule out transverse myelitis or find cause
SAH
Altered level of consciousness in patients with diagnosis uncertain after CT/MRI
CIDP (Chronic Inflammatory Demyelinating Polyneuropathy)
AIDP (GBS etc)
MS

Therapeutic -
measurement and TX of raised ICP
Benign intracranial hypertension
To introduce intrathecal medications in chemotherapy or to give broad spectrum antibiotics in cases of
meningitis

Complication -
bleeding (hematoma in epi/sub dural space or SC whatever)
infection,
perforation (spinal cord damage or injury to peripheral nerve roots)
Severe headache or coning/herniation of brain/brainstem

Contraindication -
any SOL (if no other diagnosis or evidence of SOL in CT and raised ICP then carefully take out 2 cc fluid for
diagnosis)
coagulopathy,
patient not of Benign intracranial hypertension but with raised ICP
L4 - L5, lateral turned position (sitting position in very obese lady if ASIS cannot be located), locate via
ASIS
[In neonates, we use cervical puncture for these purposes by using a 3 cc syringe)
Bone marrow biopsy (neeche se mota, upar se patla)

Pleural needle

Syringe - IM/IV injection, needle thoracostomy

Complication - infection (abscess), air embolism, ischemic necrosis/gangrene of distal body parts,
coagulopathy (MC contraindication too - not given in thrombocytopenia or deranged PT/INR such as in
dengue, liver disease), bleeding (massive/hematoma), IE (in drug abusers), anaphylaxis
Insulin syringe (in Units - 10, 20, 30, 100 cc) looks like a small LP needle, LP needle has a longer needle
and a smaller orange cap

Indications
Give insulin IV/IM/SC - uncontrolled or tx of DM I
Vaccination
IM injection in neonates
Anticoagulant heparin SC

Complications
bleeding,
hypoglycemia,
infection,
perforation

Contraindications
hypoglycemia in patient,
RBS not increasing do NOT give insulin
Foley's catheter (rubber tube, two way or three way) and urine bag

Indications:
Urinary retention due to any cause, BPH or in acute emergency (stone in children blocking opening)
Pre op for surgical procedure
Neurological bladder dysfunction
Unconscious patient or with altered GCS
Measurement of intake - output in immobile patient (for females, use condom catheter and pamper)
Paraplegic patients due to spinal injury (or even immobile with spinal injury)

Complication -
infection,
bleeding,
perforation (urethral rupture/tear - not bladder (bladder can be punctured in suprapubic catheter)),
wrong placement in vagina in females

Contraindication -
strictures,
coagulopathy,
prostatic cancer,
severe BPH

(Wear gloves, sterilise, patient privacy, aseptic management of area, just get the edge out of the packet,
put xylocaine and pass it slowly until urine comes out, inflate via 5 - 10 cc air or NS - 20 cc if old patient
with wide urethra)

3 way if you have to give medicine or wash out

Feeding syringe (large, thick syringe) with NG Tube. 1st mark is lower end of esophagus, 2nd is body of
stomach, 3rd is pylorus and 4th is duodenum and last one curves in duodenum

Diagnostic indication -
Monitor gastric pH for diagnosis of abdominal TB (AFP smear and gene expert)
pernicious anemia
malignancy
TB lavage
Patient with poisoning to know nature and amount of poisoning (organophosphorus poisoning - never
given in corrosive/pesticide/bleach poisoning)

Therapeutic -
Feeding of patient (unconscious or refusal to eat or malignancy or old age or psychiatric patient s)
give medicines (hepatic encephalopathy etc)
Decompensation of intestinal obstruction
Gastric lavage in any poisoning except corrosive poisoning

Complication -
infection,
bleeding,
perforation (trachea etc), damage of laryngeal nerve,
wrong placement (in trachea leading to aspiration pneumonia)

Contraindication
nasal laceration/bleeding or maxillofacial trauma
Cervical injury (any trauma or bony fracture - will give in myelopathy)
Coagulopathy
Trucut biopsy needle (long LP needle type with a broad end)

Biopsy from kidney (6 or 4)

Biopsy for liver (6) - keep monitoring vitals, spinal position and listen to gut sounds and keep patient for
around at least four to six house, 7th to 8th intercostal space in midclavicular line using all aseptic
measures, press when patient takes a deep breath, after putting a cut/incision in skin

Indications
Diagnosis of unexplained LFTs
Assess prognosis of disease and tx response
Any SOL
Wilson's or hemechromatosis to assess iron/Copper levels
PBC or PSC
Fever of unknown origin
Reactive splenomegaly of chronic malaria
Grading and staging of hep, alcoholic liver disease, nonalcoholic steatohepatitis

Complication -
Infection
Bleeding
Perforation

Contraindication -
coagulopathy
ETT (endotracheal tube)

Indications
General anesthesia
Positive pressure (BIPAP) endotracheal intubation
Mechanical ventilation in desaturating patient
Altered level of GCS (<8)

Complications -
Bleeding
Infection
Perforation (laryngeal nerve, esophageal etc)

Contraindications
severe airway trauma or obstruction
severe cervical spine injury
patients with Mallampati III/IV classification
facial trauma
head trauma
active epistaxis
expanding neck hematoma,
oropharyngeal trauma
apneic patients.

Mask

Indications -

Nebulisation

Delivery of oxygen in desaturating patients

central venous pressure (CVP) line

Indications
Volume resuscitation.
Emergency venous access.
Nutritional support.
Administration of caustic medications (eg, vasopressors)
CVP monitoring.
Transvenous pacing wire introduction
Hemodialysis.

Contraindications
Distorted local anatomy (eg, from vascular injury, prior surgery, or previous irradiation)
Infection at insertion site
Presence of anticoagulation or bleeding disorder
Patient who is excessively underweight or overweight
Uncooperative patient
Current or possible thrombolysis

Complications
local or systemic infection
Lacerating or puncturing the subclavian artery
hemothorax
pneumothorax
Catheter-related thrombosis may lead to pulmonary embolism.
air embolism
Dysrhythmia
Atrial wall puncture can lead to pericardial tamponade.
lost into the vein
anaphylaxis
Chylothorax is a possible complication on the left side.
IV Cannula:
Indications:
Repeated blood sampling
IV administration of fluid
IV administration of medications
IV administration of chemotherapeutic agents
IV nutritional support
IV administration of blood or blood products
IV administration of radiologic contrast agents for computed tomography (CT), magnetic resonance
imaging (MRI), or nuclear imaging

Contraindications
Peripheral venous access in an injured, infected, or burned extremity should be avoided if possible.
Some vesicant and irritant solutions (pH < 5, pH >9, or osmolarity >600 mOsm/L) can cause blistering and
tissue necrosis if they leak into the tissue, including sclerosing solutions, some chemotherapeutic agents,
and vasopressors. These solutions are more safely infused into a central vein. They should only be given
through a peripheral vein in emergency situations or when a central venous access is not readily
available.

Complications:
Pain
Failure to access the vein
Blood stops flowing into the flashback chamber
Difficulty advancing the catheter over the needle and into the vein
Difficulty flushing after the catheter was placed in a vein
Arterial puncture
Thrombophlebitis
Peripheral nerve palsy
Compartment syndrome
Skin and soft tissue necrosis
Chest tube

Indications:
Surgery or trauma in the chest
pneumothorax
pleural effusion
A tear in the esophagus

Complications
Bleeding
infection
Improper placement of the tube
Injury to the lung
Injury to organs near the tube, such as the spleen, liver, stomach, or diaphragm

Contraindications
pulmonary adhesions
pulmonary disease
trauma
Coagulopathy
diaphragmatic hernias