Instruments 2
Dr Poornachand. V
Asst Prof
CIMS
Choose any one !
• Nasogastric tube • Spinal needle
• Endotracheal tube • Bone marrow needle
• Suction catheter • Liver biopsy needle
• Ambubag and mask • Shakir’s tape
• Laryngoscope • Infantometer
• Foley’s catheter • I.V cannula
• MDI and spacer
Identify ?
Spinal needle with Stylet
What are the parts?
What are the uses?
I. Diagnostic
• CSF analysis: Meningitis, encephalitis, subarachnoid
hemorrhage, Guillain – Barre syndrome
• Measurement of CSF pressure
• Instillation of intrathecal dye for imaging procedures
(e.g.: myelography)
II. Therapeutic
• Spinal anesthesia
• Intrathecal medications (chemotherapeutic CNS
prophylaxis in leukemia, tetanus immunoglobulin in
tetanus)
• What are the contraindications for
Lumbar puncture?
I. Elevated Intracranial pressure (fundus examination
is mandatory)
II. Local infection at the site
III. Thrombocytopenia ( ˂ 20,000 cells/mm3 )
IV. Severe respiratory distress & shock etc. as that may
worsen with positioning in flexion
• What are the complications of Lumbar
puncture?
I. Post LP headache and backache
II. Cerebral herniation in sudden drop of elevated
intracranial pressure
III. Iatrogenic meningitis
Identify ?
SALAH Bone marrow aspiration needle
What are the parts?
Stylet
Needle
Guard
• What are the uses?
• Diagnostic
I. Leukemia, lymphomas and other non hematologic
malignancies
II. Megaloblastic anemia
III. Myeloproliferative disorder
IV. Myelodysplastic syndrome
V. ITP
VI. Bone marrow culture in diseases like typhoid, malaria
• Therapeutic
I. To secure intraosseus access
• How do you perform bone marrow aspiration?
• Sites:
I. Posterior superior Iliac spine
II. Tibial tuberosity
• Procedure:
• Patient is placed in prone position.
• Clean the area with povidone iodine followed by alcohol
(70%)
• Infiltrate skin, subcutaneous tissue & periosteum with 2%
lignocaine (2 – 5 ml)
• With a boring movement introduce the needle
perpendicularly into the cavity of ileum at the center of
posterior iliac spine
• A give away feeling is felt when the needle enters the marrow
contents
• When site chosen is tibia, the needle should be
directed away from the knee joint as damage there
can impair growth of epiphysis
• What are the contraindications?
I. Local site infection
II. Severe Thrombocytopenia (<20000)
III. Osteomyelitis
Identify?
JAMSHIDI Bone Marrow Biopsy Needle
What are the parts?
Needle
Stylet
• What are the indications?
I. Dry tap in BMA
II. Suspected Aplastic anemia and myelofibrosis
• Site
• Posterior iliac spine
• What are the contraindications?
I. Local site infection
II. Severe Thrombocytopenia (<20000)
III. Osteomyelitis
Identify?
Vim Silverman Liver biopsy needle
What are the parts?
What are the uses of liver biopsy needle/
indication for liver biopsy?
1. Chronic hepatitis – Hep B, Hep C
2. Autoimmune hepatitis
3. Wilson disease
4. Cirrhosis
5. Storage disorders – Glycogen storage disorders
6. Malignancies
7. Undiagnosed hepatomegaly
8. To differentiate between neonatal hepatitis and
biliary atresia
What are the types of liver biopsy?
I. Percutaneous liver biopsy – most common
II. Ultrasound guided/ CT guided liver biopsy
III. Trans Jugular liver biopsy
What are the contraindications for liver
biopsy?
I. INR > 1.5
II. Platelet count < 60000
What are the complications of liver
biopsy?
Minor Major
• Pain • Bleeding
• Subcapsular bleeding • Hemobilia
• Infection • Pneumothorax
• Minor bile leak/ • Hemothorax
arteriovenous fistula • Death
Always open stylet and needle
Long Short No Needle
and and guard is bifid
slender has a
guard
Identify?
Shakir tape
How to measure mid upper arm
circumference?
What is the color based grading of
malnutrition using Shakir tape?
<11.5 cm 11.5- 12.5 cm > 12.5 cm
Identify?
Infantometer
How to use Infantometer?
Identify?
I.V cannula
What are the sizes available?
Color Guage size Uses
Yellow 24 G Newborns
Blue 22 G Pediatric age group
Pink 20 G Older children
Green 18 G Blood transfusion
What are the uses?
• IV fluids administration
• IV medications
• Blood transfusion
Identify?
(Metered dose inhaler) MDI with
spacer
What are the parts?
What is a Metered Dose Inhaler?
• Delivers a fixed amount of medication
in aerosol form each time it is
activated
• Requires considerable coordination,
which might not be possible in young
children
• What are the drugs commonly available as MDI?
I. SABA- Salbutamol
II. LABA- Salmeterol, Formeterol
III. Terbutaline
IV. Inhaled corticosteroids (ICS)- Budesonide, Fluticasone
How to use MDI with Spacer?
1. Remove cap, shake inhaler and insert into
spacer device
2. Place mouth piece of spacer in mouth
3. Start breathing in and out gently and observe
movements of valve
4. Once breathing pattern is established press
canister and continue to breath 5-1O times
(tidal breathing)
5. Remove the device from mouth and wait for
30 seconds before repeating steps 1-4
How to use MDI with Spacer and
mask?
1. Attach baby mask to the mouth end of spacer
2. Shake MDI; insert in the MDI end of spacer
device
3. Cover baby’s moth and nose with baby mask
4. Press canister and encourage the child to take
tidal breathing with mouth open (If possible)
5-1 O times
5. Remove baby mask and wait for 3O-60
seconds before repeating steps 1-4
Identify?
Nebulization chamber
What are the parts?
Mask
Chamber
Inlet
Connecting
tube
What are the drugs given in the form of
nebulization?
• Salbutamol – Asthma
• Adrenaline – Croup, post intubation
• Hypertonic saline - Bronchiolitis
• Budesonide - Asthma
How do you give nebulization?
1. Connect oxygen source to nebulizer chamber by the
tubing provided with nebulizer
2. Put measured amount of drug in nebulizer chamber; add
normal saline to make the total volume 2.5-3 ml
3. Switch on the compressor and look for aerosol coming
out from the nebulizer chamber
4. Attach face mask to nebulizer chamber; ensure
appropriate fit to cover nose and mouth of the child
5. Encourage child to take tidal breathing with open mouth