Applying Pharmaceutical Supply

Chain Management:
Unit 1: Medical Supplies and
Reagents
By: Diriba F (B.Pharm, MSc-PSCM & MPH-HSM)
 Definition of Terms

Medical Supplies:
Medical supplies refer to consumable items used in the provision of
healthcare services.
These items are typically used and discarded, and they play a crucial
role in patient care and treatment.
Examples: bandages, syringes, gauze, gloves, and other disposable
materials.

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 Definition of Terms…
• Reagents:
• Reagents are substances or compounds used in laboratory
procedures to produce a chemical reaction or to detect, measure,
or prepare other substances.
• In the context of medical supplies, reagents are often associated
with diagnostic testing.
• They play a critical role in medical laboratories for various
purposes, such as:
o analyzing blood samples
o conducting tests for diseases
o performing other diagnostic procedures.

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 Medical supplies: Surgical Dressings
• Surgical dressings: refer to the materials and products used to cover
and protect wounds or surgical incisions.
• These dressings serve various purposes, including:
o promoting wound healing
o preventing infection
o absorbing exudate (fluids oozing from the wound)
o providing support to the injured area.

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 Surgical Dressings
Dressing selection should be made on the basis of:
The degree of exudation.
The presence of likelihood of infection.
Presence of necrotic tissue.
Anatomical site.
The state of wound repair.

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 Surgical Dressings…
Ideal wound dressings should:
• Provide mechanical and bacterial protection
• Maintain a moist environment at the wound/dressing interface
• Remain non-adherent to the wound
• Nontoxic and non-allergic
• Well acceptable to the patient (e.g., providing pain relief and not
influencing movement)
• Cost effective

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 Surgical Dressings…
Ideal wound dressings…
• Highly absorbable (for exuding wounds)
• Absorb wound odor
• Sterile
• Easy to use (can be applied by medical personnel or the patient)
• Require infrequent changing
• Available in a suitable range of forms and sizes

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 Classification of Dressings
Functionally classified as:
1. Primary dressings
directly in contact with the wound
it may provide absorptive capacity of secondary dressings
it may prevent desiccation, infection
Prevent adhesion of secondary dressing to the wound
E.g., Plain Gauze, Impregnated Gauze, & Film Dressing

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 Classification of Dressings…
2. Secondary dressings
placed over a primary dressing
provide further protection, absorptive capacity, compressions
(firmness), or occlusion
E.g., surgical cotton (absorbent), surgical gauze, bandages,
adhesive tapes

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 Classification of Dressings…
Dressings may also be classified as:
1. Fibers e.g. cotton
2. Fabrics e.g. Absorbent Gauze
3. Bandages e.g. Elastic Bandages
4. Self adhesive plasters e.g. ZnO plasters
5. Compound dressings

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 Surgical Dressings…
Primary Wound Dressings
1. Plain Gauze
Stick to all but clean, incised wounds
Although this property has been used to debride exudative, infected,
and necrotic wounds
this practice may be painful and is often counter productive, causing
the removal of granulation tissue and new epithelium

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 Classification of Dressings…
2. Impregnated Gauze
impregnation used to reduce its adherence to wounds
cotton, rayon, or cellulose acetate gauze has been impregnated with a variety of
substances such as paraffin, Zinc saline, or Sodium chloride solutions
When used with an appropriate secondary dressing, these dressings may be used in
heavily exudating wounds

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 Classification of dressing…
3. Film Dressings
• transparent film, occlusive or semi occlusive
• films of polyurethane with acrylic or polyether adhesives
• Semi-permeable membrane to water vapor & oxygen, and yet are water proof.
• in lightly exuding wounds, they permit enough evaporation to promote moist wound
healing & prevent maceration exclude bacteria from wounds.

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 Classification of dressing…
Primary dressing
• permit observation of the wound
• adhere well to intact skin & have low adherence to wound tissue
• shouldn’t be used in infected or heavily exuding wounds

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 Classification of dressing…
Secondary Wound Dressings
 include: absorbents, bandages and adhesive tapes
I. Absorbents
• Required to absorb and retain a wide range of fluids from the blood and serous exudate
of damaged tissue
• Surgical cotton, surgical gauzes, etc…
• They are available in a number of forms:
1. Fibrous (staple) absorbents
2. Fabric absorbents
3. Fiber plus fabric absorbents, and
4. Wound dressing pads

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 Classification of dressing…
a) Surgical cotton
• cotton is the basic surgical absorbent, purified cotton of USP grade
• raw cotton fiber, mechanically cleaned of dirt and carded into layers
but not otherwise treated
• has a limited use for padding & covering of unbroken surfaces and
supplied under the name “non absorbent cotton”

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 Classification of dressing…
• absorbent cotton is prepared from the raw by processes that
remove natural waxes and all impurities (making hydrophilic)
 rendered absorbent
• absorbent cotton is a practically pure, white cellulose fiber
• absorbent cotton is available in the form of rolls and balls

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 Classification of dressing…
b) Surgical Gauzes
• is known as ‘Absorbent Gauze USP’
• to provide an absorbent material of sufficient tensile strength for
surgical dressings
Classification of surgical gauze
• Classified according to its mesh, or number of threads per inch
• The close-meshed gauze is required for extra strength and greater
protection

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 Classification of dressing…
II. Bandages
Function:
• To prevent contamination of wound by holding dressings in
position.
• To provide support to the part that is injured, dislocated joint.
• To prevent & control hemorrhage.
• To restrict movement / immobilize a fracture or a dislocation.
• To maintain pressure e.g. elastic bandages applied to the improve
venous return.
They may be inelastic, elastic, or rigid to be applied after
shaping for immobilization

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 Classification of dressing…
1. Common Gauze Roller Bandages
• each bandage is in one continuous piece, tightly rolled and
substantially free from loose threads
• Made from absorbent gauze

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 Classification of dressing…
2. Muslin Bandage Rolls
• are made of heavier unbleached material
• very strong and are used wherever gauze bandages do not provide
sufficient strength or support
• Frequently used to hold splints or bulky compression dressings in
place

