Description

It is a flexible tube made of rubber or non-toxic, medical grade PVC

compound, and it has bidirectional potential. It can be used either to

feed or remove the contents of the stomach including air to

decompress the stomach or to remove small solid objects and fluid,

such as poison from the stomach.

Indications

Diagnostic indications for nasogastric tube (NG) intubation include

the following:

Evaluation of upper gastrointestinal (GI) bleeding (i.e. presence

and volume)

Aspiration of gastric fluid content

Identification of the esophagus and stomach on a chest radiograph

Administration of radiographic contrast to the GI tract.

Therapeutic indications for NG intubation include the following:

Gastric decompression including maintenance of a decompressed

state after endotracheal intubation, often via the oropharynx

Relief of symptoms and bowel-rest in the setting of small bowel

obstruction

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Aspiration of gastric content from recent ingestion of toxic material

Administration of medications in comatose patients

Feeding when patient is unconscious or when the patient is

conscious but unable to swallow voluntarily

Bowel irrigation.

Contraindications

Absolute contraindications for NG intubation include the following:

Severe midface trauma

Recent nasal surgery.

Relative contraindications for NG intubation include the following:

Coagulation abnormality

Esophageal varices

Recent banding of esophageal varices

Alkaline ingestion (the tube may be kept if the injury is not severe).

Verification of Position of Ryles Tube

Verify proper placement of the NG tube by auscultating a rush of air

over the stomach using the 60 mL Toomey syringe or by aspirating

gastric content

Obtaining a chest radiograph

Colorimetric capnography is another valid method for verifying NG

tube positioning in mechanically ventilated patients.

SUCTION CATHETER

A suction catheter is a medical device used to extract bodily

secretions, such as mucus or saliva from the upper airway. A suction

catheter connects to a suction machine or collection canister.

FOLEYS CATHETER

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Description

Foley catheter (named for Frederic Foley, who produced the original

design in 1929), the tube has two separated channels, or lumens

running down its length. One lumen open at both ends, drains urine

into a collection bag. The other has a valve on the outside end and

connects to a balloon at the inside tip. The balloon is inflated with

sterile water when it lies inside the bladder to stop it from slipping out.

Saline should not be used to inflate the bulb, as it can crystallize

within. Air must not be used to inflate as it will float over the urine.

Coatings include polytetrafluoroethylene, hydrogel, or a silicon

elastomer—the different properties of these surface coatings

determine whether the catheter is suitable for 28-day or 3-month

indwelling duration.

Indications

Acute retention of urine

Chronic retention of urine with overflow

In cases of neurogenic bladder

In surgery involving bladder and prostrate

In all perineal operations

Intravesical chemotherapy

To carry out urethrography

To monitor urine output.

Contraindication

Urethral trauma is the only absolute contraindication to placement of

a urinary catheter.

SAHLI’S HEMOGLOBINOMETER

Used to estimate hemoglobin: Method used is acid hematin

method.

NEUBAUER CHAMBER/HEMOCYTOMETER

Description

The Neubauer chamber is a thick crystal slide with the size of a glass

slide (30 × 70 mm and 4 mm thickness). In a simple counting

chamber, the central area is where the cell counts are performed.

Use: Used to count red blood cell/white blood cell (RBC/WBC).

INSULIN SYRINGE

Description

Syringes for insulin users are designed for standard U-100 insulin.

The dilution of insulin is such that 1 mL of insulin fluid has 100

standard “units” of insulin. Even 40 IU syringes are available.

Use

It is used for subcutaneous insulin administration.

TUBERCULIN SYRINGE

Tuberculin syringes are small syringes with fine needles that hold

up to one-half to one cubic centimeter of fluid, used to administer

medication (antigen) under the skin and perform a tuberculosis test

called purified protein derivative (PPD)/Mantoux test.

Insulin 40 Versus Insulin 100 Versus Tuberculin Syringe

U-40 insulin syringes markings on the barrel are up to 40 units, while

in U-100 markings are up to 100 units. While in case of 1 mL

tuberculin syringes the markings are at zero (0) and each 0.05 mL,

e.g., 0.05, 0.1, 0.15, 0.2, 0.25, 0.3, etc.

