PEDIATRIC
INSTRUMENTS
LARYNGOSCOPE
It has 2 parts
• A handle( has batteries)
• A blade(contains light source) – straight (Miller)
-- curved (Macintosh)
• Straight blade more useful in young children, since larynx is
placed more anteriorly and above
• Curved blade in older children & adults, helps to displace the
tongue
SIZE
• 0 : Preterm & LBW
•1 : Term
•2 : Children between 2-10 years
•3 : Children > 10 years
USES
• DIRECT LARYNGOSCOPY IN
1. In Cord palsy
2. To detect foreign body obstructing the larynx
3. Anatomical lesion
• PRIOR TO ET INTUBATION
1. Neonatal asphyxia
2. Meconium aspiration
3. RDS
4. CDH/TEF
5. Mechanical ventilation
RELATIVE CONTRAINDICATIONS
• Diseases or injuries of cervical spine
COMPLICATIONS
• Mechanical injury
• Hyperextension of neck- stimulation of posterior pharyngeal
wall- vasovagal attack
ENDOTRACHEAL TUBE (ET TUBE)
PARTS
• PROXIMAL END: 15mm adapter (connector) that fits to a
ventilator or AMBU Bag
• CENTRAL PORTION:
A vocal cord guide (black line)
Radio opaque
Cuffed / uncuffed
• DISTAL END: Murphy’s eye
USES
• Mechanical ventilation
• During resuscitation
• Direct suctioning of trachea
• Angioneurotic edema
• In epiglottitis & life-threatening croup
COMPLICATIONS
• Mechanical trauma
• Prolonged intubation – pressure necrosis of laryngeal structures
(hoarseness)
• pneumothorax
SELF-INFLATING BAG
Parts to a self-inflating bag:
1. Air inlet and attachment site for oxygen reservoir
2. Oxygen inlet
3. Patient outlet
4. Valve assembly
5. Oxygen reservoir
6. Pressure release (pop-off) valve
AMBU BAG
• Intermittent positive pressure ventilation during resuscitation
• Mask can be cushioned or uncushioned
• Round/anatomical( triangular)
• Mask should cover nose, mouth including tip of chin, but not the
EYES
CONTRAINDICATIONS
• Congenital diaphragmatic hernia
FACE MASK
Usually made of plastic or rubber
Types Shapes
• Uncushioned * Round
• Cushioned * Triangular
• Mask should cover nose, mouth including tip of chin, but not the
EYES RIGHT SIZED MASK
Advantages of Cushioned mask
• Mask conforms to the face
• Requires less pressure to obtain air tight seal
• Less chances of damage to eyes or other structures of the face
OXYGEN HOOD
• INLET – oxygen connector (source)
• USES – administer humidified oxygen
• Advantages: non – invasive
• Disadvantage :
• Change in the position of the hood may result in oxygen
leaking outside the hood
• Oral feeding is difficult
• Oxygen flow may be insufficient in cases where the
respiratory drive is poor
GUEDEL AIRWAY
INDICATION
Oropharyngeal airways are indicated for unconscious patients in
the setting of
• Bag-valve-mask ventilation
• Spontaneously breathing patients with soft tissue obstruction of
the upper airway and have no gag reflex
CONTRAINDICATIONS
Absolute contraindications:
• Consciousness or presence of a gag reflex
Relative contraindications:
• Insertion of an oropharyngeal airway may not be feasible in
some settings, such as
Oral trauma
Trismus (restriction of mouth opening including spasm of
muscles of mastication)
1 2
3
TUBES
1. NASO/ORO GASTRIC FEEDING TUBES
2. RYLES TUBE
3. SUCTION CATHETER
4. MUCUS EXTRACTOR
.
INFANT FEEDING TUBE
INDICATIONS
o DIAGNOSIS OF
1. Internal bleeding in stomach & upper GI
2. Tuberculosis (gastric lavage)
3. TEF
4. Poisoning
5. Localisation of oesophageal strictures
6. Gastric analysis
THERAPEUTIC
.
