INSTRUMENTS

Instrument
• Uses/Indications- Diagnostic and theraupeutic
• Contra-indications
• Procedure
• Complications
 Endotracheal tube
• Cuffed : > 8 years
• Prevents displacement and aspiration
• Uncuffed : < 8 years
• Deciding tube size- age in years /4 + 4 for un cuffed
(+ 3.5 for cuffed)
• Sizes available 2.0 to 6.5
UNCUFFED ENDOTRACHEAL TUBES

CUFFED ENDOTRACHEAL TUBES

 Endotracheal tube
• Preterm : 2 – 2.5 mm
• Term : 3 – 3.5 mm
• 1 – 6 months : 3.5 – 4.5 mm
• 6 months – 1 yr : 4.5 – 5 mm

• Size is the internal diameter in mm

• Length is from tip in cm
• Has a radio opaque line
 Endotracheal tube
Uses :
• Imminent arrest
• Low GCS
• Respiratory failure
• Hypotensive shock

Complications :
• Mechanical trauma to oral cavity
• Stimulation of post pharyngeal wall – vasovagal episodes
• Pneumothorax
• Prolonged intubation – pressure necrosis of larynx
 Laryngoscope
• Blade- miller, Mac Intosh
• straight for < 1 year, curved for > 1 yr
• uses-
– intubation, direct laryngoscopy
• sizes- 0 to 4, 0 for neonate, 4 for adult
• handle- battery container
• complication- injury to teeth and lips/ tongue, Vagal
stimulation- bradycardia
 Ambu bag
• Artificial Manual Breathing Unit
• Self inflating bag valve mask / non rebreathing/ silicon bag
• Valve assembly
– fish mouth valve&
– Pop off valve

• Size- 250 ml neonates, 500 ml pediatric, 1500 ml adult

• Parts-
Ambu bag
 Ambu bag
• Bag-mask ventilation is used to provide oxygenation
and ventilation for a child with
– apnea
– bradypnea,
– Hypoxemia, neonatal resusitation

• EC-clamp technique :

Contraindications :
Meconium aspiration
Diaphragmatic hernia
Ambu bag - EC clamp technique

Signs of effective BMV :

Visible chest rise
Improvement in Oxygen saturation
Improvement in heart rate
 Face mask
• Made of silicon
• Types- circular (pediatric), triangular (adult)
• Size- cover mouth nose chin, does not cover
eyes
 De lee’s mucus extractor
• Parts
mouth piece & baby end
• For suctioning of oro pharyngeal and nasal
secretions during resuscitation
• No mechanical trauma
• Easy availability
Salah’s Bone marrow biopsy needle
Parts:
• Stillete/ trocar
• Cannula
• Adjustable guard-to prevent the deep penetration of trocar
into the bone

Jamshidi needle
 BONE-MARROW ASPIRATION NEEDLE
 Diagnostic indications:
 Aplastic anemia , ITP
 Leukemia
 Megaloblastic anemia
 Infections – e.g. Kala-azar
 Storage disorders – e.g. Gaucher’s disease
 PUO
 Myelofibrosis
 Therapeutic indications:
 Bone – marrow transplantation
 Intra–osseous during shock Site
 Intra osseous drug route • > 1 Year
• Iliac crest
• < 1 Year
• Proximal tibia medial to tibial tuberosity
• To prevent injury to pelvic structures in infants
 Lumbar puncture needle
Indications :
Diagnostic:
PARTS
Infections
• Stillet Meningitis
Encephalitis
• Spinal needle
Inflammatory
SIZES Multiple sclerosis
• 16 to 30 G Gullain-Barre syndrome
Oncologic
Site: Metabolic
• Top of iliac crest Spontaneous subarachnoid hemorrhage
• Corresponds to L4 Therapeutic:
spinal anesthesia
intra thecal administration of drugs
 LUMBAR PUNCTURE NEEDLE
Contraindications:
• Increased intracranial pressure
– Cerebral herniation
– Impending herniation
– Possible increased ICP
– Coagulopathy
– Prior lumbar surgery
– Severe vertebral osteoarthritis or degenerative disc disease
– Significant cardiorespiratory compromise
– Infection near the puncture site
 Lumbar puncture needle(Spinal needle)

Indications
Site
• Between L3 and L 4 space
• Between L4 and L5 space

Complications
headache,
local back pain or infection
Brainstem herniation
PROCEDURE:
Patient position
➢ Lateral decubitus position
➢ Sitting
• A line connecting the posterior
superior iliac crest will intersect
the midline at approx. the L4
spinous process.
• Spinal needles entering the
subarachnoid space at this point
are well below the termination
of the spinal cord.

• Make sure the hips and

shoulders are aligned & are
perpendicular to the bed
surface.
Pressure :
Newborn 90 – 120 mm H2O
Young children 60 – 180 mm H2O
Older children 12 – 120 mm H2O

Cells : 0 - 5 / mm3 WBCs

• Polymorphonuclear cells are always abnormal
• Increased polymorphs – bacterial meningitis
• Lymphocytosis – aseptic meningitis, TBM, fungal meningitis
RBCs – NIL
• If present – traumatic tap or subarachnoid hemorrrhage
Proteins : 20 – 40 mg (newborns upto 120 mg)
• Increased – meningitis, GBS, CSF block, tumors

Glucose : 40 – 70 mg (60% of plasma glucose)

