DEVICES

Maham Fazal
NC-785

Uses: Medicine OSPE – do only the indications contraindications and uses

Paediatrics and Surgery table viva – do all details
 Endotracheal Tube
• Indications:
1. Airway maintenance in decreased levels of
consciousness GCS <8 (coma, stupor,
inhalation of noxious fumes)
2. Airway maintenance in General
Anesthesia
3. Relief of airway obstruction e.g.
epiglottitis, smoke inhalation, burns, vocal
cord trauma
4. Protection of airway: aspiration, absence
of coordinated swallow
5. Difficult mask ventilation
6. Cardiac arrest – drug administration
7. Respiratory failure – hypoxia, hypercapnia,
ARDS, asthma COPD exacerbations
8. Pulmonary toilet, PPV
 Endotracheal Tube
Contraindications:
1. Severe airway trauma that doesn’t permit safe way of ETT
2. Cervical spine injury
3. Conscious person with intact gag reflex
4. Mallampati III/IV or other difficult airway signs
5. Foreign body in pharynx or larynx

Complications:
1. Upper airway trauma, sore throat, laceration of lips gums pharyngeal
mucosa
2. Laryngospasm, Bronchospasm 3. Perforation of trachea
4. Esophagus perforation 5. Esophageal intubation
6. Injury to vocal cords 7. Hoarseness
8. Laryngeal edema 9. Tachycardia HTN
 Endotracheal Tube
• CUFF: Used in children above 6-8 years and adults (Pediatric are
uncuffed as trachea easily damaged by pressure)
Cuff Pressure: 20-25cm of water. It will burst if >30 cm of water. 5-
10ml air is injected usually
Types: high volume low pressure low volume high pressure
1. Seals the airway and prevents aspiration
2. Prevents leakage of air during ventilation so PPV can be given
3. Keeps tube in place

Too much pressure – ischemic necrosis of tracheal wall

 Endotracheal Tube
• Murphy’s eye: Allows ventilation/gas exchange if the bevel or
opening of ETT becomes blocked by secretions or tracheal wall

• Bevel: usually left facing. Allows easy visualization of vocal cords and
easy access into trachea

• Radio opaque line: easy visualization through Chest Xray

Endotracheal Tube
 Oropharyngeal Airway
• Uses:
1. To maintain airway in
unconscious patients without gag
reflex
2. To improve airway hygiene
3. Facilitate ventilation during CPR
4. Prevents tongue fallback that
would obstruct airway

Contraindications:
1. Awake patients (with intact gag
reflex)
2. Foreign body obstructing airway
3. Severe coagulopathy
 Oropharyngeal Airway
• Complications:
1. If patient is awake, gagging and vomiting
2. Damage to oral cavity, teeth
3. Obstruction of airway due to large size of tube
4. Bleeding due to improper size

• Parts:
Curved tube – curve upwards when placing then rotate inside mouth
(can be placed directly in children)
Flange – to keep it in place
Oropharyngeal Airway
 Nasopharyngeal Airway
• Indications:
1. Conscious and semi conscious
patients
2. Intact gag reflex
3. People who are clenching
their teeth
4. Facilitate suctioning
5. Apply CPAP
6. Guide for fiberscope/ NGT
 Nasopharyngeal Airway
• Contraindications:
1. Skull base fracture
2. Coagulopathy or patient taking Anti coagulation medications
3. Nasal fractures or any nasal pathology e.g. polyps
4. History of epistaxis requiring medical treatment

• Complications:
1. Epistaxis and aspiration of blood
2. Sinusitis
3. Injury to posterior pharyngeal wall
4. insertion through cribriform plate into brain
5. Ulceration, injury to nasal turbinates
Nasopharyngeal Airway
 Laryngeal Mask Airway
• Indications:
1. Difficult airway
2. Guide/conduit for ETT
3. When ETT has failed
4. Elective ventilation
5. Pre-hospital setting
emergency airway
 Laryngeal Mask Airway
• Contraindications
Absolute:
1. Inability to open the mouth/trismus
2. Complete upper airway obstruction
Relative:
1. Risk of aspiration
2. Suspected or known abnormalities of supraglottic region
3. Need for high airway pressures

• Complications:
1. Aspiration of gastric contents
2. Local irritation
3. Upper airway trauma, sore throat
4. Improper placement – obstruction, laryngospasm
5. Positive pressure ventilation – pulmonary edema, bronchoconstriction
 Laryngeal Mask Airway
• Insert while patient is in sniffing position
 Tracheostomy Tube
• Indications:
1. Respiratory obstruction
(infections, neck trauma,
neoplasm, foreign body, congenital
anomalies, laryngeal edema)
2. Retained secretions (inability to
cough)
3. Resp insufficiency (lung
conditions)

