pediatric equipments.pptx

Pediatric equipment

1. COMMON EQUIPMENTS USED IN PEDIATRICS Guided by :- Dr. Minakshi Chaudhary MD ( Ayu . ) Sr.Lecturer Presented by Dr.Anjna Kumari MD scholar PG Deptt . of Kaumarbhritya Rajiv Gandhi Govt. Post Graduate Ayurvedic College and Hospital Paprola Kangra .

2. UMBLICAL CORD CLAMP The umbilcal cord clamp is a medical device used to hold the cord in place when the cut is made , and the clamp may stay on for several days while the remaining cord attached to the baby dries. Late cord clamping (performed approximately 1-3min.after birth)is recommended for all births, while initiating simultaneous essential neonatal care. Early umblical cord clamping (less than 1min after birth) is not reccomended unless the neonate is asphyxiated and needs to be moved immediately for ressucitation .

3. Umbilcal cord clamp

4. INFANT MUCUS SUCKER The infant mucus sucker is design for aspiration of secretion from oropharynx in infant to ensure free respiration. Infant mucus sucker is clear, transparent and has low friction surface it provide easy visual examination and enables trauma free insertion of the aspiration. Mucus sucker includes: 1 container (capacity 20ml), with graduations from 0 to 20 ml. There are two tubes attached to container one tube is inserted in newbon’s mouth and other tube with funnel shaped adapter at its proximal end is used for suction. A lid for safe sealing and transport the aspirate if needed.

5. TYPES Types of mucus sucker Mannual:1.bulb type 2.rat tail type or De Lee trap Foot operated Electric

6. Types

7. NASOGASTRIC TUBE A nasogastric tube is a thin ,soft tube that is passed through a nostril , down the back of their throat , through the oesophagus and in to the stomach. Inserting the the tube is usually a short procedure ,and the tube will go down easily if child is relaxed.

8. Nasogastric tube

9. INDICATIONS Feeding sick and premature infants Feeding an unconscious child To administer medications . Gastric lavage in case of poisoning For diagnosis of tracheoesophageal fistula For gastric decompression in case of intestinal obstruction , paralytic ileus .

10. CONTRAINDICATIONS Facial trauma Base of skull fracture Recent esophageal perforation/repair

11. PRECAUTION Stop the insertion immidiately ,if the child has bouts of cough or develops respiratory distress. This often indicates wrong insertion in to airway instead of esophagus . While removing the NG tube always pinch the outer end to avoid emptying the contents in to phyranx .

12. Size of nasogastric tube age NG tube size( fr ) <1m 6-8 1-6m 8-10 1-3yr 10-12 3-6yr 12 6-8yr 12-14 >8yr 14-16

13. SELF INFLATING BAG Ambu bag is a device used to provide positive pressure to a patient who is not breathing or who is breathing inadequately. Self inflating bag of 250-500ml capacity is ideal for resuscitation of a newborn baby . It should be provided with a pop off valve or with a facility to attach a pressure gauze. An oxygen reservoir in the form of a corrugated tube or rubber bladder ,helps to increase the oxygen concentration to 90 to 100%. When self infalting bag is used without an oxygen reservoir , it delivers 40 to 60%oxygen because room air enters the bag with each inflation.

14. Self inflating bag

15. MASK Usually made up of plastic or rubber Types Uncushioned Cushioned Shapes Round Anatomically shaped – somewhat triangular in shape

16. INDICATIONS When to begin Baby is apneic or gasping Heart rate is below 100beats/min. When to stop Baby is having spontaneous respiration Heart rate is more than 100/min Improving color

17. CONTRAINDICATION Baby with diaphragmatic hernia Congenital diaphragmatic hernia is a hole or opening in the baby’s diaphragm , the muscle that seprates the abdomen from the chest . This defect allows the abdominal organs such as stomach ,intestine , liver and spleen , to move up the chest cavity . These other organs crowd the baby’s lungs and prevent them from growing and developing properly.

18. ENDOTRACHEAL TUBE Endotracheal tube- it is a flexible plastic tube that is placed through the mouth in to the trachea to help a patient breathe. Endotracheal intubation- the placement of a tube in to the trachea in order to maintain an open airway in patients who are unable to breathe on their own airway.

19. INDICATION OF ET INTUBATION When bag and mask ventilation is ineffective(heart rate below <80/min) or prolonged . When chest compressions are performed. When tracheal suction is required i.e.for aspiration of meconium . When diaphragmatic hernia is suspected Extremely preterm babies (<28weeks or<1000g)and neonates requiring adminstration of surfactant .