• Decreased – bacterial, tuberculous, viral meningitis
LIVER BIOPSY NEEDLE
Indications of liver biopsy
➢ To differentiate between neonatal hepatitis and biliary atresia
➢ Cirrhosis of liver
➢ Cryptogenic cirrhosis Indian childhood cirrhosis, Biliary Cirrhosis (Primary
& Secondary)
➢ Storage disorders:
➢ Hemochromatosis, Glycogen Storage disorders, Wilson’s disease
➢ Malignancy:
➢ Leukemia, Lymphoma, Wilm’s Tumour, Hepatoblastoma, Neuroblastoma
➢ Infiltration:
➢ Tuberculosis, Sarcoidosis, Infections, CMV,
Herpes.
INTRAOSSEOUS NEEDLE
 9. SUCTION CATHETER

INSTRUMENT:
• Appropriate sized catheter
• Size- 6, 8, 10, 12 Fr
• Open tip
• Uses- ET suction, oral suction , neonatal
resustitation
 Infant feeding tube/ naso-orogastric
tube
Parts:
• Blunt end with lateral opening, radio opaque line,
markings, external end with lid
• Size- 5,6 (newborn) 8,10 (term)
• How to measure: tip of the nose/ angle of mouth to
tragus to below xiphi sternum
 Indications:
Diagnostic:
• Aspiration of gastric contents – RGJ for CBNAAT
• Diagnosis of TEF, choanal atresia

• Therapeutic Uses:
– Nasogastric Feeds.
– To remove gastric contents as in poisoning, persistent GI bleeding,
abdominal distention with bilious emesis, Hepatic encephalopathy
– Conservative Treatment of Intestinal obstruction
– Management of Poisoning
– Administration of drugs
– Pre-operatively to decompress the stomach if an emergency surgery is
to be carried out & sufficient time for fasting is not available
 Nebuliser mask
• parts- air inlet, chamber, baffle, cap
 Nebuliser mask
Jet nebuliser :
• Jet of gas forced thru narrowed lumen
• Negative pressure in chamber
• Solution is aerosolised into droplets

• INDICATIONS :
– CROUP
– ACUTE ASTHMA
– BRONCHIOLITIS
 Nebuliser mask
How to Use a Nebulizer?
• Assemble the tubing, nebulizer cup and mouthpiece

• Fill the nebulizing chamber with the medication.

• Fill the chamber with 4–5 mL of normal saline. If lesser volume is used,
nebulization may not be possible (avoid distilled water)

• Medications used – salbutamol , levosalbutamol, adrenaline

ipratropium , budesonide , normal saline , 3 % nacl , N-acetyl cysteine ,
tobramycin .
 Metered Dose Inhaler (MDI)
• Acute attack of asthma
• Long term maintenance therapy

• Commonly used medications : salbutamol , levosalbutamol ,

salmeterol , budesonide
Limitations :
Requires perfect co-ordination between inspiration and
activation of device which is not possible in small children
Drug wastage – deposition in oropharynx
SIDE EFFECTS:
Tremors – beta agonists
Palpitations & tachycardia – beta agonists
Oral candidiasis – steroid deposit in mouth
Sore throat – dude to steroid deposit in pharynx and larynx
 Spacer
• Acts as a reservoir for aerosolised drug
• Greater drug delivery to lungs
• Less wastage to atmosphere
• Reduces deposition in oropharynx
 SPACER
• Spacers are bottle-shaped plastic devices which have a mouth
piece at one end and other end has an opening which the MDI
can be attached
• Age < 4 yrs – use with face mask
• Age > 4 yrs – without face mask
• 8 – 10 breaths are needed to completely empty the spacer
 Intravenous cannula
Parts:
• Catheter
• Stillete
• Sizes: 22 (blue); 24( yellow)

• Uses:
• Venipuncture for :
– Collection of blood
– Infusion of IV fluids, drugs, blood, etc.
– ABG analysis
 Side effects:
• Thrombo phlebitis

Advantage:
• Long lasting ( 2 to 3 days)
• May not damage the endothelium
SCALP VEIN SET
 Intra venous set
Parts:

• Plastic cannula- to be inserted into IV bottle

• Plastic tubing
• Murphy’s chamber- regulation of speed of IV drip
• Connector- to attach to IV cannula

Indications:
• Administration of IV fluids, drugs, TPN

Complications:
• Air embolism( if not properly flushed
BLOOD TRANSFUSION SET
PEDIATRIC DRIP SET
Foley’s catheter
Should be inflated with distilled water
USES:
Urinary
* To monitor urine output in shock or renal failure
* To differentiate anuria from retention
* For incontinence of urine
* To give bladder washes (in Cystitis)
* For suprapubic cystostomy
Non-Urinary:
* To arrest post-nasal bleeding in cases of intractable
epistaxis
* To arrest bleeding from esophageal varices in case of
portal hypertension
COMPLICATIONS:
• Injury to urethra or urinary bladder
• Inadvertent catheterization of the vagina may occur
• Urinary tract infection in the absence of aseptic precautions

CONTRAINDICATIONS:
• Urethral distruptions, usually traumatic
• Absolute neutropenia
• Profound thrombocytopenia or other hypocoagulable states
 Uro bag

• For measuring the urine

output
OROPHARYNGEAL AIRWAY
 15. GUEDEL ORO PHARYNGIAL AIRWAY
• Prevent tongue from falling backwards
• Opening aspiration
INSULIN SYRINGE
It is a 1 cc syringe with a white piston (plastic
syringe) or a metal piston (glass syringe)
• Uses of the insulin Syringe:
– To administer PPD for Mantoux Test.
– To administer BCG vaccine.
– To administer Test doses of drugs such as Penicillin.
– Provocative Testing — To test for allergens in Bronchial asthma, Atopy.
– Insulin injections in Diabetes Mellitus.
– Giving small doses of drugs e.g. Gentamicin, Phenobarbitone, Digoxin.
TONGUE DEPRESSOR
O2 MASK AND TUBING
O2 NASAL PRONGS
NON REBREATHING MASK (NRM MASK)
VENTURI MASK