Instruments - Pediatrics Notes for MBBS VI semester

LIVER BIOPSY NEEDLE

Types

Vim Silverman needle

Menghini needle

Tru cut needle

Idenification

Outer hollow needle

Stylet

Split (bifid) inner long needle

Indications

Cirrhosis liver- diagnosis/ cause

Storage disorders- glycogen, lipid, MPS

Metabolic liver disease

Neonatal cholestasis

Inflammaion- CAHà Viral/ immune

Granulomatous hepatitis

Malignancies- primary/ secondary

PUO

Pre-requisites

Blood grouping

Arrange for donor & cross matching

LFT esp S. bilirubin

PROTHROMBIN TIME- single most important investigation

Hb, platelet count, BT, CT

USG to r/o vascular tumours

PR/ BP/ abdominal girth measurement

Contra-indications

Prolonged PT

Altered coagulation profile

Local infection

Severe jaundice esp. obstructive

Hepatic failure/ encephalopathy

Hydatid cyst

Vascular tumors- hemangioma

Procedure

Informed consent

Sedation

Position

                        * Supine at the edge of the table

                        * Arms held behind the head

                        * Restraint

Percuss out the upper border

Palpate the liver in the mid-axillary line

Contd…

Site à 10^th space in the mid-axillary line

Huge liver à Subcostal

Cleaningà draping

L/A- 0.5% Lignocaine

Small nick with the scalpel

                        WATCH THE PROCEDURE

Specimenà Formalin / Absolute alchohol

Monitoring

Local dressing

Pulse- BP- Abd girth monitoring

Modifications

USG guided

CT guided

Complications

BLEEDING   

HAEMATOMA

INFECTION

INJURY

BONE MARROW NEEDLE

Instrument

SALAH’s needle

Identification

# Hard body

# Guard

# Stylet

Bone marrow trephine biopsy

Swain- Jamshidi needle

Indications

Haematological malignancy- diagnostic/ prognostic

Disseminated malignancy- lymphoma/ neuroblastoma/ LH histiocytosis

ITP- b’4 starting steroids

Systemic infections- kala azar/ enteric fever

Storage disorder- Gaucher/ Niemann- Pick

PUO

Intra-osseous infusion

Procedure

Sites:-

Iliac crest/ post superior iliac spine- commonest

Tibia- infants

Sternum- adults

                        PROCEDURE

Contra-indications

Local infection

Severe bleeding tendency

Moribund pt

Complications

Bleeding- haematoma

Pain

LUMBAR PUNCTURE NEEDLE

Identification

Body & stylet

Small children

No.22g needle

Other use

Renal Biopsy

Indications- diagnostic

CNS infectionsà meningitis/ encephalitis

SAH

GBS

Multiple sclerosis/ SSPE

Indications- therapeutic

Intrathecal chemotherapy- ALL

Spinal A/N- LSAB

Tetanus globulin

BIH

Contraindications

­ ICT

Severe bleeding

Local infection

Moribund / sick patients

Pre-requisite:-

Fundus examn to r/o papilledema

Procedure

Informed consent

Edge of the table

Flexion of head, neck , trunk & lower limbs

Palpate ant sup iliac spine

Corresponding spaceà L1/L2

ICT:-

* GUARDED L.P.

NASOGASTRIC (Ryles’) TUBE

Identification:-

Metal beads

Markings

Uses:-                           Stomach wash

Ryles’ tube aspiration            Continuous

Feeding

Procedure

Measure

Nostril à tragus

Tragus à xiphisternum

Noteà insert à confirm

Infant feeding tube

Smaller             No markings

                             No beads 

Method of insertion - same

       

Uses

Gastric lavage à poisoning, gastritis- amniotic fluid/ meconium

Gavage feeding à pre-terms, sick patients, neurological prob, post- surgical

ET- umbilical vein cannulation

Diagnostic X- rayà Oesophageal atresia

Intrarectal Diazepam/ Na valproate

Urinary catheterà MCU

MANTOUX SYRINGE

Identification

Total ONE ml

Metallic

Total strength

Difference with insulin syringe

100U

Plastic

Uses

Mantoux test- 5TU

BCG vaccn/ BCG test

Other intradermal tets

Giving drugs (small doses)

Insulin/ terbutalin/ digoxin

In neonates à Lasix/ pheno/ phenytoin

Causes of false +ve Mx

Atypical mycobacteria

Recent BCG vaccn

Repeated Mx testing

­ dose

Causes of false –ve Mx

Wrong technique

Immunosuppression- steroids/ HIV

Severe forms of TB- miliary, TBM

Malignancies

Infections- measles

C/c inflammations- sarcoidosis

IV CANNULA/ SCALP VEIN SET

IV CANNULA

Available in different sizes- No.s 24, 22, 18

Used for venous access

Can be retained in situ for upto 72 hrs

Harder to fix

Other use

PD in neonates

SCALP VEIN SET (Butterfly)

Used for IV infusion

One time use

Easy to fix

Cannot be retained for long 

BLOOD BAG

Used to carry blood & blood products

Made of polymer

Contains anticoagulant (Acid-citrate-dextrose)

Refrigerated

No warming required

Platelets à In constant motion

Indications

Acute

Blood loss

Severe anaemia 

Before / during surgery

Chronic

Haemolytic anaemia

Aplastic anaemia

Leukemia on treatment

Dose

Whole blood

20ml/kg

Packed RBCs

10ml/kg

Components

Packed RBCs à Commonest

Granulocyte

Platelet

FFP

Cryoprecipitate 

Screening

HIV

HBV

HCV

VDRL

Tranmissible diseases

Merozoite induced malaria

CMV (Leukocyte filter)

Parvovirus B19 

Reactions

Early (Immediate) < 72hrs

Hemolytic reaction (Incompatible) à ABO/Rh

(Jaundice/Pallor/Hburia)

Febrile reaction

Fluid overload

Air embolism

Allergic reaction

Contd…

Late (>72hrs)

Infections

Hyperkalemia

Hypocalcemia

Long term

Hemosiderosis

PLEURAL ASPIRATION

Instrument

Pleural aspiration needle

Children

No. 18g needle

Indications

Diagnostic

Pleural effusion

Empyema

Pneumothorax

Therapeutic

Massive effusion/ pneumothorax

Empyema

Pleorodesis

Position

Leaning forward

                       

            Site

Point of maximum dullness

Lower part of intercostal space

Complications

Pleural shock

Bleeding

Lung injury

Pneumothorax

Modification

CT/ USG guided

BREAST PUMP

Use

To express milk to treat engorged breasts/ mastitis/ abscess

Not sterlisableà melts

Expressed milk cant be used

Now manual expression preferred

THERMOMETER