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 Classification of dressing…
3. Elastic Bandages
• are made in several types
A. Woven Elastic Bandage
• is made of heavy elastic webbing containing rubber threads
• good support & pressure are provided by this type
B. Crepe Bandage
• is elastic but contains no rubber
• its elasticity is due to a special weave that allows it to stretch to
particularly twice its length

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 Classification of dressing…
C. High-Bulk Bandage
• is made of multiple layers (typically six) of crimped cotton gauze
• the high bulk is designed to provide padding protection in wound
dressing applications
• also provides the absorbent capacity of a cotton dressing component

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 Classification of dressing…
D. Compression Bandage
• is composed of cotton knitted or woven with either viscose,
polyurethane, nylon, or elasthane threads
• Comfortable and easy to apply
• Used primarily to maintain controlled levels of pressure when
compression therapy is required
• they should be utilized with caution on patients with marked
peripheral ischemia or impaired arterial blood supply
Example; Tensopress, Yeinopress, Setopress

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 Classification of dressing…
4. Triangular Bandages (Cravat bandage)
• are made by cutting a square of bleached muslin diagonally from
corner to corner, forming two right triangles of equal size & shape
• are used in first aid work for head dressings and arm slings and as
temporary splints for broken bones

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 Classification of dressing…
• Triangular bandages are used for maintaining compressions on a
head wound
• for keeping body parts, such as shoulders, stationary during the
healing process
5. Tube Bandages
• is applied using an applicator, & is woven in a continuous circle
• used to hold dressings or splints onto limbs, or to provide support to
sprains, and it stops the bleeding

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 Classification of dressing…
6. Orthopedic Bandages
• used to provide immobilization and support in the treatment
of broken bones and in certain conditions of bones & joints
• Plaster of Paris: impregnated gauze, has been the standard
material for this purpose.
• more recently introduced are synthetic cast materials made of
polyester, cotton or fiberglass.

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Classification of dressing…
III. Adhesive Tapes
• have two components: backing & adhesive mass
• adhesive tapes available today may be divided into two broad
categories:
those with a rubber based adhesive
those with an acrylate adhesive

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Classification of dressing…
• Rubber adhesives are commonly used when strength of backing,
superior adhesion and economy are required;
e.g., athletic strapping
• Acrylate adhesives are used widely in surgical dressing applications,
when reduced skin trauma is required, as in operative &
postoperative procedures

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Sutures and Ligatures
Introduction
• The technique of closing wounds by means of needle and thread is
several thousand years old
• Physicians have used sutures for at least 4,000 years.
• Archaeological records from ancient Egypt show that Egyptians used
linen and animal sinew to close wounds.
• In ancient India, physicians used the heads of beetles or ants to
effectively staple wounds shut.
• The oldest known reports of surgical suture is in a mummy from
1100 BC (ancient Egypt)

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Introduction…
• Before catgut became the standard surgical suture material
towards the end of the 19th century, many different paths had
been followed to find a suitable material for sutures and ligatures.
• Materials that had been tried included gold, silver and steel wire,
silk, linen, hemp, flax, tree bark, animal and human hair,
bowstrings, and gut strings from sheep and goats.
• Sterile catgut was achieved in 1906 with iodine treatment.
• The chemical industry drove production of the first synthetic
thread in the early 1930s,
• Polyglycolic acid was discovered in the 1960s and implemented in
the 1970s.
• today, most sutures which are made of synthetic polymer fibers
are in use.

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Introduction…
• A surgical suture: is a medical device used to hold body tissues
together after an injury or surgery.
• It generally consists of a needle with an attached suturing material
(thread).
• There are numerous types of surgical sutures that vary by the size,
nature and length of thread and shape and length of the needle.
• The choice of surgical sutures depends on the task it is required for,
the handling characteristics and the surgeon‘s preference
• Skill full wound closure requires knowledge of proper surgical
techniques and sutures.

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Classification of suture materials
• The two main classes of suture materials are:
 absorbable and non-absorbable.
1. Absorbable
• Those that are absorbed or digested by the body cells and tissue
fluids in which they are embedded /made/ during and after the
healing processes.
• two types:
a. Natural origin
• Surgical gut: Derived from the small intestine of healthy sheep.
• It is uniformly fine-grained and possesses great tensile strength and
elasticity.

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Classification of suture materials…
• Chromic suture material: Undergone various intensities of tanning
with the salt of chromic acid to delay the tissue absorption time.
• Typical examples of chromic suture and absorption times are:
o Type A plain, 10 days,
o Type B mild chromic, 20days
o Type C medium chromic, 30days
o Type D medium chromic, 40days
• Limitation: can be digested by enzymatic action → can initiate tissue
reaction

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Classification of suture materials…
b. Synthetic
• Absorbable synthetic sutures are made from polyglycolic acid
or other glycoside polymers.
• Most of the synthetic suture materials have proprietary
names, such as Dexon® and Vicryl®.
• Dexon® (Polyglycolic acid): Widespread absorbable suture
material of synthetic origin
• Dexon® has low rate of reactivity and infection rate, and has
excellent knot security and tensile strength.
• A drawback of Dexon® is its high friction that binds and
snags/difficult/ when wet.
• Polyglatin [Vicryl®]- synthetic absorbable sutures
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Classification of suture materials…
2. Non Absorbable
• Not absorbed by the body cells or fluids.
A. Natural origin
• Surgical silk: Suture made of raw silk spun by silkworm
• Problem of acute inflammatory reaction that may lead to
encapsulation by fibrous connective tissue
B. Synthetic
• Nylon (ethilon): monofilament nylon is the most commonly used in
surface closures.

