Pediatric Instruments

Endotracheal tube
Non cuffed
• In the pediatric population, the cricoid ring is sufficiently narrow to
form a seal all by itself
• Cricoid ring is ellipsoid rather than circular
Cuffed
• In the adults, the trachea is considerably wider
• The cuff helps
• to seal the trachea, so that positive pressure cannot escape from the lower
airway
• seal the upper airway, so that material above the glottis cannot enter the
trachea
Tube Weight Gestatio
Size of the nal Age
baby (g)
2.5 <1000 <28
weeks
3.0 1000 - 28 – 34
2000 weeks
3.5 2000 - 34 – 38
3000 weeks
4.0 >3000 > 38
weeks
Indications
• Neonatal resuscitation
• Congenital diaphragmatic hernia
• Non vigorous infant with meconium
aspiration
• To deliver medications or surfactant
• Prolonged PPV or Bag and mask
Contraindication
• Laryngeal Edema
• Epiglottitis
• Laryngotrachoebrochitis
• Absence of upper airway (eg. radical
laryngectomy)
• Laryngeal trauma which would be
exacerbated by ETT insertion (eg.
fractured larynx)
• Transection of the airway which could be
exacerbated by ETT insertion
AMBU (Artificial Manual Breathing Unit)

• Patient outlet (larger)

• PEEP valve - prevents ventilator induced
lung injury
• One-way valve unit (fish mouth valve) -
prevents reverse flow of exhale CO2
• Pressure release valve / safety valve
(maintain pressure of 30 – 40mm H20)
• Self inflatable rubber bag (250 – 750ml)
• Oxygen inlet (smaller) – connected to O2
source
• Reservoir bag
Indications
• Neonatal resuscitation
• Apneic baby at birth / not crying
• Low breathing rate – emergency
• Cardiopulmonary resuscitation
• Hyperventilation (eg – in
meningitis)
Contraindication
• Non vigorous infant with meconium
aspiration
• Congenital diaphragmatic hernia (bowel in
thorax- airflow worsens hernia
• Foreign body aspiration
• Tracheoesophageal fistula
Tongue depressor Face mask

Metallic device or disposable wooden tongue • Made of plastic or rubber

depressor • Maybe of cushioned or nonncushioned type
• Cushioned type provides less pressure to face,
Used to and damage to any facial structures
• To examine gag reflex • There are round and triangular shaped masks
• To examine oral cavity, tonsils and pharynx • Correct size mask will seal cover the nose and
• To examine movement of palate and uvulae mouth
• Spatula test - to test spasm of masseter muscle • Used to deliver positive pressure ventilation
in suspected tetanus
Laryngoscope
Parts include
1. Handle - to hold the laryngoscope and to insert the
batteries
2. Hook – to attach the blade to the handle
3. Blade - Detachable
• Flange - to guide instrument and deflect tissue
• Bulb – to illuminate and visualize the passage
• Spatula – to depress tongue
• Tip – to elevate epiglottis

Types

Straight Blade - Miller

Curved Blade - Macintosh
 Uses

Infants
• Neonatal asphyxia
• Meconium Aspiration syndrome
• Respiratory distress syndrome
• Tracheo-esophageal fistula
• Mechanical ventilation

Older children
• Resuscitation
• Epiglottitis
Blade Size 0 – Preterm and LBW babies • During administration of general anesthesia
Blade Size 1 – Term neonates • Kerosene poisoning
Blade Size 2 – Children age 2 – 10
Blade Size 3 - Children >10 years
Guedels Oropharyngeal
Suction tube
Airway

• Size no. 6 is used in pediatrics

• Size is determined according to age (distance from • It has no closing caps at the ends, both ends
midpoint incisor to angle of mandible )
are open
• One end encircles the lip while he other end is introduced
into the oral cavity(to reach the pharynx)
Uses
Uses • Suction clearance of oral and nasal passages
• To prevent tongue from falling back • Oxygen administration through nose
• Bilateral choanal atresia • To diagnose choanal atresia
• Persistent seizures • Meconium aspiration syndrome
• Nasal Prongs
• Status epilepticus
Delee mucus sucker
• Used to suck mucus from the nose and mouth of newborn during
resuscitation
• The apparatus is held in hand and negative pressure is created on
mouthpiece with the mouth and aspiration done from other end.
Aspirated content collected in the drum

• Advantages include,
• No risk of mucosal damage
• No need of electricity to operate
• Easy to carry around
• Composition of aspiration can be seen
• Can be operated with minimum skill
Infant feeding tube(NG tube)
• Made up of polythene or rubber
• Length to be inserted decided as,
o Neonates – length from alae nasi -> tragus -> xiphisternum
o Adults – Markings on tube
1. Single circular mark – 40 cm , upper CI to cardiac
orifice of stomach
2. Two circular marks – 50cm , upper CI to body of
stomach
3. Three circular marks – 57cm , upper CI to pylorus
4. Four circular marks – 65 cm, upper CI to first part of
duodenum
• To confirm the tube is in the stomach, 2cc of air is injected into
the tube while auscultating over epigastrium. Gurgling sound
confirms that tube is in the stomach
• It can also be confirmed with x-ray of chest and abdomen
Uses
Diagnostic
• In newborns
• Tracheo- esophageal fistula
• Choanal atresia
• Neonatal sepsis screening
• All age groups
• Upper GI bleeding
• Upper GI obstruction

Therapeutic
• Nasogastric feeding – Unconscious patients, preterm, sick babies
• Nasogastric suction – Intestinal obstruction, GI bleeding, Acute Abdomen, Post operatively
• Gastric lavage – Pyloric stenosis, non corrosive poisoning, drug overdose
Foley’s self retaining balloon catheter (Indwelling catheter)
2-way Foley catheters (retention catheters)

• Has an inflatable balloon that encircles the tip

near the lumen or opening of the catheter.

