PEDIATRICS

INSTRUMENTS
BY TRISHAN
INSTRUMENTS FOR ASTHMA

• MDI (Metered Dose Inhaler)

• Spacer (Volume holding chamber)
• Baby face-mask
• Rotahaler
• Revolizer
• Nebulizer
 METERED DOSE INHALER
Actuator (where the Canister containing the
cannister is fitted) drug
PARTS : Mouth Piece

• Delivers the drug in form of AEROSOL. Delivers 11-12% drug.

• Steps :
1. Shake (to mix the Hydrofluoroalkane/HFA propellant with the drug
properly). First 3 false puffs if used for first time.
2. Hold the MDI with thumb on base and one or two fingers on
cannister, bring it near the mouth.
3. Exhale slowly and deeply to empty the lungs.
4. Fix the mouth piece in mouth between teeth with lips tightly closed,
then take a slow deep inspiration and press the cannister.
5. Remove the MDI and hold breath for 5-10 seconds before exhaling.
6. Wash mouth with water.
 METERED DOSE INHALER

• How to know if • Advantages • Disadvantages • Drugs

empty? • Salbutamol (100
1. By checking the • Needs good co- mcg/puff)
• Easy to carry
number in the dose ordination while • Levosalbutamol (50
counter. • Multi dose device simultaneously taking
mcg/puff)
• Cheaper inspiration and
2. By marking on paper
pressing the canister. • Budesonide (200
for each dose. • Side effects are less mcg/puff)
than oral drugs • Can’t be used in small
3. Empty canister floats children and in
in water. emergency.
 Mouth Piece

SPACER (VOLUME HOLDING

CHAMBER)
• Made up of polyamide (very low electrostatic charge,
doesn’t interfere with drug delivery).
• While cleaning, never wipe inside, as it may
generate static electricity or destroy polyamide
coating, reducing drug delivery.
• Advantage : Overcomes the co-ordination problem in
children.
• Hold the spacer for 4-5 inhalations (roughly for 10
seconds, count 1-10 for babies)
 MDI+SPACER+MASK

BABY FACE-MASK
• Devices :
• Less than 4 years : Inhaler + Spacer +
Face mask
• 4-6 years : Inhaler with spacer
• More than 6 years : Inhaler with or
without spacer or dry powder inhaler.
• Adult : Inhaler with or without spacer
or Dry Powder Inhaler
• Acute exacerbation in any age :
Nebulization
 DRY POWDER INHALER

ROTAHALER REVOLIZER
• For 6 years and
above.
• Required
inspiratory flow
rate : 30-60 L/min.
ROTAHALER

• Delivers the drug in form of DRY POWDER

• Parts : Chamber with a fin (projected part that breaks the
capsule); raised square hole for capsule; mouth piece.
• Place the capsule with colored part above, then close and
rotate to break the capsule with fin, then take the drug in a
rapid, deep inspiration.
• Advantage : small, easy to carry, single device for all drugs.
• Disadvantage : Requires high inspiratory flow (unfit for small
children and in emergency), higher oropharyngeal deposition.
NEBULIZER
A NEBULIZER IS A DEVICE WHERE THE LIQUID SOLUTION IS CONVERTED INTO A
‘MIST’ OF LIQUID PARTICLES BY HIGH FLOW OXYGEN OR COMPRESSED AIR, WHICH
IS INHALED THROUGH A MASK COVERING THE MOUTH AND NOSTRILS.

• Required oxygen flow : 6-9 L/min (minimum)

FACE MASK
• Proper dose of drug is given in chamber (at least 3 ml of fluid
should be there. If 1ml of drug is required, add 2ml NS.)
• Then attach the oxygen tube into the bottom of the chamber.
• Attach face mask and turn the flow on. Fluid goes inside the baffle
via capillary action and forms a mist by mixing with the oxygen. BAFFLE

• When the chamber is empty, it makes a sputtering sound.

Chamber for
Drugs
• Advantage : No co-ordination required, can be taken in tidal
breathing, ideal for small children or emergency condition; can mix
multiple drugs. Inlet for
• Disadvantage : Difficult to carry, chances of cross-infection if not oxygen tube
sterilized properly.
DEVICES FOR OXYGEN DELIVERY

• Oxygen hood / Oxygen head box

• Nasal prongs
• Oxygen face mask / simple oxygen mask
OXYGEN HOOD OR HEAD BOX

• Used for children less than one year.

• Hood covers whole of the head, so continuous use
causes CO2 accumulation and sweating.
• Rate of oxygen flow required : 5 L/min
• FiO2 : 30%
• Flow may be as high as 10-15 L/min, with FiO2 up to
80%.
• Rubber guard for neck that can be adjusted according
to the required size
 NASAL PRONGS NASAL PRONGS

• Two nasal prongs are inserted in two

nostrils.

• Rate of oxygen flow required : 1-2 L/min

• FiO2 : 30-40%
• Advantage : Feeding can be continued.
• Disadvantage : Nasal mucosal edema/injury,
frequently displaced
OXYGEN FACE MASKS WITH TUBE
• Elongated shape for better visualization.
• Contains 2 exhalation ports, elastic
strips for attachment etc.
• Rate of oxygen flow required : 5-10
L/min
• FiO2 : 30-60%
• Advantage : No nasal mucosal edema,
less chance of displacement.
• Disadvantage : Feeding can’t be
continued.