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Classification of suture materials…
• Sutures based on thread structure
Monofilament threads
• Synthetic monofilament threads are produced by a special
extrusion process in which molten plastic is extruded under
high pressure through fine spinnerets.
• The monofilament structure is used mostly for thinner
threads.
• With thicker threads the wiriness that is a characteristic of all
monofilament threads impairs handling and in particular
renders knot-tying more difficult.
• Surgeons choose which type of suture to use depending on
the operation.
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Classification of suture materials…
• A monofilament has what is called low tissue drag, meaning it
passes smoothly through tissue.
• Monofilament threads have minimal tissue reactivity and
resists infection greater when compared to braided
(multifilament) suture materials.
• The disadvantage of nylon (monofilament nylon) is the
difficulty in achieving good knot security.
• Because of this at least 4-5 "throws (knots) are required to
achieve a secure knot.

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Classification of suture materials…
Multifilament threads
• Multifilament threads are composed of many fine individual threads
either twisted or braided together.
• Twisted multifilament threads include e.g. silk threads.
• Multifilament threads have a rough surface that impairs passage
through tissue but results in considerably better knot holding
security.
• Multifilament threads are generally coated.

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Classification of suture materials…
Multifilament threads…
• The coating smoothens the irregular surface and thus facilitates
passage through tissue without impairing knot-holding security.
• Braided or twisted sutures may have higher tissue drag, but are easier
to knot and have greater knot strength.
• Braided sutures are usually coated to improve tissue drag

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Characteristics of suture Materials
The ideal suture has the following characteristics:
• Sterile
• All-purpose (composed of material that can be used in any
surgical procedure)
• Causes minimal tissue injury or tissue reaction
• Easy to handle
• Holds securely when knotted (i.e., no fraying or cutting)
• High tensile strength
• Favorable absorption profile
• Resistant to infection
Note: at present, no single material can provide all of these
characteristics.
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Suture sizes
• Currently, two standards are used to describe the size of
suture materials; USP and EP.
• USP standard is more commonly used.
• In the USP standard the size is represented by a combination
of two Arabic numerals: a 0 and any number other than 0,
like 2-0(or 2/0) > (4/0=0000)
• The higher the first number, the smaller the suture material.
• Size greater than 0 are denoted by 1, 2, 3 etc.
• This standard size also varies with the type of suture
material.
• Table below summarizes both EP and USP standards.
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 Non-absorbable Sutures
USP SIZE METRIC SIZE (EP) DIAMETER (mm)
12-0 0.01 0.001– 0.009
11-0 0.1 0.010 – 0.019
USP SIZE METRIC SIZE (EP) DIAMETER (mm)
10-0 0.2 0.020 – 0.029
9‐0 0.4 0.040 – 0.049
9-0 0.3 0.030 – 0.039
8-0 8-0 0.5 0.4 0.050 – 0.069
0.040 – 0.049
7-0 7-0 0.7 0.5 0.070 – 0.099
0.050 – 0.069
6-0 6-0 1 0.7 0.10 – 0.149
0.070 – 0.099
5-0 5-0 1.5 1 0.10 – 0.149
0.15 – 0.199
4-0 4-0 2 1.5 0.15 – 0.199
0.20 – 0.249
3-0 2 0.20 – 0.249
3-0 3 0.30 – 0.339
2-0 3 0.30 – 0.339
2-0 3.5 0.35 – 0.399
0 3.5 0.35 – 0.399
1 4 0.40 – 0.499
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Medical Supplies 0.50 – 0.599 44
 Suture Size…
Natural Absorbable sutures

USP SIZE METRIC SIZE (EP) DIAMETER (mm)

9‐0 0.4 0.040 – 0.049
8-0 0.5 0.050 – 0.069
7-0 0.7 0.070 – 0.099
6-0 1 0.10 – 0.149
5-0 1.5 0.15 – 0.199
4-0 2 0.20 – 0.249
3-0 3 0.30 – 0.339
2-0 3.5 0.35 – 0.399

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 Table: Synthetic absorbable Sutures
USP SIZE METRIC SIZE (EP) DIAMETER (mm)
12-0 0.01 0.001– 0.009
11-0 0.1 0.010 – 0.019
USP SIZE METRIC SIZE (EP) DIAMETER (mm)
10-0 0.2 0.020 – 0.029
9‐0 0.4 0.040 – 0.049
9-0 0.3 0.030 – 0.039
8-0 8-0 0.5 0.4 0.050 – 0.069
0.040 – 0.049
7-0 7-0 0.7 0.5 0.070 – 0.099
0.050 – 0.069
6-0 6-0 1 0.7 0.10 – 0.149
0.070 – 0.099
5-0 5-0 1.5 1 0.10 – 0.149
0.15 – 0.199
4-0 4-0 2 1.5 0.15 – 0.199
0.20 – 0.249
3-0 2 0.20 – 0.249
3-0 3 0.30 – 0.339
2-0 3 0.30 – 0.339
2-0 3.5 0.35 – 0.399
0 3.5 0.35 – 0.399
1 4 0.40 – 0.499
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Medical Supplies 0.50 – 0.599 46
Suture indications by location
• Much of the process regarding suture selection depend on surgeon
training and preference
• Mucosal lacerations (mouth, Tongue or genitalia)
o Absorbable Suture 3-0 or 4-0
• Scalp, Torso (chest, back, abdomen), Extremities
o Superficial Non absorbable Suture 4-O or 5-O
o Deep Absorbable Suture 3-O or 4-O
• Face, Eyebrow, Nose, Lip
o Superficial Non absorbable Suture 6-O
o Deep Absorbable Suture 5-O

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Suture indications by location…
• Ear, Eyelid
o Superficial: Non absorbable Suture 6-O
• Hand
o Superficial: Non absorbable Suture 5-O
o Deep Absorbable Suture 5-O
• Foot or sole
o Superficial: Non absorbable Suture 3-O or 4-O
o Deep Absorbable Suture 4-O
• Penis
o Superficial: Non absorbable Suture 5-O or 6-O

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Surgical needles
• Surgical needles are produced from stainless steel alloys, which have
excellent resistance to corrosion
• Ideal surgical needle characteristics:
High-quality stainless steel
Smallest diameter possible
Stable in the grasp of the needle holder
Capable of implanting suture material through tissue with minimal
trauma
Sharp enough to penetrate tissue with minimal resistance
Sterile and corrosion-resistant to prevent introduction of
microorganisms or foreign materials into the wound

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Point types
1. Cutting: The needle has at least 2 opposing cutting edges (the point
is usually triangular).
This type is designed for penetration through dense, irregular, and
relatively thick tissues.
The point cuts a pathway through tissue and is ideal for skin
sutures.
Sharpness is due to the cutting edges.