VIM SILVERMAN LIVER BIOPSY NEEDLE

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2.

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Description

It has three parts:

Cannula

Stylet/trocar

Prong/fork/bifid needle—longer than needle and it protrudes out of

the needle. It has a very sharp cutting edge and has longitudinal

groove. This retains the tissue when the needle and cannula are

withdrawn.

Indications for Liver Biopsy

In evaluation of jaundice

Liver cirrhosis

Storage disorders: Glycogen storage disease, hemochromatosis,

and Wilson’s disease

Granulomatous lesions like tuberculosis and sarcoidosis

Infections: Viral [cytomegalovirus (CMV), herpes, and parasitic

(amoebic liver abscess where it is both diagnostic and therapeutic)]

To diagnose Benign and malignant neoplasms.

Contraindications of Liver Biopsy

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Bleeding diathesis

Hemangiomas

Hydatid cyst

Severe ascites.

Complications of Liver Biopsy

Hemorrhage

Infection

Adjacent structures can be injured (gallbladder, colon, and blood

vessels)

Rarely there can be precipitation of hepatic coma.

TRUCUT BIOPSY GUN

Description

A needle with a gap near its tip is passed into the lesion. A

surrounding sheath with a cutting tip is passed down the needle. The

sheath cuts a specimen corresponding to the gap in the needle. The

needle and sheath with the specimen are then removed from the

patient.

Use: For tissue biopsy—liver/kidney.

BONE MARROW ASPIRATION NEEDLE

Indications

The diagnosis of acute leukemia staging for lymphoma, evaluation of

pancytopenia, thrombocytopenia, investigation of anemia, fever

(pyrexia of unknown origin), lymphadenopathy, and

hepatosplenomegaly.

Contraindications

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Bleeding disorders and coagulopathy

Local skin infection/osteomyelitis.

Sites

Posterior superior iliac spine, anterior superior iliac spine. Sternum,

tibial tuberosity.

BONE MARROW BIOPSY NEEDLE (JAMSHIDI

NEEDLE)

Biopsy done when bone marrow tap is dry

Also for infiltrative disorders.

LUMBAR PUNCTURE NEEDLE

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Description

Lumbar puncture is a technique done to obtain cerebrospinal fluid

(CSF) sample.

It also provides an indirect measure of intracranial pressure (ICP).

It is usually done between L3 and L4 (3rd lumbar space) through the

dura and into the spinal canal..

Indications for Lumbar Puncture

Diagnostic Indications

Meningitis

Encephalitis

Subarachnoid hemorrhage

Primary or metastatic malignancy (e.g. acute leukemias and

lymphoma)

Demyelinating diseases: Multiple sclerosis and

Subacute sclerosing panencephalitis (SSPE)

Guillain–Barré syndrome

Injecting the radio-opaque dye for myelography.

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Therapeutic Indications

Spinal anesthesia and epidural analgesia

Intrathecal injection of chemotherapeutic drugs for CNS

prophylaxis/relapse of acute lymphoblastic leukemia (ALL),

lymphomas

Therapeutic CSF drainage in cases of normal pressure

hydrocephalus.

Contraindications for Lumbar Puncture

Raised intracranial pressure, coagulopathy

Local infective lesion

Bony deformities at site of puncture.

Complications of Lumbar Puncture

Postspinal headache.

Herniation of cerebellum through the foramen magnum due to

raised intracranial pressure.

Introduction of infection by the lumbar puncture needle through the

infected skin or subcutaneous tissue.

For further details on lumbar puncture analysis, findings of CSF

analysis refer to page number 978 for Exam Preparatory Mannual of

Medicine for Undergraduates by the same author.

INTRAVENOUS DRIP SET

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IV Drip Set

Used for administering intravenous fluids, drugs, and blood products.

Intravenous (IV) fluids are administered through thin, flexible

plastic tubing called an infusion set or primary infusion

tubing/administration set (Perry et al. 2014). The infusion

tubing/administration set connects to the bag of IV solution. Primary

IV tubing is either a macrodrip solution administration set that delivers

10, 15, or 20 drops/mL, or a microdrip set that delivers 60 drops/mL.