Exhalation port
INFUSION / TRANSFUSION

• IV Cannula
• Three way cannula
• IV infusion set / Macro-drip set
• Micro-drip infusion set with volume chamber
• Blood transfusion set
• Scalp vein set
INTRAVENOUS
CANNULA Lock (Luer Lock Port)

• Size : Purple (26G), Yellow (24G), Blue (22G), Flashback

Pink (20G), Green (18G), Gray (16G), Chamber
Orange (14G)
• Purple and yellow commonly used in Injection port with cap
paediatrics (higher the Gauge, smaller the
size).
Wings
• Veins used : Dorsal venous arch, cephalic
vein, antecubital vein, saphenous vein, dorsal Cannula with needle
metacarpal vein etc. inside
• Complications : Cellulitis, Thrombophlebitis,
deep puncture/double puncture, hematoma.
THREE WAY CANNULA

• Two inlets and one outlet

• Used in :
1. For giving two infusions simultaneously.
2. Exchange transfusion.
3. Pleural/ascitic fluid aspiration.
INTRAVENOUS INFUSION SET /
MACRO-DRIP SET Spike

• For intravenous fluids/drugs. Drip Chamber

• 1 ml = 20 drops = 60 microdrops
• ml / hour = microdrops / min

Roller Clamp (flow

regulator)
MICRO-DRIP INFUSION SET
WITH VOLUME CHAMBER
Injection port
• For precisely controlled
drug delivery, like Air vent
dopamine, noradrenaline
etc. Graduated volume
• Volume chamber has two chamber
ports at upper end,
injection port and air vent.
At lower end, it has a Spike
rubber guard inside to
prevent air bubble entry Rubber guard
when the chamber is
empty.
• 1ml = 60 micro drops. Micro-drip chamber
BLOOD TRANSFUSION SET
Spike

• Contains a clot filter or strainer that strains clot

Clot filter/strainer
i.e. prevents entry of microthrombus into the
bloodstream during transfusion.

Roller Clamp (flow

regulator)
SCALP VEIN SET

• Parts : Needle, Cannula and Wings

Wings
• Can be used upto 4-5 years
• Inserted in temporal vein,
posterior auricular vein.
• Used for giving medications, Cannula and
blood drawing, ABG sampling needle
etc.
SYRINGES

• Syringe
• Tuberculin syringe
• Insulin syringe
DISPOSABLE PLASTIC SYRINGE

• Parts : Cylinder, piston and Nozzle

nozzle.
• Size : 1,2,5,10,20,50 ml.
• Use : Cylinder
1. For drug delivery
2. Drawing blood
3. Fluid aspiration Piston
4. Gavage feeding of newborn
(remove the piston)
TUBERCULIN SYRINGE

• 1ml disposable syringe with 26 gauge needle of ½ inch length.

• Black coloured (glass syringe is blue)
• Used in :
1. Mantoux test
2. Small amount of drug injection
3. Intradermal injection
4. ABG Sampling
INSULIN SYRINGE

• Red in colour.
• Measurement is in ml and units, 1 ml = 40 units of insulin.
TUBES AND CATHETERS

• Infant feeding Tube

• Suction Catheter
• Simple rubber catheter
• Foley catheter
 INFANT FEEDING TUBE

• Distal end is closed with two lateral eyes, proximal end has a cap.
• Length = 52 cm.
• Before insertion, length is calculated by adding the distance from
bridge of nose to tragus/ear lobule, and from tragus to
xiphisternum. Confirm by blowing air and auscultate.
• Use :
1. Feeding of preterm/neonate/PEM patient
2. Giving gastric Lavage / stomach wash. Finding abnormal gastric
contents.
3. Detection of choanal atresia, tracheoesophageal fistula etc.
 INFANT FEEDING TUBE

• Made up of polyethylene Closed end of

• In newborns, 6 French size is used. feeding tube

Open end of
suction catheter
SUCTION CATHETER

• Distal end open.

• Length = 52cm.
• For suction of secretions.
SIMPLE RUBBER CATHETER

• Non self-retaining
• Reusable (sterilization by boiling/autoclaving)
• Use :
1. Acute retention of urine
2. In MCUG (Micturating Cysto-urethrogram)
3. For giving bowel wash.
FOLEY CATHETER (FOLEY BI-WAY SELF-
RETAINING URINARY CATHETER)
• Proximal end has two ports : black end to inject saline for inflating the balloon,
and the yellow end is connected to urobag for excretion of urine.
• Distal end is closed with two lateral eyes.
• Use :
1. In retention of urine
2. For comatose patients
3. To differentiate between anuria and retention of urine
4. In major surgeries
NEEDLES

• Bone marrow aspiration needle

• Lumbar puncture needle with stylate
• Trucut biopsy needle
BONE MARROW ASPIRATION
NEEDLES

• For bone marrow biopsy. Klima Needle

Salah Needle
with guard
LUMBAR PUNCTURE NEEDLE WITH STYLET

• Site of lumbar puncture : commonly between L3-L4

• Indications : diagnostic (viral/bacterial/tubercular meningitis, Guillain-Barre
syndrome etc.) and therapeutic (anesthesia)
• Contraindications are : infected skin over puncture site, raised intracranial
tension (may cause uncal herniation) etc.
TRUCUT BIOPSY NEEDLE

• Bifurcated needle.
• Used for liver biopsy / renal biopsy.