1. Nasogastric feeds
2. Remove gastric contents in poisoning, persistent GI bleed,
abdominal distension with bilious emesis
3. Administration of drugs
4. Gastric decompression pre operatively, when sufficient time
for fasting is not available
Other uses
• As an oxygen catheter
• For nasal, endotracheal & tracheostomy suction
• As a tourniquet
PROCEDURE
• Select the appropriate tube
• Determine the approximate
length to be passed by
measuring the distance from
tip of nose to tragus to
xiphisternum
SUCTION TUBE
• Size - french
• Premature : 6 Fr
• Term : 6-8 Fr
• Infant : 8 Fr
• Older children : 10-14 Fr
INDICATIONS
• Orotracheal/ nasotracheal suction both direct & ET/tracheostomy
clearance
• E.g.: MAS
• Inability to clear airway
• Keep suction pressure at 80-100mm hg
FOLEY’S CATHETER
• Self retaining catheter, made up of latex
• Self retaining by means of a balloon which should be inflated
with saline
Use 5ml distilled water for inflating
balloon ( NS will crystallise)
INDICATIONS
URINARY NON-URINARY
# Arrest postnasal bleeding
Monitor urine output in intractable epistaxis
in case of shock/renal failure # Arrest bleeding from
Differentiate anuria oesophageal varices in
from retention portal hypertension
Urinary incontinence
Suprapubic cystotomy
SIMPLE RUBBER
CATHETER
• Made up of India Rubber with blunt tip & opening on the lateral side
• Can be sterilized by autoclave
Uses –
Uses – Therapeutic
Diagnostic • To relieve acute retention of
• To differentiate between anuria & urine
retention of urine • Monitor urine output in
• Urine culture - sample collection shock, renal failure
• Diagnosis of hematuria • In paraplegia to facilitate
• Diagnosis & localization of passage of urine
strictures in the urethra
Complications
• Trauma – bleeding, stricture (chronic)
• Infection
• Allergy to India rubber
• Para - phimosis
THREE –WAY CONNECTOR
• T shaped device
• Device contains 2 inlets and 1 outlet
USES
• Administration of IV fluids and IV medications
• Exchange transfusion in case of neonatal hyperbilirubinemia
• Haemodialysis in case of renal failure/ poisonings
• Pleural/ ascitic tap
VENOUS CANNULAE
• Being plastic in nature, it doesn’t damage the endothelium of
the vein
• Plastic sheath being flexible, can be inserted into thin & tortuous
vein easily
• Uses: venepuncture, transfusion of drugs/ blood
SCALP VEIN NEEDLE
USES
• Collection of blood
• Infusion of IV fluids, drugs, blood etc.
• ABG analysis
INTRAVENOUS (IV) SET
USES :
• Administration of IV fluids
• Drugs administration
• TPN administration
COMPLICATIONS:
• Thrombophlebitis
• Air embolism
PEDIATRIC DRIP SET
TUBERCULIN SYRINGE
INJECTIONS
USES –
• Administer PPD for Mantoux test
• Administer BCG
• Administer test doses of drugs such as penicillin
• Provocative testing – test for allergens in bronchial asthma,
atopy
LUMBAR PUNCTURE/ LP
NEEDLE
Indications of Lumbar puncture
Therapeutic
• Analgesia ,anaesthesia
• Administration of antibiotics
• Intrathecal anticancer drugs
Diagnostic
• Infections (meningitis)
• Pleural, ascitic tap Subdural tapping in case of subdural
empyema
Contraindications
• Increased ICT
• Cerebral herniation
• Focal neurological deficits
• Coagulopathy
• Hemodynamically unstable
Complications
• Herniation
• Cardiorespiratory compromise
• Headache
• Pain
• Infection
• CSF leak
BONE MARROW
ASPIRATION NEEDLE
INDICATIONS
Diagnostic
• ITP
• Aplastic anemia
• Megaloblastic anemia
• Leukaemia
• Myelofibrosis
• Infections
• PUO
• Storage disease (Gaucher’s disease)
Therapeutic
• Bone marrow transplantation
• Intra osseous drug administration
CONTRAINDICATIONS
• Hemorrhagic disorders e.g. coag factor deficiencies, DIC
• Skin Infection (local site)
• Bone disorders e.g. Osteomyelitis, Osteogenesis imperfecta
Site
• In more than 2 Years: iliac crest
• Less than 2 years: proximal tibia medial to tibial tuberosity(to
prevent injury to pelvic structures)
COMPLICATIONS
• Haemorrhage
• Infection
• Retroperitoneal hematoma
• Trauma to neighbouring structures( gluteal artery injury, soft
tissue injury )
Bone marrow biopsy needle
JAMSHIDI-SWAIN marrow biopsy needle
VILM – SILVERMANN’S
NEEDLE
INDICATIONS
Cirrhosis of liver e.g. ICC,Biliary Cirrhosis
Storage disorders e.g. Glycogen Storage Disorder , Wilsons,
Hemochromatosis
Malignancy , primary & metastasis. E.g. hepatoblastoma,
Neuroblastoma, Leukemia, Lymphoma
Infiltrations e.g. Tb, sarcoidosis, Infections(Herpes, CMV)
METERED DOSE INHALER
Spacers are bottle shaped plastic devices which
have a mouth piece at one end and other end has
an opening where the MDI can be attached.
ADVANTAGES
• Deliver the drug into lower airways
• Less coordination between inspiration and activation
USED IN
• Children
• Adults without coordination
USES
• Prevention and management of asthma
Medicines given via MDI
• Short acting drugs e.g. salbutamol, terbutaline
• Long acting e.g. salmetrol, formetrol
• Inhaled anti cholinergic drugs e.g. ipratropium bromide
• Inhaled steroids e.g. budesonise, fluticasone etc.
• S/E: oral candidiasis ( tackled by rinsing mouth after use of steroid
inhaler)
DRY POWDER INHALERS
Rotahaler