Instruments Commonly Used In Pediatrics
Dr. Manish Narang
Professor
Dr. Narender
Senior Resident
Dr. Arunima Gupta
Post Graduate Resident
Oxygen delivery devices
Low Flow System High flow system
Room air is entrained Mixing of the room air does not occur.
Flow is insuffcient to meet total Provide adequate gas flow to meet total
inspiratory demand of patient inspired flow requirement of patient.
Provide lower Fio2 Low/high Fio2
Face mask : Simple, Partial Rebreathing, Non Rebreathing Mask
Venturi
Face Tent Oxygen Hood
Oxygen Tent Bag Valve Mask Ventilation
Nasal Cannula Endotracheal Airway
NASAL PRONGS/CANNULA
• Low flow oxygen device- up to 5 L/min
• Oxygen concentration of 28-44%
• Indications : Low-moderate o2 requirement ,no-mild
distress, long term o2 therapy
• C/I : Poor efforts, Apnea, Severe hypoxia ,mouth
breathing
• Comfortable, well tolerated
• Rates above 5 L/min can result in drying of nasal
passages, and possibly nasal bleeds
Nasal Cannula
Oxygen Mask
• Low flow device, flow rate of 6-10 L/min
• Deliver 35-60% o2
• Indications : moderate flow o2 requirement, mild-moderate
distress
• C/I :Poor respiratory efforts, Severe hypoxia , Apnea
• Disadvantage : Does not deliver high o2 concentration,
interferes with eating and talking.
TYPES OF FACE MASKS
Oxygen Hood
• High Flow device: 10-15 L/min
• 80-90% o2 concentration
• Neonates and infants
• Well tolerated
Oxygen Hood
Nebulizer with mask
Nebulization mask
Nebulization chamber
• Drug delivery device.
• Treatment of asthma, WALRI, bronchiolitis, LTB
• Particles of more than 5 um in diameter are likely
to deposit in mouth and throat
• With/without oxygen.
• Drugs –corticosteroids, salbutamol, ipratropium
bromide ,adrenaline
Self inflating bag
(AMBU)
• Size of bag – 240 to 750 ml
• Oxygen capacity -- capable of delivering
90-100% oxygen
• Safety features – capable of avoiding
excessive pressures
• Size of mask – appropriate sized mask
Capacity of the Bag
Neonate- 250 ml
Pediatric- 500ml
Adults- 1600 ml
Different Types of
Resuscitation Devices
Flow inflating bags Self inflating bags
Fills only when Fills spontaneously
after it is squeezed,
oxygen from a pulling oxygen or air
compressed source in to the bag
flows in to it
Indications of Bag & Mask Ventilation
Failure of ventilation
Failure of oxygenation
After 30 seconds of Initial steps if
• Baby is not breathing or is gasping
• Heart rate is less than 100 bpm and /or
• Is Cyanotic despite supplemental oxygen
Self Inflating Bag Without
Oxygen Reservoir
Self Inflating Bag with Oxygen
Reservoir
Safety Features
• Pop – off valve set at 30 – 40 cm H20
• Port to attach a manometer
Pop off Valve
Face mask positions
Correct
Incorrect Incorrect
Correct Position of Mask
E T Tubes
E T Tube
Characteristics of Endotracheal Tubes
• Most effective and reliable method of assisted ventilation:
• The airway is isolated ,ensuring adequate ventilation and o2
delivery
• Reduces aspiration chance
• Interposition of ventilation with chest compressions can be
accomplised efficiently
• Inspiratory time and PIP can be controlled
• PEEP can be delivered
Indications :
• Inadequate CNS control of ventilation
• Functional/anatomic airway obstruction
• Loss of protective airway reflexes
• Excessive work of breathing
• Need of high PIP/PEEP
• Potential occurrence of any of the above if patient is to be
transported
• Surfactant administration
• Suctioning of Non Vigorous MSL Babies
Type of Endotracheal Tubes
Cuffed
Non-Cuffed
Cuffed tube for 8-10 years or older
In younger children normal anatomic narrowing
at the level of cricoid cartilage provides a
functional cuff.
Size of ET tube
Tube size Weight Gestational ( ID -mm)
Age
2.5 <1000 < 28 wks
3.0 3 1000-2000 28-34
3.5 2000-3000 34-38
4.0 4 > 3000 >38
• ET Tube Size : Age (in Years)/4 + 4
• Length = Age/2 +12
• Depth of insertion = Tube size * 3
Drugs through ET
• Lidocaine
• Epinephrine
• Atropine
• Naloxone
Checking correct placement of Tube
• Chest movements
• Auscultation of chest and epigastrium
• Change in appearance of patient
• Fogging in tube
• Pulse oximetry
• CXR
• End Tidal CO2
Sizes of Blades
Pre-Term Neonate 00
Term Neonate 0
Infant 1
1-3 years 2
3-12 years 2-3
12 3-4
How to Hold Laryngoscope
Sagittal Section of Airway with Laryngoscope in place
Guedel airway
Insulin Syringe
I/V Cannula
I/V cannula
• Consists of a thin plastic sheath which is guided into the vein by
a metallic stillete
• Colour coding according to size (gauge )
• Bigger the gauge no. smaller is the needle
I/V cannula
colour size (in gauge ) flow rate (ml/min)
Purple 26 10
Yellow 24 15
Blue 22 36
Pink 20 60
Green 18
Ash grey 16
IV Drip set
Intra-Venous set
Parts
• Plastic cannula – to be inserted into the iv bottle
• A clear plastic tubing
• Murphy’s chamber-regulate the speed of IV drip (by counting
the no. of drops per min )
• Connector –to be connected to IV cannula directly or via a
three way connector
Pediatric Micro drip set
Micro drip set
• Clear , soft, cylindrical and calibrated measured volume
chamber .