20. Endotracheal tube

21. SIZE OF ET Tube size (mm) Weight(g) Gestational age (weeks) 2.5 <1000 <28 3.0 1000-2000 28-34 3.5 2000-3000 34-38 4.0 >3000 >38

22. LARYNGEOSCOPE To pass endotracheal tube To examine vocal cord

23. TYPES Straight blade- Miller-the straight miller laryngeoscope blade is traditionally recomended for intubation in infants . Curved -Macintosh Size of blade O-preterm 1-term 2 -adults

24. UMBLICAL CATHETER A small tube inserted in to one of the vessels in the belly button , this cathater is connected all the way to the aorta . This cathater is used to draw blood and delivery necessary fluids , medications, blood , and nutrients to the baby.

25. WEIGHING MACHINE Accurate weight record of babies is a sensitive index of their wellbeing and availability of a sturdy and reliable weighing machine fullfills a fundamental need. Electronic weighing machine with a digital read out though expensive is desirable for sake of convenience and accuracy. The chances of cross infection should be minimized by using a sterile paper or a towel over the pan before weighing each infant.

26. Weighing machine

27. INFANTOMETER Infantometer is an infant length measurement device which can be used everywhere. For precise measurement it has a flat firm base board to place the baby equiped with scroll in mechanism for low weight babies up to 24months. Technique The infant is placed supine on the infantometer . Assistant or mother is asked to keep the vertex or top of the head snugly touching the fixed vertically plank . The leg are fully extended by pressing over the knee ,and feet are kept vertical at 90 degree.

28. STADIOMETER A stadiometer is a medical equipment used for measuring human height . It is usually construced out of a ruler and a sliding horizontal headpiece which is adjusted to rest on the top of the head. Stadiometers are used in routine medical examinations and also clinical tests and experiments.

29. OXYGEN CYLINDER OXYGEN CONCENTRATOR Portable oxygen cylinders are expensive and not readily available in a district hospital or community health centre. Oxygen concentrators are work both on a battery and mains.

30. OXYGEN HEAD BOX A square-shaped box made of transparent plastic or perspex which can enclose the head of the infant is useful for adminstration of higher concentration of oxygen. The box should be made of unbreakable material molded as a single piece without any joints. It can be used whether the baby is nursed in an open cot or incubator

31. BASSINETS A varriety of bassinets are avilable for routine use in nursery . It is desirable to use bassinets, which can be easily cleaned and and equipped with a locker and head tilting mechanism. The locker can be used to hold the supplies of an individual baby , such as diapers, frocks, sterile gauze, cotton , thermometer, feeding equipments , drugs.

32. TONGUE DEPRESSOR To examine oral cavity and throat To test for gag reflex

33. RADIANT HEAT WARMER A portable heat lamp with two 150watt white ordinary or bakery bulbs or infrared bulb fixed on the wall about 2-3 feet about the level of table or trolley is all that necessary. The infrared heat is prefrable because it directly warms the subject without affecting the temperature of intervening environment. When an overhead radiant warmer is intended to be used for a prolonged period ,it should be combined with a skin sensor and a servo control system.

34. PHOTOTHEARPY UNIT Photothearpy is now generally accepted as a safe and effective method for treatment of neonatal hyper bilirubinemia . Blue light is more effective than the white light but the former interferes with the observation of the infant . Special blue lamps with a peak output at 425to 475 nm are most efficient for phototherapy and these do not emit harmful ultraviolet rays. The nude infant may be exposed under a portable or fixed light source kept at a distance of about 45 cm from the skin

35. PROCEDURE Undress the baby completely Covers the eyes and genitalia (in males) Keep baby 30-45 cm from the source Turn the baby after each feed to ensure maximum exposure Monitoring of temp. after every 2-4 hours Ensure adequate breast feeding Record weight daily

36. Phototherapy is very useful in treating Jaundice in Neonates. In this unconjugated bilirubin gets converted into water-soluble photo products on exposure to light of a particular wavelength i.e 425-475nm. These photoproducts are water soluble and non toxic and excreted in intestine and urine.  

