This document provides information on common pediatric medical instruments including: 1. AMBU/BMV bags which are used for artificial ventilation and come in reusable silicone bags of 250ml or 500ml size. 2. Endotracheal tubes which are single-use PVC tubes placed through the mouth into the trachea during intubation or ventilation. 3. Laryngoscope blades which are used during intubation to visualize the vocal cords and come in curved or straight styles for different ages. 4. Foley catheters which are single-use latex tubes placed in the urethra for urinary drainage or decompression. 5. Feeding tubes which are single-

1. MBBS PRACTICLE
INSTRUMENTS
Dr Ninad Patil
Department of Pediatrics

2. AMBU/BMV
• Artificial Manual Breathing Unit/ Bag Mask Valve unit
• Material- silicon rubber bag ,self inflating bag
• Reusable -Sterilized with autoclave
• Used for artificial ventilation
• Portable and easy to use
• Valves – 3 valves , all are unidirectional
Inlet valve- entry of oxygen
Outlet valve-fish mouth valve/ patient end valve
Pop Up valve- 60 cm H2O , prevent baro-trauma

3. • AMBU Bag Sizes 250 ml/ 500 ml
• Outlet valve have standard 15 mm size opening (face mask attachment
port)
• USES-
 administration of High flow oxygen
 provision of control ventilation
 Provision of PEEP
FACE MASK applied in CE technique
Contraindication of AMBU ventilations –
Diaphragmatic hernia
cleft palate

5. CE technique of mask application

6. ET tube – endotracheal tube
• Material – PVC tube , single use
• Parts – 15 mm connector
- bevel edge - ease of passage through vocal cord
- Murphy eye- alternate air entry passage /obstruction
- radio-opaque line ( x ray detection)
- level marking – guide for fixation
- cuff ( not in pediatric size)
• Position of tube fixed after intubation –
ideally just above the bifurcation of trachea
Neonates = 6 + weight in Kg
Pediatrics= 4 + (age/4)
• Conforming the tube position – clinically B/L air entry and chest movements
- x ray
- end tidal CO2 (capnography)-Gold std

7. ET TUBE

8. laryngoscope
• Consist of 2 parts – handle and blade
• Handle – rough surface(non-slippery) for grip and contain 2 battery units
• Blade with light , goes in to oral cavity
• Blade – two types
Curved/macintosh - used in pediatric age
Straight/miller- younger age (infant) ,Epiglottis is floppy . Straight blade will
facilitate the lifting of it
• Blade sizes – 00 smallest /0 small -used in preterm/ 1- used in normal
newborn

9. Intubation steps
RSI-rapid sequence intubation

10. Foleys catheter
• Material – siliconized latex rubber ,single use
• Used – urinary drainage/sample collection
- torniquet
- epistaxis
- variceal bleed
Fr

11. Procedure of placement
Introduce your self , explain the procedure ,consent  hand wash , glove
,local cleaning with betadine  local lignocaine application  insert the full
foleys  balloon inflation with air  connect drainage bag
Complication of procedure
• Pain
• Local mucosal injury and bleeding
• Urethral stricture

12. Feeding Tube
• Material – Polyvinyl chloride (pvc), Silicone
• Single use
• Uses – Feeding in newborn / drug delivery
- gastric decompression in intubated/obstruction patient
- Gastric lavage in poisoning cases
- TEF cases diagnosis
- assessing and treating upper GI bleeding
• Contraindications – Acid/alkali poisoning ,esophageal stricture ,
suspected neck/basal skull fracture

13. •Procedure of insertion
Introduce your self , explain the procedure ,consent --
hand wash , glove  measure the distance from Bridge of
nose to ear tragus to xiphisternum local lignocaine
application slight neck flexion insert the tube
in(Nose/Mouth) forwarding motion and ask patient
swallow conform its positionfix it , label
Conformation-
• Gastric secretion through tube
• Syringe and tube
• X ray
Complications-
• trauma to nasal/esophageal
mucosa
• insertion in trachea

14. Bone marrow needle
• Reusable metal needle with stylate
• Aspiration- BM fluid is aspirated for examination
• Trephine biopsy- core of BM is taken out
• Jamshidi needle used for Biopsy
• Site –MC posterior Superior iliac spine
obese- Anterior
less than 18 months- Anterio-medial face of tibia
Indication Aspiration- abnormal PS like blasts cell
- suspected aplastic anemia/ BM failure syndrome
-PUO
-follow up haematological malignancy/BM transplant
Needle size
• 18 Gauge –Infant
• 15 gauge Pediatrics

15. • Indication Biopsy
- suspected BM fibrosis
- diagnosis and staging of Hodgkin & Non-Hodgkin Lymphoma
- diagnosis of aplastic anemia/MDS
• Contraindications-
- congenital coagulation disorders
- DIC
- local skin infection
- osteomyelitis

16. • Procedure done under short GA – Introduce your self , explain the
procedure ,consent  position prone or lateral in PSIS /Supine in ASIS
hand wash , glove ,local cleaning with betadine & Spirit  local
lignocaine application in skin and subperiosteal area  insert the BM
needle at 90 degree to bone in screw like fashion once you are in the
BM space remove stylate and attached heparinized syringe(10 ml) and
aspirate the BM (1ml) withdraw the needle and apply the firm
pressure with gauze piece

17. Lumbar Puncture needle
• LP needle with stylet
• Size- 22 or 25 gauge
Indication-
• Meningitis/encephalitis
• Suspected sub arachnoid bleed with normal CT brain
• Diagnosis/monitoring/treatment of hematological malignancies
Contraindications-
• Raised ICT
• GCS less than 8

18. • Procedure done under short GA
• 2 people needed - doctor + person to hold the baby
• Position – lateral lying (fetal position) preferred in pediatric
- upright – in newborn
Introduce your self , explain the procedure ,consent  position lateral
draw imaginary line from the upper border of iliac crest, it will intersect
the intervertebral space at L3-L4 junction  palpate the intervertebral
space L4 or below level hold the needle with bevel edge facing toward
ceiling & go forward directing toward the umbilicus  initial resistance
followed by give away of the resistance means you are in the space
remove the stylet and look for the free flow of the spinal fluid
Collect the sample – 3 container/ 10 drops each container
- sent it for RM/ glucose / cultures
Remove the needle and seal the site with tincture iodine