• Chamber injection port- to inject medication into
burette chamber .
• Chamber vent – to allow air into the chamber .
• Burette size – 110 ml .
• Murphy,s chamber - To regulate number of drops
falling/ min
- A fluid level must be maintained in
chamber .
Blood transfusion set
• Similar to IV set except for
the presence of a filter in
murphy’s chamber to
remove clots .
Three way connector
Three way connector
• T-shaped with 2 inlets & one outlet
• Advantages- iv fluids & iv antibiotics can be given together
• Uses -Exchange transfusion
Hemodialysis
Pleural/ascitic tap
TPN
• CVP can be attached to one inlet
Naso gastric Tubes
Indications
Parts
Insertion- measuring length
Confirming position
Age NG tube size(Fr)
<1 m 6-8
1-6 m 8-10
1-3 yr 10-12
3-6yr 12
6-8yr 12-14
>8yr 14-16
Measuring the length of tube
Umbilical Cannula
Umbilical Cannula
Lifesaving procedure –vascular access,resuscitation
Indications
• Vascular access
• Exchange transfusions
• Central venous access
Contraindications
• Omphalitis
• Peritonitis
• Necrotizing enterocolitis
Complications
• Infection
• Hemorrhage
• Vessel perforation
• Creation of false luminal tract
• Hepatic abscess or necrosis
• Air embolism
• Catheter tip embolism
• Portal vein thrombosis
• Pericardial tamponade or perforation
Suction Catheters
• Flexible , long tubes used to remove
secretions from different body parts.
• One end is connected to a collection
container and a device that generates suction
• The open end is advanced through the airway
to remove secretions
• Precautions while inserting/ removing
Foley’s catheter
Foley’s catheter
• Self retaining catheter made up of latex
• Types
Two-way catheter
Three-way catheter
• Size (in french)-6, 8, 10, 12, 14
• Volume for inflation of balloon-written over lumen
(usually 3-5 ml )
Size according to age & wt
Age Weight (kg ) Size (in french )
0- 6 month 3.5-7 6
6 mo-1 yr 10 6-8
1 yr-2 yr 12 8
2 yr-3 yr 14 8-10
3 yr-5 yr 18 10
5 yr-6 yr 21 12
6 yr-12 yr 14
Indications
Urinary Non urinary
• To relieve urinary retention • In epistaxsis-to arrest post
• To monitor urine output in nasal bleeding
shock and renal failure • In portal hypertension-to
• For incontinence of urine arrest bleeding from
• For suprapubic cystostomy oesophageal varices
• In unconcious patients
Urobag
• Disposable plastic bag
• Has markings in ml to measure urine output
• Contains non return valve to prevent
backflow
• Contains conical outlet with cap to empty the
contents of bag
• Should be placed at lower level than the
body to facilitate urinary drainage by gravity
Bone Marrow Aspiration needle
Bone marrow aspiration needle
Parts
Stillete
Thick body
Guard 2 cm from the tip
Site
Posterior superior iliac spine
Anterior superior iliac spine
Sternum ( only in adults )
Tibial tuberosity (only in infants < 2 yr)
Indications for bone marrow aspiration
Diagnostic Therapeutic
• Idiopathic thrombocytopenic • Bone marrow
purpura transplantation
• Aplastic anaemia
• Leukemia
• Megaloblastic anaemia
• Infections eg. Kala azar
• Storage disorders eg. Gaucher
disease
• Pyrexia of unknown origin
• Myelofibrosis
Bone biopsy needle
Bone biopsy needle
• Most commonly used is JAMSHIDI NEEDLE
• Tapered at distal end to help retain the
specimen
Indications
• Aplastic anaemia
• Myelofibrosis (dry tap )
INFANTOMETER
Dilys Mucus Extractor
Umblical cord clamp
Trucut biopsy needle
Uses
• Liver biopsy
• Kidney biopsy
• Lung biopsy -
rarely
Automatic biopsy needle
Lumbar puncture needle
Lumbar puncture needle
• Consists of a pointed cannula with a hub at one end and a
stillete which fit cannula .
• Size- 16 gauze to 30 G
• In children ,instead of LP normal needle commonly used .
• In case of increased ICT , spinal needle is better because stillete
can be withdrawn gradually .
Indications Of Lumbar puncture
• Infections – bacterial, fungal,
mycobacterial,and viral CNS infections
• Subarachnoid hemorrhage
• CNS malignancies
• Demyelinating diseases
• Guillain –Barre syndrome
Contraindications
No absolute contraindication
Caution
Raised intracranial pressure
Thrombocytopenia or other bleeding
diathesis
Suspected spinal epidural abscess
Complications
• Post LP headache
• Infection
• Bleeding
• Cerebral herniation
• Minor neurological symptoms - radicular pain or numbness
• Late onset of epidermoid tumors of the thecal sac
• Back pain
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