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Point types…
• Conventional cutting: This type of needle has 3 cutting edges
(triangular cross-section that changes to a flattened body).
• The third cutting edge is on the inner, concave curvature (surface-
seeking).
• Reverse cutting: The third cutting edge is on the outer convex
curvature of the needle (depth-seeking).
• These needles are stronger than conventional cutting needles and
have a reduced risk of cutting out tissue.
• The needles are designed for tissue that is tough to penetrate (e.g.,
skin, tendon sheaths, oral mucosa).
• Reverse-cutting needles are also beneficial in cosmetic and
ophthalmic surgery, causing minimal trauma.

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Point types…
• Side Cutting: (spatula): These needles are flat on the top and
bottom surfaces to reduce tissue injury.
• The needles allow maximum ease of penetration and control
as they pass between and through tissue layers.
• Side-cutting needles were designed initially for ophthalmic
procedures.
2. Taper-point (round needle): This type of needle penetrates
and passes through tissues by stretching without cutting.
A sharp tip at the point flattens to an oval/rectangular shape.

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Point types…

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 Point types…

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 Time frame for removing sutures
• Time frame for removing sutures: Times will vary according to the
location and depth of the wound.
• However, the average time frame is 7-10 days after application.
• The following general rules can be used in deciding when to remove
sutures:
Scalp: 6-8 days
Face, Eyelid, Eyebrow, Nose, Lip: 3-5 days
Ear: 10-14 days
Chest and abdomen: 8-10 days
Back: 12-14 days
Extremities: 12-14 days
Hand: 10-14 days

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 Label
The label on sutures must state:
1) the length of the strand in centimeters or in meters;
2) the gauge number;
3) For single use only;
4) where applicable, the Needle length, curvature and profile;
5) Lot number
6) Manufacture date;
7) Expiry date
8) Sterilization method;
9) Storage instructions;
10) Manufacturers Name & Address.

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 Handling
• To prevent needle damage when suturing, it is recommended
that you hold the needle between the middle and one third
from the end.
• If touched at all, suture material should only be held by
forceps or needle holders at the end of the thread.
• Each time it is held, the suture is damaged and this is
considerably more serious with monofilament threads.
• Any damage has an effect on the tensile strength of the
suture.

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 Handling…

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 Handling…

Needle Holders
• Using needle holder
• Grasp needle about 2/3rd of the way back from point

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Other Medical Supplies

61
Other Medical Supplies
• Needles and syringes
• Gloves
• Masks
• Surgical blades
• Scissors
• Forceps
• Catheter
• Nasogastric tubes
• Endotracheal tubes

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 Needles and syringes
Syringes
• Instruments intended for instillation of liquids into the body or its
cavities, OR to withdraw body fluids from the body
• categories based on principle of action:
i. Hypodermic/Plunger Syringes
• Have three parts: plunger, barrel with ml calibration and tip
• Hypodermic Syringes are best examples

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 Needles and syringes
i. Hypodermic Syringes
• are used to administer medication subcutaneously, or intradermally,
intravenously, or intramuscularly
• hypodermic indicates-administered by injection beneath the skin
• Plunger movement (pull & push) inside the barrel allows the syringe
to take in and expel a liquid.

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 Needles and syringes
i. Hypodermic Syringes…
• The open end of the syringe may be fitted with:
• a hypodermic needle
• a nozzle
• Tubing to help direct the flow into and out of the barrel.
• The barrel of a syringe is made of plastic or glass
• Usually graduated in units of volume (ml)
• Nearly always transparent

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 Needles and syringes
i. Hypodermic Syringes…
• Glass syringes may be sterilized in an autoclave
• Most modern medical syringes are plastic with a rubber piston
because:
Seals much better between piston and barrel
Cheap enough to dispose off after used only once
Reduce risk of spreading blood-borne diseases (no reuse)
Re-use
Spreads HIV, Hepatitis….
Safe for insulin injection at home, if used only by one person.

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 Needles and syringes
i. Hypodermic Syringes…
• Medical syringes are sometimes used without a needle for:
Oral administration of liquid medicines to young children or
animals, or
Oral feeding of milk to small young animals
Pre-filled syringes:
Supplied as a standard dosage container
Each carry a single dose of sterile medication

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 Needles and syringes
i. Hypodermic Syringes…
Graduation:
• Syringes are usually graduated in ml
• Common size ranges from 2 ml to 50 ml
• Up to 200 mL available for veterinary use & transfusion
• ≤ 1 mL syringes graduated in 0.1- or 0.01-ml
• Also graduated with special units e.g. Insulin U

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 Needles and syringes
i. Hypodermic Syringes…
• hollow needle commonly used with a syringe to inject
substances into the body
• also used to take liquid samples from the body
• can be used for IM, or IV, Intra-articular, intradermal, intra-
spinal
• hypodermic needles used are meant for single use needles are
embedded in a plastic or aluminum hub that attaches to the
syringe barrel by means of a press-fit or twist-on fitting

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 Needles and syringes
Hypodermic Needles are mainly characterized by:
1. Gauge: outside diameter of the cannula (needle shaft)
 The larger the number, the smaller the diameter
 Needles in common medical use range from 11 gauge (the largest) to
32 (the smallest)
 Needle diameter depends on purpose of use
 For injection administration, gauge usually not greater than 6 G (1.65
mm) is used
 21 gauge needles are most commonly used for drawing blood for
testing purposes

70
 Needles and syringes
Hypodermic Needles are mainly characterized by:
2. Needle length:
 Length of needle shaft (starting from where the cannula joins hub)
 Depends on Purpose
 Usually ranges from 0.25 to 6 inches
3. Bevel:
 The slanting cutting edge which has
a tapering point/tip.
 Facilitates penetration and injection through tissue or rubber closures

