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Paediatrics Instruments

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182 ROHIL H
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47 views

Paediatrics Instruments

Uploaded by

182 ROHIL H
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Instruments

IV cannula

22G 24G
Bevelled end Butterfly needles
Indications:
• For administering iv fluids, drugs,
blood..
• To obtain blood for investigations
Sites:
• Forearm veins
• Antecubital vein
• Scalp and Foot veins ( in infants )
Sizes used:
• Infants – 21, 23, 25
• Children (1-12 yrs) – 20, 22, 24
Lumbar Puncture Needle
needle stylet
Indications:
• Diagnostic – to obtain CSF for analysis in
meningitis, SAH, GB synd, culture, CSF pressure,
spinal imaging
• Therapeutic – to instill chemotherapeutic drugs,
to remove CSF in idiopathic intracranial
hypertension

Contraindication:
• Absolute – increased ICT (as evidenced by
papilledema on fundal examination)
• Relative – bleeding diathesis, local infections,
respiratory distress, cardiovascular compromise,
spinal abnormalities, coma
Needle size:
• Usually size 20G or 22G Quincke is used
• <2 yrs – 1.5”
• 2-12 yrs – 2.5”
• >12 yrs- 3.5”
Position:
• Fetal (universal flexion)
• Sitting
Site:
• L4 – L5 interspinous space in neonates
• L3 – L4 in older children and adults
(corresponds to the iliac crest)
L4 – L5 space
Complications:
• Post dural puncture headache
• Epidermoid tumour
• Infection
• Cerebral herniation
• Spinal hematoma
Deelee’s Infant Mucus
Extractor
Graduations (20-30ml)
Indications:
• Aspiration of oropharynx and
nasopharynx immediately after birth
• For Bacteriological purposes

Procedure:
• The oral cavity should be cleared of
mucus before the nasal cavity
Menghini’s Liver Biopsy
needle

Has 5 parts
Indications:
• For diagnosis and staging of liver
diseases – hepatitis B & C, hemochromatosis,
Wilson’s disease
• To differentiate biliary atresia from
neonatal hepatitis
• To diagnose a liver mass
Types of liver biopsy:
• Percutaneous
• Transjugular
• Laparascopic
• FNA
Types of Needles:
• Aspiration type – Menghini’s needle
• Cutting type – Vim Silverman needle,
automatic biopsy needles

Vim Silverman needle


Contraindication:
• Any bleeding diathesis (Give Vit K im 3
days before the biopsy, check the
prothrombin time), patient on
anticoagulants
• Vascular tumours of the liver
• Hydatid cysts, infections in the rt
pleural cavity or rt hemidiaphragm,
ascites
Complications:
• Mortality 1 in 10,000 to 12,000
• Haemorrhage, bile peritoneitis,
Bone Marrow Aspiration
needle
Jamshidi’s type

Guard
Wide bore needle
Indications:
• Unexplained anaemias
• Suspected leukemias – myelofibrosis, hairy
cell, multiple myeloma
• Bone marrow transplantation
• Intraosseous transfusion – In an emergency
in infants, site – 1” below and medial to the tibial
tubercle, used for administration of drugs or blood
Sites:
• < 2 yrs – Tibia
• > 2 yrs – Posterior ilium
• Other sites – anterior ilium, sternum (adults),
femur
Contraindication:
• Bleeding diathesis

Complications:
• Haemorrhage, hematoma
• Infection
• Osteomyelitis
• Needle breakage
Endotracheal Tube

Uncuffed ET tube
Cuffed ET Tube
Indications:
• Respiratory arrest
• Cardiac arrest
• Coma, arreflexia
• For general anaesthesia

Types:
• Cuffed and uncuffed
• Others – Nasal tube, Rae tube, Double lumen tube,
Tracheostomy tube, etc.
Features:
• The tube has a radio opaque line to
locate it radiologically
• Uncuffed tubes are used in children
because –
their airway is circular in cross section
and the narrowest part is the subglottis
(so the tube fits in snugly)
Formula:
To calculate the required ET tube size –
Internal Diameter (mm) = (age in
yrs/4) + 4
(For a normally nourished child)

Sizes:
• From 1 - 10.5mm (internal diameter)
• Term neonates – 3mm
• Premature infants – 1 to 2.5mm
Laryngoscope
Indications:
• Direct laryngoscopy
• Intubation

Parts:
• Rigid handle with batteries
• Interchangable blade with a light
source
• Blade can be straight (Miller, used in infants)
or curved (Macintosh, used in older children and
adults)
Neonatal laryngoscope with straight blade
Sizes:
• Neonate – blade 0 or 1
• 1mo to 1 yr – bade 1 or 2
• 1 yr to 15 yrs – blade 2 or 3
• > 15 yrs – blade 3

Curved laryngoscope blade


Infant Feeding Tube
Indications:
• Orogastric or nasogastric feeding –
prematurity, any illness, congenital deformities like
cleft palate
• Drug administration
• Tracheo-oesophagal fistula
• Management of poisoning
• Gastric Lavage
Sizes:
• #5 or #6 French for premature infants
• #6 or #8 French for other infants
• No.5 to No.12 are commonly used in
pediatrics
Features:
• Has a radio opaque line for
radiological identification
Bag Valve Mask Ventilation
• It is a device for Positive Pressure
Ventilation
• It is self inflating
Indications:
• Whenever spontaneous breathing is
failing (in respiratory failure, apnea,
cardiopulmonary arrest, etc.)
• Appearance of cyanosis or HR<100 in a
spontaneously breathing infant
AMBU
• Artificial Mechanical Breathing Unit
• It is a proprietary name
Contraindications:
• Diaphragmatic hernia – because air entry
through the oesophagus will aggravate the hernia
and the respiratory distress
• Meconium Aspiration – because the
aspirated meconium will be pushed further into the
respiratory tract
• Relative contraindications: any facial or
eye trauma, any foreign body in the airway
Types:
• Disposable and reusable
• Adult , pediatric and infant types
Parts:
• Mask – 0 & 1 are for infants
• Bag – self inflating, 1-3 L
• Valve – pop off type,

prevents overinflation
• Reservoir – a bag or a corrugated tube
Pop-off valve Valve for excess
Bag reservoir air

Mask

Inlet for air or oxygen Bag reservoir


Infantile masks – 0 and 1 sizes
Technique:
• Choose appropriate size mask
• Single person or Two person method
Two person method
Single person method
E-C clamp technique
Pressure application:
• For 1 kg infant – use thumb and 1 finger
• 2 kg infant – thumb and 2 fingers
• 3 kg infant – thumb and 3 fingers
• Too much pressure will cause
overinflation
• This is prevented by the pop-off valve,
it will be released when the pressure
goes above 40cm of H2O
• Rate should be 40 breaths/min and
cardiac massage should be at 120/min.
Tongue Depressor

Lack’s tongue depressor Wooden tongue depressors


Indications:
• Examination of the pharynx
• Indirect laryngoscopy

Types:
• Lack’s tongue depressor (metal)
• Wooden tongue depressors
Intercostal Drainage Tube
Indications: Underwater Seal
Bag

• Pneumothorax
• Hemothorax
• Empyema
Contraindications:
• Coagulapathies
• Local skin infection
• Need for immediate
thoracotomy
Position:
• Supine
• Inclined at 45o

Site:
th th
• 4 or 5 intercostal space, in the mid-
axillary line
• The catheter is inserted
posterosuperiorly
• Malecot’s cathether is used
Malecot’s catheter
Complications:
• Improper placement
• Tube dislodgement
• Haemorrhage
• Hemoperitoneum
• Empyema
• Organ penetration

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