Pediatric Instrument spotters for RGUHS.pptx

Instruments or equipment used in pediatrics departement of medicine, MBBS Spotters pediatric instruments, tubes, oxygen delivery systems, canuula, IV IO Cannula, catheters, laryngoscope, ryle's tube, NG tube

1. INSTRUMENTS VIVA Identify/Name the instrument Parts of the instrument Indications/Uses Method of usage/ Assemble/ Attach/ Procedure Contraindications Complications

2. AMBU BAG ARTIFICIAL MANUAL BREATHING UNIT = AMBU Consists of: Self-inflating Bag (250 -750ml) Face mask Face mask – cushioned (better as it provides air tight seal and less trauma)/ un-cushioned Circular (preterm) or Triangular(term) Should cover mouth, nose, chin but not the eyes Reservoir Bag Without reservoir bag – FiO2 – 40% With reservoir bag – FiO2 – 90-100% Oxygen inlet pipe (will be asked to identify and attach the parts) Indications : Intubation failure Apnoea/ Neonatal Asphyxia Neonatal resuscitation Contraindications : Congenital Diaphragmatic Hernia Facial trauma Complications : Barotrauma Gastric insuffulation

3. LARYNGOSCOPE Consists of: Handle Blade - curved Macintosh) /Straight(Miller) Straight blade is more useful in children as the larynx is more anteriorly placed Curved blade is useful in older children & adults as it helps to displace the tongue Blade sizes – 0 (preterm/LBW) to 4 (>10y) Will asked to assemble the instrument, holding position (HOLD INVERTED AND IN LEFT HAND), turn on the LED, and insertion method Indications – diagnostic usage as direct laryngoscopy imaging for: Foreign body detection Check for Cord palsy/ RLN/SLN palsy Therapeutic uses – Endotracheal Intubation Neonatal asphyxia/ Meconium aspiration/ RDS/ Resuscitation CDH/ TEF Administering GA Contraindications – Cervical spinal injury/ Severe Respiratory Obstruction Complications – Trauma Hyperextension of neck – can lead to vasovagal attack Displacement of ET tube

4. Procedure: Align the mouth, pharynx, trachea by extending the neck by placing a shoulder bag or towel/blanket Hold the laryngoscope in your left hand, upside down, blade pointing away from you Insert the blade along the midline of the base of the tongue Insert ET tube from the right corner of the mouth An assistant can put pressure on the cricoid to better help in visualisation Insert till the glottic marker on the tube is at the level of the vocal cords Secure the tube after confirming the position

5. PROCEDURAL VIDEOS

6. ENDOTRACHEAL TUBE Consists of: Proximal end (blue) – 15mm adapter that attaches to ventilator/ AMBU bag or kept open PVC tube with radio-opaque line with vocal cord mark such that the tip of the tube lies at the bifurcation of the trachea Pilot Ballon/ Valve – inflating the cuff Distal end – Murphy’s eye is a lateral opening, which prevents blockage of tube in case the bevelled tip gets blocked/impacted Cuffed tube is used in older children to keep the ET tube in place and prevent aspiration of secretions Uncuffed is used infants with narrow subglottis UNCUFFED ET TUBE CUFFED ET TUBE

7. Size of ET Tube - Formula to calculate the internal diameter of the ET tube (in mm) = (Age in years/4 )+ 4 Length = Diameter x 3 Premature – 2-2.5mm Term – 3-3.5mm 0-1 year – 4-4.5mm Indications : Mechanical ventilation in case of Epiglottitis, ATLB, Asthama Resuscitation IPPV Tracheal Suctioning (MAS) Complications : Trauma Pressure necrosis leading to TEF Pneumothorax Vasovagal stimulation on posterior pharyngeal wall stretching Rarely, allergic reaction

8. NASOGASTRIC TUBES INFANT FEEDING TUBE Thin, flimsy PVC Nasogastric feeding tube Radio-opaque line for Xray confirmation of insertional site Distally – lateral eye RYLE’S TUBE Larger, thicker, firmer PVC NG tube Indications Gastric content aspiration Decompression in Bowel obstruction Gastric lavage Feeding SIZES OF NG TUBES ARE MEASURED IN FRENCH UNITS (FG)