71
 Needles and syringes…
Needles designed for a variety of purposes
• Factors to be considered for selection: safety, rate of flow, comfort of
patient, and depth of penetration
• Long-bevel needles: for LA, aspirating, and SC administration
• Short-bevel needles: for iv administration, infusions, and transfusions
• Special short-bevel needles : for intradermal and spinal administration.
• For local anesthesia: 26 to 20 G, ½ inch to 6 inches
• IV, blood transfusion needles: 19-15 G, 1¼ inch to 2½ inch

72
 Needles and syringes
ii. Bulb Syringe
 Bulb syringes frequently are preferred when sterility is not necessary
and plunger-type syringes, because of their force, would be dangerous
to use.
 They are particularly important in the nose and ear, and for wound
and urinary irrigation.
 Bulb syringes customarily are known by name of part of the body for
which they are intended (Nasal, Ophthalmic, Vaginal and Rectal)

73
 Needles and syringes
ii. Bulb Syringe…
Nasal syringes or Nasal aspirators: are soft rubber bulbs with an
acorn-shaped nasal tip to fit the nostril.
The tip may be glass, plastic, or hard rubber.
A glass tip allows visual examination of the mucous removed from
the nostril.
Ear syringes and ulcer syringes: are one-piece molded bulbs of soft,
flexible rubber, with long, narrow nozzles and are employed in
treating the eye, ear, and nose and for irrigation of any open cavity or
ulcer.
If necessary, bulb syringes should be sterilized with germicidal
solutions.
Prolonged boiling will injure the rubber.

74
 Needles and syringes
ii. Bulb Syringe…
Rectal syringes: are customarily of the bulb type, with narrow nozzle.
They are frequently employed in administration of enemas to
infants.
Although many syringes provide hard rubber or vulcanite tips, the
use of hard tips should be discouraged because of occasional injury
to the soft tissues from their use.
Vaginal syringes: are used for irrigation of the vagina.
Pressure on the bulb forces the medicated or
irrigating liquid through the tip of the syringe.
These syringes are provided with rubber, sleeve-shaped, round or
oval shields to prevent leakage when in use.
Caps sealing the nozzles are provided to avoid leakage or loss of the
contents before use

75
 Needles and syringes…
Insulin syringes
• Have markings to show how much insulin is inside the syringe
• Insulin syringes come in different sizes and lengths to match insulin
strength
• Sizes of insulin syringes:
1cc insulin syringe: For doses of 100 units or less
1/2 cc insulin syringe: For doses of 50 units or less
3/10 cc insulin syringe: For doses of 30 units or less

76
 Needles and syringes…
III. Intravenous Cannula
A flexible tube which when inserted into the body is used either to
withdraw fluid or administer medication.
Cannulae normally come with a trocar (a sharp pointed needle)
attached which allows puncture of the body to get into the
intended space.
Cannulas are characterized by their size, length, and internal and
outer diameters as indicated in table below

77
Needles and syringes…

78
 Needles and syringes…
Description:
Intravenous cannula (IV) Set Sterile Polythene with introducer and
injection Valve external diameter 1.3mm Length 45mm 18G.

10 Ivca-72 Cannula Intravenous Set - 18G

11 Ivca-73 Cannula Intravenous Set - 20G
12 Ivca-74 Cannula Intravenous Set - 22G
13 Ivca-75 Cannula Intravenous Set - 24G

79
 Medical Gloves
• are disposable gloves
• used during medical procedures
• prevent contamination between care-givers and patients
• prevent contact with certain chemotherapy drugs
• Include: examination gloves, surgical gloves, and chemotherapy
gloves
• meet performance criteria such as leak resistance, tear resistance,
etc.

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 Medical Gloves
• Surgical gloves
sold as sterile products
• Examination gloves
not usually sold as sterile products
packaged in pairs or boxes of single gloves
• Chemotherapy gloves
sold as sterile or non-sterile products
usually packaged in boxes of single gloves or fitted pairs
properties to protect the wearer from chemotherapy drugs

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 Medical Gloves
• surgical gloves to protect a surgical wound from contamination
• examination gloves to prevent contamination or infection when
examining or treating a patient
• chemotherapy gloves when working with chemotherapy drugs
• Non-medical gloves: such as those used for household cleaning or for
fire or injury protection, are not regulated by FDA.
They do not meet FDA requirements for use in patient care

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 Medical Gloves
Before using medical gloves:
• Wash hands before putting on sterile gloves
• Make sure gloves fit properly
• Check allergy of natural rubber latex gloves (PVC, polyurethane)
• Be aware that sharp objects can puncture medical gloves
• Change your gloves if they rip or tear
• After removing gloves, wash your hands thoroughly with soap and
water or alcohol-based hand rub
• Never reuse medical gloves
• Never wash or disinfect medical gloves
• Never share medical gloves with other users

83
Disposable Scalpel
• A disposable scalpel is a surgical instrument designed for a single use
• Used to cut the skin, sometimes called a surgical knife.
• It is typically made of materials that allow for easy sterilization and
safe disposal after use.

84
Surgical blades
• Specialized cutting instruments used in various medical
procedures, including:
surgeries and
minor medical interventions.
• These blades are designed for precision and are typically
attached to a handle to form a complete surgical scalpel.
• They are available in different shapes and sizes, each
serving a specific purpose in various medical applications.

85
Scissors
• Medical scissors are cutting instruments used in various healthcare
settings for a range of applications, including:
surgical procedures,
wound care, and
other medical interventions.
• These scissors are designed to provide precision and control in
cutting tissues, bandages, sutures, and other materials.