Macrodrip sets are used for routine primary infusions. Microdrip IV

tubing is used mostly in pediatric or neonatal care, when small

amounts of fluids are to be administered over a long period of time

(Perry et al. 2014). The drop factor can be located on the packaging

of the IV tubing.

Primary IV tubing is used to infuse continuous or intermittent fluids or

medication. It consists of the following parts:

Backcheck valve: Prevents fluid or medication from traveling up the

IV

Access ports: Used to infuse secondary medications and give IV

push medications

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Roller clamp: Used to regulate the speed of, or to stop or start, a

gravity infusion

Secondary IV tubing: Shorter in length than primary tubing with no

access ports or backcheck valve; when connected to a primary line

via an access port used to infuse intermittent medications or fluids.

A secondary tubing administration set is used for secondary IV

medication.

Flow Rate Calculation

When calculating the flow rate of IV solutions, remember that the

number of drops required to deliver 1 mL varies with the type of

administration set. Administration sets are of two types:

Macrodrip set (delivers 10–20 drops/mL)

Microdrip set (60 drops/mL).

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Flow rate = Volume of infusion in mL × Drip factor (in drops/mL)/Time

of infusion in minutes.

INTRAVENOUS CANNULA

Used for administering intravenous fluids, drugs, and blood products.

Size Color Length

mm

Flow rate

(mL/min)

Uses

14G Orange 45 250–300 Used for adolescent and adult major

surgery and trauma

Infusion of large amount of fluids and

colloids

16G Gray 45 150–240 Adolescent and adult major surgery and

trauma

Infusion of large amount of fluids or

colloids

18G Green 45 100–120 Adolescent and adult major surgery and

trauma

Infusion of large amount of fluids or

colloids

20G Pink 32 55–80 Older children, adolescent, and adult

Ideal for IV Infusion or blood infusion

Medication administration

Emergency management

22G Blue 25 22–50 Older children, adolescent, and elderly

adult

IV Infusion with moderate flow rate

Medication administration

24G Yellow 19 23 Infant, toddler, and older children

Major surgery and trauma among

children

Can administer fluid and medications

26G Violet 19 10–15 Neonate, infants, and elderly adults

Suitable for infusion but infusion rate is

low

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OXYGEN MASK

Used for administering oxygen.

An oxygen mask provides a method to transfer breathing oxygen

gas from a storage tank to the lungs. Oxygen masks may cover only

the nose and mouth (oral nasal mask) or the entire face (full-face

mask). They may be made of plastic, silicone, or rubber.

INHALER DEVICES

It can be meter dose inhaler, dry powder inhalers, or nebulizers.

Inhalant Drugs

Broncodilators—salbutamol, formeterol, ipratropium, tiotropium

Corticosteroids—beclomethasone, budesonide, and fluticasone

Mucolytic agents—acetylcysteine

Antimicrobials—ribavirin and tobramycin

Immune modulators—cyclosporine and interferon α

Anesthetics—opioids.

Metered Dose Inhaler

Spacer

A spacer is a device used to increase the ease of administering

aerosolized medication from a metered dose inhaler (MDI). It adds

space in the form of a tube or “chamber” between the mouth and

canister of medication. Most spacers have a one-way valve that

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allows the person to inhale the medication while inhaling and exhaling

normally; these are often referred to as valved holding chambers

(VHC).

Metered dose inhaler

Advantages Disadvantages

Rapid application

Handling

Multidose

Hand-breathe coordination

Ineffective use in poor ventilated patients

Oropharyngeal deposition and local side effects

Dry Powder Inhalers

Dry powder inhalers

Advantages Disadvantages

Less patient coordination required

Spacer not necessary

Compact portable

No propellant

Usually, higher lung deposition than a pressurized

metered dose inhaler (pMDI)

Work poorly if inhalation is

not forceful enough

Many patients cannot use

them correctly

Most types are moisture

sensitive

Need to reload capsule each

time

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