37. INCUBATOR The incubators are essential to provide an ideal micro environment for high risk babies. About one third of nursery beds should comprise of incubators . The main function of an incubator are isolation , maintenance of thermoneutral ambient temperature , desired humidity and administration of oxygen. It is desirable to nurse extremely low birth weight (<1000g) stable babies in the incubator. The sensory stimuli ,like light ,sound ,touch and pain, should be kept to the barest minimum without compromising the quality of care. It is essential that an incubator should not interfere with observation of infant , should offer easy acess to the baby and be readily cleanable.

38. NEBULISER Nebulizers are devices which are useful in delivering aerosolized drugs. Used in –acute severe episodes of asthma,bronchiolitis or status asthamaticus . Helpful when inspiratory effort is weak as in case of infants.

39. DRUGS USED IN NEBULISER Beta -2 agonist- salbutamol dose-.15mg/kg/dose Ipratropium bromide- 0-5 yrs of age (for treatment of acute asthma only)-125-250micrograms up to a total daily dose of 1mg 6-12 age -250 micrograms up to a total daily dose of 1mg Adult -250-500micrograms 3 to 4 times daily Inhaled steroids- Budesonide Dose-children aged 6months and above -.25-1.0mg daily Adults and children/ adoloscents over 12years of age.5-2.0mg daily Inhaled racemic epinephrine- in case of bronchiolytis

40. PULSE OXYMETER Pulse oximeter provides a simple ,convenient and non invasive method for continuous monitoring of hemoglobin saturated with oxygen.

41. HEART RATE MONITOR Among various electronic gadgets for monitoring vital signs, cardiac monitor showing digital display of heart rate or an electrocardiographic configuration on an oscilloscope or both is useful . Generally an apneic attack is followed by bradycardia within 20seconds so that heart rate monitor can be used with advantages over an apnea monitor.

42. BLOOD PRESSURE MONITOR A blood pressure cuff connected to a machine which will automatically take the baby’s blood pressure at regular intervals.

43. INTRAVENOUS LINE Tubes that deliver nutrients or medications directly in to the baby’s bloodstream. In infants these lines are inserted with an IV commonly placed in the arm, leg or scalp.

44. THANK YOU

45. Transcutaneous oxygen carbon dioxide monitor A small circular pad attached to the baby’s skin to measure the baby’s oxygen and carbon dioxide levels. The transcutaneous monitor needs to heat the skin in order to get thsese measurements, so it is moved to different areas of the baby’s skin periodically to avoid heating the skin in excess.

46. C-PAP MACHINE A method of adminstering air to the baby’s lungs which uses tubes inserted in to baby’s nose or mouth and through the windpipe. The tubes are connected to a mechanical ventilator The ventilator assists the baby with breathing rather than breathing for the baby completely .

47. INDICATIONS Respiratory distress syndrome Apnea of prematurity Post extubation in preterm VLBW infants Transient tachypnea of newborn Meconium aspiratin syndrome

48. MECHANICAL VENTILATOR This machine , which is connected to an endotracheal tube, sends warm air and oxygen through the tube and monitors air pressure , breath quantity ,and oxygen levels. This device is used to help the baby’s lungs recover by temporarily breathing for them.

49. X-RAY MACHINE X-RAYS use electromagnetic energy beams to create images of bones , tissues, and organs . They are used to monitor ,detect and diagnose many different health conditions , injuries,or disorders They may be taken in the NICU with portable x-ray machines right at the baby’s bedside

50. ULTRASOUND Ultrasound machine use high frequency sound waves to create images of organs, tissues, and blood vessels. This visual tool is painless for the baby and is commonly used in the NICU to examine the structures of the baby’s brain , heart ,and abdomen.

51. COMPUTED TOMOGRAPHY A CT scan uses a combination of x-rays and computer technology to create horizontal or axial images of the body. CT scans are more detailed than x-rays and require less exposure to radiation . CT scans are often done in the NICU to check for brain bleeds and require the baby to be in a special room for the imaging procedure. It may also require sedation because this type of imaging requires that the baby does not move during the scan.

52. OXYGEN ANALYSER This is useful for monitoring ambient oxygen concentration in order to protect the infant against oxygen toxicity. It helps in regulating the flow rate of oxygen is delivered to the infant depending upon his clinical condition and oxygen requirement

53. FEEDING EQUIPMENTS Glass or stainless steel bowls of adequate size (120ml)capacity should be avilable in the nursery for collection of expressed breast milk , mixing and preparing the formula A hot air autoclaving oven or a pressure sterlizer should be provided for autoclaving feeding equipment. Storage facility like a refrigrator , should be avilable in the nursery