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 Catheters

Tubes, vessel that can be inserted into a body cavity, duct

Thin, flexible tubes allow drainage, injection of fluids or access by
surgical instruments
process of inserting a catheter is catheterization silicone rubber, latex,
and thermoplastic elastomers

87
OTHER MEDICAL SUPPLIES
Catheters
Placement of a catheter into a particular part of the body may allow:
draining urine from the urinary bladder as in urinary
catheterization
drainage of fluid collections, e.g. in abdominal abscess
administration of intravenous fluids, medication or parenteral
nutrition

88
 Types of Catheters
Catheters come in several basic designs.
Foley catheter is retained by means of a balloon at the tip which is
inflated with sterile water.
Robinson catheter also known as ‘Simple catheter’ is a flexible catheter
used for short term drainage of urine.
Unlike the foley catheter, it has no balloon on its tip and therefore
cannot stay in place unaided.
Coude catheter is designed with a curved tip that makes it easier to
thread the catheter pass the prostate or obstructions in the urethral
canal.
A coude catheter tip may be provided with a balloon or not.
Irrigation catheter: has a separate lumen to carry irrigation fluid into the
bladder.
This is useful following endoscopic surgical procedures or in the case
of gross hematuria.

89
 Types of Catheters
Foley catheters
Foley catheters are flexible (usually latex) tubes that are passed
through the urethra during urinary catheterization and into the
bladder to drain urine.
Foley catheters are of two types; 2-way and three-way.
Two-way catheters have two lumens, one for inflating the balloon
and the other for drainage.
Three-way catheters have one more lumen for irrigation in case of
blockage

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OTHER MEDICAL SUPPLIES
Endotracheal (Breathing) tubes
• Catheter that is inserted into the trachea through the mouth
or nose in order to maintain an open air passage or to deliver
oxygen or to permit the suctioning of mucus.
• To provide direct & unimpeded airway to and from lungs
• Used in general anesthesia, emergency, intensive care
• Made from special non-toxic, clear, thermo-sensitive
siliconized PVC material
• Smooth tip aids atraumatic intubations

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OTHER MEDICAL SUPPLIES
Nasogastric tube (NG tube)
Clear plastic tube that passes through the patient’s nose and throat
and ends in the patient’s stomach
Allows for direct “tube feeding” to maintain the nutritional status
Removal of stomach acids
Main use of NG tube is for feeding and for administering drugs and
other oral agents

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OTHER MEDICAL SUPPLIES
NG tube…
Nasogastric aspiration (suction) is the process of draining the
stomach’s contents via the tube
NG aspiration can also be used in poisoning situations when
a potentially toxic liquid has been ingested
For preparation before surgery
under anesthesia and to extract
samples of gastric liquid for analysis

93
OTHER MEDICAL SUPPLIES…
Tongue depressor
Used to depress the tongue to allow for examination of the mouth
and throat
Common modern tongue depressors have thin wooden blade,
smoothed and rounded at both ends
Inexpensive and difficult to clean
Wooden tongue depressors are normally labeled for disposal after a
single use
Available for adults and infants

94
 OTHER MEDICAL SUPPLIES…
Otoscope
used to look into the ears
it is possible to see the outer ear and middle
ear
The head contains a light source and a simple low-power
magnifying lens
Sphygmomanometer
used to measure arterial pressure

95
 OTHER MEDICAL SUPPLIES…
Glucometer
for determining the approximate concentration of glucose in the blood
key element of home blood glucose monitoring by people with
diabetes mellitus

96
 OTHER MEDICAL SUPPLIES…
Laryngoscope
used to obtain a view of the vocal folds and the glottis

97
OTHER MEDICAL SUPPLIES…
Ophthalmoscope
Allows to see inside the fundus of the eye
It is crucial in determining the health in the retina and the vitreous
humor
Forceps:
Grasping and controlling tissue with forceps is essential to proper
suture placement.
However, whenever force is applied to skin or other tissues,
inadvertent damage to cells can occur if an improper instrument or
technique is used.
Be gentle when grasping tissue, and never fully close the jaws on
the skin.

98
 Medical Reagents Used in the Medical Laboratory

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 Definition
• Reagents are chemicals and biological that are used in
laboratory testing for detecting or measuring an
analayte.

• Reagents vary widely in cost, stability, storage

conditions requirements, availability, and the hazards
associated with each one of them.

• They are further classified into liquid and solid.

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 Hematologic tests

• Typical hematologic tests include Complete blood

count, White blood cells, and platelets.

• Other tests include examination of blood film for

differential WBC count and red cell morphology

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 1. Complete blood count(CBC)

• Includes TLC, DLC, RBC count, Hgb, Hct and platlets.

A. Total white blood cell(WBC)

• It is mostly helpful in diagnosis of infectious disease.

• It estimates the total number of white cells in cubic mm

of a blood.

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 • Reagents

• Turks solution
• Glacial acetic acid
• 1% aq solution of gentain violet
• Distilled water
• 1N hydrochloric acid

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 B. Platelet count

• Reagents required
• Diluting fluids
• Ammonium oxalate solution(1)
• Distilled water
• Rees- ecker method
• Trisodium citrate
• Neutral formaldehyde
• Brilliant cresyl blue distilled water

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 C. Differential WBC: also aids the dx of different
infectious disease.
• Reagents: romanosky stains
D. Red blood cells(RBC) count
• Diluting fluid: should be isotonic to prevent hemolysis.
• Sodium citrate (1)
• Formalin
• Distilled water
• hayem’s fluid(2)
• Mercuric chloride
• Sodium chloride
• Sodium sulphate
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• Distilled water 105
 E. Measurement of Hemoglobin(Hb)

• measurement of hgb is used to diagnose anemia.

• The commonest methods to measure Hb in blood are

acidhaematin(sahali) and cyanomethaemoglobin.

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 I. Acidhaematin method(dsahali method)
• This is a visual method of hemoglobin estimation
and it is applied in laboratories where there is no
photometer.

• Sahali hemoglobinometer consisting of comparater(

glass strands) and sahali graduated tube.

• 0.1N HCL

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 II. Cyanomethaemoglobin method: it is colorimetric
method where a commercial cyanomethaemoglobin
standard is used for comparison.