3-way Foley catheter (retention catheter)

• One lumen drains the urine through the catheter

into a collection bag.
• The second lumen holds the sterile water when
the catheter is inflated and is also used to deflate
the balloon.
• The third lumen may be used to instill
medications into the bladder or provide a route
for continuous bladder irrigation.
Common balloon size used is 5 mL, and it is typically inflated
with 10 mL of sterile water, which accounts for the lumen
volume and the balloon volume
Indications for catheterization
• On patients who are anesthetized or sedated for surgery or other medical care
• On comatose patients
• On patients with acute urinary retention
• On patients who are unable to use either standard toilet facilities due to paralysis or physical
injury
• Following urethral surgeries
• On patients with kidney disease whose urine output must be constantly and accurately
measured
• Before and after cesarean section
• Before and after hysterectomy
• On patients who have had genital injury
Contraindications for catheterization
• Blood at the meatus. Insertion of the catheter can worsen an
underlying injury.
• Gross hematuria.
• Evidence of urethral infection.
• Urethral pain or discomfort.
• Low bladder volume/compliance
Bone marrow aspiration syringe
• Parts include trocar cannula and guard
• Aspiration is done at the
o Iliac crest – at any age
o Anterior surface of tibia, below tuberosity -
<2yrs
o Sternum - >2yrs
• Indicated in,
1. Lymphoma, leukemia
2. Aplastic anemia
3. Myeloproliferative disorders
4. Enteric fever
5. Kala azar, Malaria
6. ITP
7. PUO
8. Storage disorders – α1 anti trypsin deficiency

• Complications include hemorrhage, suction pain

Lumbar puncture needle
• Parts include needle with short beveled tip and stellate
• Site of lumbar puncture is,
o L3 – L4 in adults
o L4 – L5 in children
• Patient is placed in left lateral position with knees to stomach
• Site is cleaned with iodine solution and the needle is inserted in
o 3 bottles of CSF collected
o 2 bottles of CSF 2ml each for Biochemistry and Culture sensitivity
• 1 bottle with about 10 – 20 drops for cytology
• Needle is with drawn out carefully and site cleaned with iodine

• Indications
o Diagnostic – Meningitis, Encephalitis , Cerebral anemia, Sub
arachnoid hemorrhage, GBS, Cerebral Leukemia, Raised ICP
o Therapeutic – Intracranial drug administration
 Inj. Hydrocortisone – TB meningitis, spinal arachnoiditis
 Inj. Crystalline penicillin – Pyogenic meningitis
 Inj.Methotrexate – ALL
 Spinal Anesthesia
Contraindications
• Raised ICP
• Sepsis of skin at site
• Bleeding diathesis or anti-coagulation therapy
• Local deformity of spine

Complications
• Spinal Headache
• Backache
• Infection
• Trauma
• Aggravation of symptoms
• Transtentorial herniation
• 6th nerve palsy
Tru cut biopsy needle
Indicated in liver and kidney biopsy
Parts include,
• Outer hollow needle/ cannula
• Inner bifid needle
• Trocar
Liver biopsy
Indicated in Position
• Liver cirrhosis
• Supine with right arm under the head and head turned left
• Portal HTN
• Left lateral position with right arm across the chest
• Chronic Hepatitis
• Carcinoma of Liver Site
• Hodgkin's Lymphoma
• Storage and metabolic disorders o Intercostal approach – Percuss maximum liver dullness
• PUO between anterior and mid-axillary lines after end
expiration. Site should be one intercostal space below that
point
Prerequisites o Subcostal approach – If liver extends below costal margin
BT normal,
PT <3sec,
Complications
Hep B –ve • Hematoma
• Pleurisy and pre-hepatitis
Contraindicated in, • Intrahepatic hematoma
• Right sided pleural effusion • Biliary periostitis
• Bleeding disorders • Intra-peritoneal or intra-thoracic hemorrhage
• Obstructive jaundice
• Uncooperative patient
• Suspected hydatid cyst or abscess of liver
Renal Biopsy Contraindication
Indicated in,
• Nephrotic syndrome • Acute Tubular Necrosis
• Cortical necrosis • Solitary functioning kidney
• Bleeding diasthesis
• Nephrotic syndrome with HTN and hematuria
• Perinephric abscess
• Recurrent hematuria • Uncooperative patients
• Renal failure requiring dialysis
• Persistent proteinuria
• Diabetes
• Amyloidosis

Site –
Line drawn from anterior end of 9th rib to L2
vertebrae
2 – 3 cm lateral to renal angle
BCG syringe

• Max 0.1ml adult size (26g or 22G needle)

• Injection given intradermally
• Used for
• Immunization against severe TB
• BCG challenge test
• Single use 26G needle used for
• Radial artery puncture and withdraw blood
• In the BCG syringe
IV cannula
• Also called a winged infusion set or scalp
vein set
• A butterfly needle consists of a very thin
hypodermic needle, two flexible "wings,"
a flexible transparent tubing, and a
connector
• The connector can be attached to a
vacuum tube or collection bag to draw
blood or to tubing from an infusion pump
or IV bag to deliver fluids or medications
• They allow for more precise placement,
particularly in hard-to-access veins.
• Butterfly needles can access superficial
veins near the surface of the skin.

Used in
• Phlebotomy
• Blood donation
• Scalp vein cannulation
3 way cannula CLOSED

OPEN OPEN

OPEN

Used to
Give two iv drugs at the same time
Pleural tap collection
In exchange transfusion two 3 way cannulas connected to the feeding tube is used