Instruments

[Link] M.D( General medicine)

Today, we are going to discuss the following
instruments.
These instruments are commonly kept in
university examinations.
• Lumbar puncture (LP) needle
• Bone marrow needle
• Catheter
• Ryle’s tube
• Endotracheal (ET) tube
Lumbar Puncture (LP) Needle
 Identification
• LP needle is a long, thin,
hollow stainless-steel
needle.
• It has a removable
stylet to prevent tissue
blockage.
• The distal end is
bevelled, and the
proximal end has a hub.
• Graduation markings
are present to assess
depth of insertion.
 Site Marking
• Lumbar puncture is performed in the midline.
• The usual sites are L3–L4 or L4–L5
intervertebral space.
• The L4 level is identified by a line joining the
highest points of both iliac crests (Tuffier’s
line).
 Procedure
• The patient is placed in lateral decubitus or
sitting position.
• Skin is cleaned and draped under strict aseptic
precautions.
• Local anesthesia is given, and the needle is
inserted in the midline.
• After removal of the stylet, cerebrospinal fluid
(CSF) is collected.
 INDICATIONS- Diagnostic
[Link] analysis
– Suspected meningitis
– Encephalitis
– SAH ( when CT negative )[Link] Pressure measurement

[Link] Pressure measurement

[Link] sclerosis
[Link]
[Link] meningitis
6. Neuro syphilis
[Link] & autoimmune neurological disordes
 Therapeutic indication
[Link] of raised intracranial pressure
[Link] drug administration
– Chemotherapy
– Antibiotics
– antivirals
[Link] spinal anesthesia
4. CSF drainage
 Contraindications
• [Link] intracranial pressure due to space-
occupying lesion.
• [Link] infection at puncture site.
• [Link] disorders and severe
thrombocytopenia.
• [Link] deformity or uncooperative patient.
 Complications
• Post-lumbar puncture headache is the most
common complication.
• Back pain and local bleeding may occur.
• Infection and nerve root injury are rare.
• Brain herniation can occur in patients with
raised intracranial pressure.
Bone Marrow Needle
 Identification
• Bone marrow needle is a
short, thick, hollow
metallic needle.
• It has a sharp beveled tip
with an adjustable
guard.
• A removable stylet is
present to prevent
blockage.
• The proximal end has a
handle for firm grip.
 Site Marking
• Common sites are the posterior superior iliac
spine (PSIS) in adults.
• Anterior iliac crest may also be used.
• In children, the tibial tuberosity can be used.
 Procedure
• The patient is placed in lateral or prone
position.
• Skin is cleaned and draped under strict aseptic
precautions.
• Local anesthesia is given up to the periosteum.
• The needle is inserted with rotatory movements
until marrow cavity is reached.
• Stylet is removed and marrow is aspirated using
a syringe.
 Indications
• Bone marrow aspiration is done to evaluate
anemia, leukemia, and pancytopenia.
• It is used for diagnosis of multiple myeloma
and marrow infiltration.
• It is useful in pyrexia of unknown origin and
storage disorders.
 Contraindications
• Local infection at puncture site.
• Bleeding disorders and severe
thrombocytopenia.
• Uncooperative patient.
 Complications
• Pain at puncture site is common.
• Bleeding and hematoma may occur.
• Infection is rare.
• Accidental injury to surrounding structures
may occur.
Urinary Catheter
 Identification
• Urinary catheter is a soft,
flexible hollow tube made
of latex or silicone.
• It has a rounded distal tip
with one or two side
holes.
• Foley catheter has an
inflatable balloon near the
tip.
• The proximal end has
separate ports for urine
drainage and balloon
inflation.
 Procedure
• The patient is placed in supine position.
• Genital area is cleaned under strict aseptic
precautions.
• Lubricated catheter is gently introduced into
the urethra.
• After urine flow is seen, the balloon is inflated
and catheter is fixed.
 Indications
• Urinary catheter is used to relieve acute or
chronic urinary retention.
• It is used for monitoring urine output in
critically ill patients.
• It is used before and after surgeries.
• It helps in bladder irrigation.
 Contraindications
• Suspected urethral injury.
• Severe urethral stricture.
• Acute prostatitis.
 Complications
• Urinary tract infection is the most common
complication.
• Urethral trauma and bleeding may occur.
• Catheter blockage and bladder spasm may
occur.
• Long-term use may cause urethral stricture.
Ryle’s Tube (Nasogastric Tube)
 Identification

• Ryle’s tube is a long,

soft, flexible tube made
of rubber or plastic.
• It has a rounded distal
tip with multiple side
holes.
• Length markings are
present on the tube.
• The proximal end is
open for attachment to
syringe or feeding set.
 Site Marking
• The tube is inserted through the nostril.
• The length is measured from nose to ear lobe
to xiphisternum.
 Procedure
• The patient is placed in sitting or semi-
recumbent position.
• The tube is lubricated and gently passed
through the nostril.
• Patient is asked to swallow while advancing
the tube.
• Correct position is confirmed and the tube is
fixed.
 Indications
• Ryle’s tube is used for enteral feeding.
• It is used for gastric decompression.
• It is used for gastric lavage in poisoning.
• It is used for aspiration of gastric contents.
 Contraindications
• Base of skull fracture.
• Esophageal stricture or obstruction.
• Severe nasal trauma.
 Complications
• Nasal irritation and epistaxis may occur.
• Misplacement into respiratory tract may
occur.
• Aspiration pneumonia may occur.
• Esophageal or gastric injury is rare.
Endotracheal (ET) Tube
 Identification

• Endotracheal tube is a flexible

tube made of PVC.

• It has a bevelled distal tip and

a side hole called Murphy’s eye

• A cuff is present near the distal

end in cuffed tubes.

• The proximal end has a

connector for attachment to
oxygen or ventilator.
 Site Marking
• ET tube is inserted through the mouth or nose
into the trachea.
• Correct depth is confirmed by vocal cord level
and chest expansion.
 Procedure
• The patient is placed in supine position with
neck extended.
• Laryngoscope is used to visualize the vocal
cords.
• The tube is passed through the cords into the
trachea.
• Cuff is inflated and tube is connected to
ventilation device.
 Indications
• ET tube is used to maintain airway patency.
• It is used during general anesthesia.
• It is used for mechanical ventilation.
• It prevents aspiration in unconscious patients.
 Contraindications
• Unstable cervical spine injury.
• Severe facial or airway trauma.
• Trismus or limited mouth opening.
 Complications
• Sore throat and hoarseness are common.
• Laryngeal or tracheal injury may occur.
• Esophageal intubation may occur.
• Prolonged intubation may cause tracheal
stenosis.
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