• Reagents: drab kin’s solution

• Potassium cyanide

• Potassium ferricyanide

• Potassium dihydrogen phosphate

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 • Cyanometheamoglobin standard available
commercially in sealed ampoules

• Photometer

N.B. drab kin’s solution is light sensitive reagents so

that it must be stored in brown bottle.

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 F. Examination of red cell morphology: red cell
morphology also aids in dx of anemia.

• Reagents
• Romanosky stain( giemsa/ wright stain)

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 2. Erythrocyte Sedimentation rate(ESR)

• ESR is rate at which erythrocyte sediment when

anti- coagulant blood is held in a vertical tube.

• There are two methods to determine ESR

• I. Westreggreen’s method
• II. Wintrob’s method

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 I. Westergreen’s method

• Westergreen’s pipette: it is open at both ends and about

30cm long with internal diameter of 2.5mm.

• The pipette has graduation of 0 to 100mm and a

capacity about 1ml of blood.

• Tri sodium citrate(3.8%)- anti-coagulant

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 II. Wintrobe’s method

• Wintrobe’s: is graduated 11cm long tube with

internal diameter of 2.5mm

• Tri-sodium citrate(3.8%)

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 3. Assesment of cloting system

a. Prothrombin time: this test measures the extrinsic

pathway of coagulation.

Reagents

• Thromboplastin

• 0.025M calcuim chloride

• Anticoagulat( tri sodium citrate)

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 B. Activated partial thromboplastin time(APTT): the test
demonstrates deficiencies within the intrinsic pathway
and the final common pathway.

Reagents

• Kaolin- suspend 0.5g kaolin in 100ml saline

• Phospholipids

• 0.025M calcium chloride

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 4. Immunological/serological tests

• Immunological tests can be used in the dx of bacterial,

viral, fungal and parasitic infectious disease.

A. ABO grouping

• Determination of ABO group is necessary both for the

donor as well as the recipient in blood transfusion.

• Reagents

• ABO grouping antisera: anti A, anti-B anti-D antiserum

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 B. Venereal disease research laboratory(VDRL) test

• it is non specific test used for the dx of syphilis.

• Reagents

• VDRL antigen
• Positive control serum
• Negative control serum

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 C. Widal test

• It is used for dx of typhoid and paratyphoid fever

caused by microorganism like S.typhi, s. parathphi A,
S. paratyphi B.

• Reagents

• S. typhi “O” antigen suspension

• S. typhi “ H” antigen suspension
• Polyspecific positive control
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 D. Test for Rheumatoid factor(RF): rheumatoid factor is
autoantibody produced by the human body against self
antigen.

Reagents

• RF latex reagents modified fraction of Immunoglobulin

G(IgG)

• Positive control

• Negative control

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 E. Serological diagnosis of viral hepatitis

• Hepatitis or inflammation of the liver is mainly caused by

hepatitis viruses such as hepatitis A virus(HAV), Hepatitis B
virus( HBV), hepatitis C virus(HCV), hepatitis Delta
virus(HDV).

• HBV is the commonest virus which causes viral hepatitis.

• Serological test using latex agglutination and

innumochromatography are the common rapid serological
tests used for dx of hepatitis B virus infection.
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 I. Latex agglutination test for hepatitis B virus surface
antigen(HBsAG)
• Material and reagents required
• Latex agglutination test kit consisting of
• HBsAG latex reagents: latex particles coated with
antibodies against HBsAG
• Negative control
• Positive control
• Pipette- stirrers: single use specimen dropper/ stirrers
• Disposable agglutination slide
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 II. Immuno chromatographic test for hepatitis B surface
antigen

• Materials required
• Test device
• Disposable plastic dropper
• Test tube
• Test tube rack
• Centrifuge
• Anticoagulant
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 F. Diagnosis of pregnancy

• Human chrionic gonadotropin(HCG) hormone is secreted by

the chrionic cells after fertillization of the ovum.

• The routine pregnancy test aims to detect HCG in urine.

A. Agglutination test

• pregnancy latex reagent; a suspension of antobody coated latex

particles in a buffer containing 0.1%sodium azide.

• Positive control

• Negative control
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 B. Strip test

Reagents

• Pregnancy test strips

• Specimen collection material

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 E. Rapid test for malaria parasite

• The development of RDT has open new perspectives

in the dx of malaria.

• These RDT are easy to perform, results can be

obtained with in short period of time and they do not
require extensive training.

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 A. PreciMALARIA P.F/P.V - Reagents/material required

• Malaria P.f/P.v antobody coated dipsticks buffer viral and

droppers

• Lancet

B. Care start rapid test: it detects all species of malaria

Material/reagents required

• Test device

• Assay buffer
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 Clinical chemistry tests
• Clinical chemistry tests assess body’s chemical balance.

• Liver function test, renal function test, measurement of

glucose, uric acid, lipid and protein levels are typical
chemistry tests

• Reagents and standards in the form of kits are of high

quality but may be expensive.

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 1. Renal function test

• The two important renal function tests are urea and

creatinine

A. Urea: is a main end product of protien metabolism in the

body.

• Urea is excreted by the kidney in urine . Therefore, its

measurment in serum and urine can be used to assess
kidney’s function

10/21/2024
• There are three methods for the determination of blood urea 128
 i. Urease method using Nessler’s reaction

Reagents required

• Enzyme reagent(R1)

• Starter reagent(R2)

• Urea standard(40mg/dl)

• Distilled water

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 ii. Urease method using berthelot reaction

Reagents required

• Buffer reagent(R1)

• Enzyme reagent(R2)

• Chromogen reagent(R3)

• Urea standard]distilled water

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 iii. Diacetyl monoxime method

Reagent

• Stock acid reagent

• Mixed acid reagent( sulfuric acid and stock acid reagent

• Stock color reagent A (Diacetyl monoxime)

• Stock color reagent B

• Mixed color reagent ( stock color reagent A and B)

• Urea standard 40mg/dl

• Distilled water
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 B. Creatinine:- measurement is used in the dx and
treatment of renal disease and monitoring patients on
renal dialysis.