9. PERIPHERAL IV CANULA PARTS AND SITES OF CANNULATION

10. FOLEY’S CATHETER Indications: URINARY INDICATIONS - Input/Output charting in Shock/Renal Failure Urinary Incontinence or Retention Bladder injury Hematuria Supra-pubic Cystotomy Intravesical Chemotherapy NON-URINARY INDICATIONS – Hemostasis in UGI bleed EASI/ IOL Complications – Injury to urethra False catheterisation of vagina UTI if done in aspetic conditions Parts of a 2 Way Foley’s catheter

11. French units (FG) = 3 x (internal diameter of lumen in milimeters ) Note – black in paediatric age group = 10FG but black in adults = 26FG 6-12FG = pediatric 12-14FG = adult female >16FG = adult male

12. FOLEY’S CATHETER Indications: URINARY INDICATIONS - Input/Output charting in Shock/Renal Failure Urinary Incontinence or Retention Bladder injury Hematuria Supra-pubic Cystotomy Intravesical Chemotherapy NON-URINARY INDICATIONS – Hemostasis in UGI bleed EASI/ IOL Complications – Injury to urethra False catheterisation of vagina UTI if done in aspetic conditions Parts of a 2 Way Foley’s catheter

13. OXYGEN DELIVERY SYSTEMS

14. NASAL CANULA Flow Rate = 0.5L – 4L/min FiO2 (fraction of inhaled oxygen) = 25-40% HIGH FLOW NASAL CANNULA (HFNC) Flow Rate = upto 6 0L/min FiO2 (fraction of inhaled oxygen) = 60-100 %

15. NON REBREATHER MASK (NRM) Flow Rate = 12L – 15L/min FiO2 (fraction of inhaled oxygen) = 80-95% OXYGEN MASK Flow Rate = 5L – 10L/min FiO2 (fraction of inhaled oxygen) = 40-60%

16. VENTURI MASK Flow Rate = 4L – 12L/min FiO2 (fraction of inhaled oxygen) = 24-60% Precise control of oxygenation OXYGEN HOOD Flow Rate = >7 L/min FiO2 (fraction of inhaled oxygen) = 20 -100%

17. RARE INSTRUMENTS Unlikely to be kept for viva

18. LUMBAR PUNCTURE NEEDLE INDICATIONS : Therapeutic : Administration of Analgesia/Anaesthesia/ Intrathecal Antibiotics/Chemotherapy Diagnostic CSF Tap for : Meningitis GBS MS SAH Malignancy CONTRAINDICATIONS : Raised ICT signs of Impending Herniation Coagulopathy Hemodynamically unstable FND + COMPLICATIONS : Herniation Respiratory failure CSF leak Site infection

19. Procedure and Site L3-L4 Intervertebral space preferred over L4-L5 space Tip is in subarachnoid space

20. BONE MARROW ASPIRATION NEEDLE INDICATIONS : Therapeutic : Bone marrow transplantation Rarely, IO drug administration/ transfusion Diagnostic : Aplastic anemia Microcytic anemia Megaloblastic anemia Leukemia Myelofibrosis PUO ITP Storage disorders CONTRAINDICATIONS : Skin infections/Disseminated infections Coagulopathy Bone disorders – Osteomyelitis/ Osteogenesis imperfecta COMPLICATIONS : Haemorrhage Infection Pain at marrow site Trauma to adjacent neurovascular structures SALAH JAMSHIDI – bone marrow biopsy needle KLIMA

21. Procedure and Site <2 years – Proximal tibia media (medial to tibial tuberosity) >2y – Iliac crest or sternum

22. LIVER BIOPSY GUN/ NEEDLE INDICATIONS : Liver cirrhosis – Indian childhood cirrhosis(obsolete), Biliary cirrhosis, Autoimmune, PBC/PSC, NASH Storage disorders – GSD, Wilson’s Malignancy – Hepatoblastoma, mets Infections CONTRAINDICATIONS : Bleeding disorders Biliary tract infections Peritoneal infection Hydatid disease COMPLICATIONS : Local Pain Intrathoracic or intraperitoneal bile leak Pneumothorax Visceral injury

23. Compiled by Vamshi