Instruments medicine
Akash P Zanwar
1. Ryle’s tube or nasogastric tube
Uses
● Diagnostic
a. Upper gastrointestinal bleeding
b. Gastric analysis
c. Poisoning
d. Tracheoesophageal fistula
● Therapeutic
a. Gastric lavage
b. Gastric compression
c. Acute cholecystitis
Contraindications
● Corrosive poisioning
● Kerosene poisioning
Complications of procedure
● Epistaxis, rhinitis
● Pharyngitis
● Oesophagitis
● Oesophageal perforation
● Gastritis
● Gastric bleeding
● Aspiration pneumonia
2. Foley’s self retaining catheter
Uses
1. Urinary
a. Acute retention of urine
b. UMN and LMN bladder
c. Transverse myelitis
d. Ruptured urethra
e. Suprapubic cystostomy
2. Non urinary
a. Epistaxis
b. Enema tube in children
Contraindications
● Meatal stenosis
● Phimosis
● Acute UTI
Complications of procedure
● UTI
● Rupture of urethra
● Stricture of urethra
● Calculus formation at the tip of catheter
3. Endotracheal tube
Uses
● Cardiopulmonary arrest
● Respiratory failure due to severe pneumonia, COPDs
● To secure the airway and clear secretion
● To administer general anesthesia
Contraindications
● Laryngeal spasm
● Laryngeal edema
● Upper airway trauma or cancer
Complication of the procedure
● Infection
● Trauma during insertion
● Tracheal necrosis
● Laryngospasm following extubation
● Hoarseness
● Subglottic, tracheal stenosis
4. Tracheostomy tube
Indications
● Laryngeal spasm due to tetanus
● Prolonged artificial ventilation
● Airway obstruction due to trauma, tumor or secretions
Uses (For Cuffed variety)
● Prevents leakage of gases during positive pressure ventilation
● Prevents aspiration
● Secures the tube in place
Complications
● Tracheomalacia
● Infection
● Trauma to airways
● Collapse of the lungs
Contraindications
● No absolute contraindications
5. Malcoet’s catheter
Uses
● Non urinary
a. Intercostal drainage
b. Feeding gastrostomy, jejunostomy
c. Abdominal drain
● Urinary
a. Suprapubic cystostomy
b. Condom cather in males
c. Self retaining catheter in females
Complications
● Allergy, highly irritant
● Bladder stone, flower detached
● Blood in urine
● Infections
● Urethral injury
Contraindications
● Bladder spasm
● Hematuria
● Urethritis
● Encrustation of catheter
6. Oropharyngeal airway
Uses
● Airway management in unconscious patient
● Protects endotracheal tube from getting bitten
● Facilities air suctioning
Complications
● May obstructs the larynx by pushing down the epiglottis
● If airway is too short, it pushes tongue backwards causing obstruction
● May stimulate vomiting
Contraindications
● On concious patient with intact gag reflex
● Patient has foreign body obstructing airway
● Patient with nasal fracture or actively bleeding nose
7. Nasal cannula
Uses
● Suspected hypoxemia
● To provide continues positive pressure ventilation
Contraindications
● Patients with nasal blockage
● Facial injuries
● Patients who will not leave the cannula in place
Complications
● Nasal dryness
● Pulmonary oxygen toxicity
8. Rotahaler
Uses
● Treatment and prevention of asthma and COPD
● For patients who are not able to use standard inhalers
Complications
● Tremors
● Change in BP
● Increased HR
Contraindications
● H/O hypersensitivity
● Primary treatment of status asthamaticus
9. Jamshedi needle
Uses
● To accurately asses marrow cellularity
● To diagnose aplastic anemia, hyperplastic leukaemia
● Myeloproliferative disorders
Contraindications
● Sternal aspirate, osteoporosis and children
● Biopsy in coagulopathies
Complications
● Hemorrhage
● Pain
● Infection
● Perforation of major vessels
● Risk of GA and sedation
10. Metered dose inhaler
Uses
● Asthma inhalers contaning medications
● Dry powder inhalers
● Treatment of COPDs
Complications
● Chances of contamination
● Difficult to deliver high doses
● Possible dosing error
● Reduced portability
11. Lumbar puncture needle
Uses
● For CSF analysis and diagnosis of meningitis, meningoencephalitis,
pseudotumor cerebri
● To drain CSF and reduce intracranial pressure
● To instill medication
Contraindications
● Increased ICP
● Cerebral mass herniation
● Reduced platelet count
● Reduced prothrombin time
Complications
● Headache
● Bleeding or fluid leak
● Infection, pain and pneumothorax
● Nerve trauma
● Brain herniation
12. Salah bone marrow aspiration needle
Uses
● Red cell disorder : megaloblastic anemia, pure red cell disorder
● Myeloproliferative disorders
● Storage diseases
● Assessment of iron stores
Contraindications
● Sternal aspirate, osteoporosis, children
● Hemophilia
● Thrombocytopenia
Complications
● Hemorrhage
● Pain
● Infection
● Perforation of great vessels