Reagents

• Picric acid reagent(R1)

• Buffer reagent(R2)

• Creatinine standard 2mg/dl

• Distilled water

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 2. Liver function tests

• LFTs are a group of clinical chemistry tests designed to

give information about the state of a patient’s liver

• Several biochemical tests are useful in the evaluation and

management of patients with hepatic dysfunction.

• LFTs include Bilirubin, SGOT, SCPT and ALP

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 A. Bilirubin
• It is formed from hem fragment of aged or damaged red
blood cells.
• Jendrassik and Grof’s method is used to determine bilirubin
level in patients serum.
Reagents required
• Sulphanic acid reagent
• Soduim nitrite solution
• Diazo reagent
• Alkaline taratarate reagent
• Ascorbic acid solution
• Standard bilirubin solution
• Distilled water

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 B. Serum glutamate oxaloacetate transaminase(SGOT)
• SGOT is also known as aspartate aminotransferase(AST).
• It is an enzyme associated with liver parenchymal cells
and is raised in acute liver damage.
Reagents
• Phosphate buffer ( disodium hydrogen phosphate and
potassium dihydrogen phosphate)
• AST substrate(DL- aspartic acid and alpha- ketoglutrate
• Pyruvate standard
• Color reagent(2,4 dinitrophenylhydrazine)
• 0.4M sodium hydroxide

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 C. Serum glutamate pyruvate transaminase(SGPT)
• Its also known as Alanine Amino Transferase (ALT)
• It is an enzyme present in hepatocytes(liver cells).
• Its concentration in the serum raises in liver damage.
Reagents
• Phosphate buffer(Disodium hydrogen phosphate and
potassium dihydrogen phosphate.
• ALT substrate(DL- alanine and alpha- ketoglutrate)
• Pyruvate standard
• Color reagent(2,4- dinitrophenylhydrazine)
• 0.4M sodium hydroxide
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 D. Alkaline phosphatase(ALP)
• It is an enzyme in the cells of lining the biliary duct of the
liver.
• ALP levels in plasma rises with large bile duct
obstruction, intrahepatic cholestasis or infiltrate disease of
the liver.
Reagents
• Buffer(2-amino 2 methyl 1-propranol and 6M Hcl)
• Substarate( sodium parnitrophenyl phosphate)
• 0.25M sodium hydroxide
• Stock paranitrophenol 10.8 mmol/L
• Distilled water
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 3. Blood glucose measurement

• Glucose is a reducing monosaccharide that serve as a

principal fuel for all tissues.

• Glucose measurement is important for dx of diabetes.

• It can be measured photo metrically and by rapid test

using test strips.

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 A. Photometric measurement- by glucose oxidase
enzymatic method
Reagents
• Phosphate buffer(disodium hydrogen phosphate di hydrate
and potassium di hydrogen phosphate.
• Color reagents
• Working glucose( stock glucose solution, benzoic acid)
B. Rapid blood glucose test

• The test can be performed by visual comparison with

standard or using glucometer

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 4. Electrolytes

• The electrolytes found in the body are Major cations(Na, K,

Mg and Ca) and Major anions(Cl, Hco3, Po4 and SO4).

A. Sodium and Potassium measurement by flame photometry

• Sodium is the main extra cellular cations and it plays a role in

fluid distribution among body compartments.

• Potassium is the major intracellular action.

• It is widely distributed in muscle tissue, nerve tissue, blood

cells and plasma.
10/21/2024 140
 Reagents required

• Stock sodium solution 100mmol/L

• Stock potassium 100mmol/L

• Working standards

10/21/2024 141
 5. Urine analysis

• Testing of urine requires low technology. Test strip

technology is used in many laboratories.

• The test strips require good laboratory practice to prevent

premature expiration.

• The routine tests for urine analysis are grouped in three;

physical, chemical and microscopic examination.

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 6. Parasitological tests

• The common parasitological tests are:

• Stool examination for intestinal parasites

• Examination of blood film for hemoparasites
• Examination of tissue aspirates for tissue
parasites

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 A. Stool examination for intestinal parasites: there are
two approaches of stool examination to diagnose
intestinal parasites

I. Direct method

Reagents

• Dobells iodine( iodine, potassium iodide)

• Physiological saline

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 II. Concentration method: there are two concentration method

a. Zinc sulphate concentration method(flotation method)

Reagents

• Zinc sulfate

• Distilled water

b. formol- Ether sedimentation technique

• 10% formalin: formaldehyde and distilled water

• Diethyl ether
10/21/2024 145
 B. Blood and tissue parasite: stained preparations are
microscopically examined for diagnosis of blood and
tissue parasites.

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 Microbiological tests

• Microbiological tests include microscopic examination

of stained preparation(gram and AFB stain), wet
mount(KOH), and isolation of a microorganism on
artificial media (culture sensitivity test).

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 A. Gram stain
• Reagents/ materials required
• Crystal violet
• Ethanol 95%
• Ammonium oxalate
• Iodine
• Potassium iodide
• Acetone 99%
• Safranin O/neutral red
• Microscope slide
• Immersion oil

10/21/2024 148
 B. Wet preparation

Reagents/material required

• Sodium chloride

• Potassium hydroxide(KOH)

• Microscopy slide

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 C. Sputum microscopy for acid fast bacilli(AFB) smears

Reagents/ material required

• Basic(carbol) fuchsin

• Methanol/ethanol absolute

• Methylene blue

• Phenol crytals

• HCL

• Immersion oil
10/21/2024 150
 Culture and sensitivity test
• Culture and sensitivity test is important to isolate
microorganism to the species level and determine
antibiotic sensitivity pattern.

• This test is frequently used to isolate bacteria and

fungi on artificial liquid(broth) or solid(agar) media.

• Most cultures require supplements for isolation of

microorganisms.

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 • Isolation and identification of microorganisms also
require differentiation reagents, strips and disks.

• After isolation, antibiotic disks are used to determine

the sensitivity pattern of isolated organism.

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 Thank you!!!

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