• Contraindications:
1. Laryngeal carcinoma
2. Coagulopathy
3. Cervical spine fracture
4. Morbid obesity with short neck
 Tracheostomy Tube
• Immediate:
Intraoperative bleeding
Apnea
Pneumothorax Pneumomediastinum
Injury to recurrent laryngeal nerves, esophagus, great
vessels
• Early:
Bleeding
Tracheitis
Displacement
Blockade
Subcutaneous emphysema

• Late:
Bleeding
TEF
Tracheal stenosis
 Tracheostomy Tube
• Types:
Cuffed with disposable inner cannula
Cuffed with reusable inner cannula
Cuffless with disposable/reusable inner cannula
Fenestrated cuffed/cuffless
Metallic
 Bag Mask Ventilation
• Indications:
1. Resp failure
2. Failed intubation
3. Elective ventilation in GA

Contraindications:
1. Complete airway obstruction
2. Facial trauma eye injuries
3. Foreign body in airway

Complications:
1. Lung aspiration
2. Lung injury volutrauma barotrauma
3. Hyper/hypoventilation
4. Gastric insufflation
 Bag Mask Ventilation

You should know functions of the valves and

parts
Direct Laryngoscope
Direct Laryngoscope
Direct Laryngoscopy
Direct Laryngoscope
 Nasogastric Tube
• Indications:
Diagnostic:
1. Evaluation of upper gastrointestinal
(GI) bleeding
2. Aspiration of gastric fluid content
3. Identification of the esophagus and
stomach on a chest radiograph
4. Administration of radiographic
contrast to the GI tract

• Therapeutic:
1. Administration of medication
2. Feeding
3. Bowel irrigation
4. Gastric decompression
5. Aspiration of gastric contents
following toxic material ingestion
6. Relief of symptoms and bowel rest
in case of obstruction
 Nasogastric Tube
• Contraindications:
Absolute: 1. Severe mid-facial trauma 2. Recent nasal surgery
• Relative: 1. Esophageal varices 2. Coagulopathies 3. Recent
esophageal banding

Complications:
1.Local trauma, irritation of throat and nose
2. Epistaxis
3. Aspiration
4. Respiratory tree intubation
5. Esophageal perforation
 Nasogastric Tube
• Types:
 Nasogastric Tube

Normally green used in adults

 Nasogastric Tube
• Parts:
Tip – Drainage ports/lateral eyes
Radio opaque line
Body with markings:
• 40cm: GE Junction
• 50cm: Cardia
• 55cm: Body of stomach
• 65cm: Pylorus
• 70cm: Duodenum
Base
 Nasogastric Tube
• Patient positioning:
Fowler’s position

• Don’t force the tube

• If gagging then rotate tube while
inserting

• Ask patient to drink water and

swallow to facilitate insertion
 CVP Line/ Central Venous Catheter
• Indications:
1. Monitoring of central venous pressure
2. Intravascular volume assessment when
urine output low/not available (renal
failure)
3. Hemodialysis
4. Plasmapheresis
5. Administration of chemotherapy,
medications
6. Parenteral nutrition (as IV cannula cant
give >10% glucose)
7. Volume resuscitation (lot of resistance so
usually not used)
8. Cardiac catheterization/pulmonary
angiography
 CVP Line/ Central Venous Catheter
• Contra indications:
1. Coagulopathies
2. Infection at site of insertion
3. Distorted anatomical
landmarks
4. SVC syndrome
5. Hemo/pneumothorax on
opposite side
 CVP Line/ Central Venous Catheter
• Complications:
1. Hemorrhage, hematoma
2. Hemothorax
3. Pneumothorax
4. Air embolism
5. Infection
6. Arterial puncture
7. Nerve injury
8. Arrythmias
9. Stenosis or thrombosis of vessel
10. Cardiac tamponade
LP Needle
 LP Needle
• Contraindications:
1. Raised ICP 2. Papilledema 3. Focal neurological deficits
4. History of recent seizures or head trauma 5. GCS <8
6. Infection at site of injection 7. Coagulopathies
8. Cardiopulmonary abnormalities

• Complications:
1. Post LP headache 2. Post LP back pain 3. Bleeding 4. Infection
5. Cerebral herniation 6. Nerve injury 7. Hematoma 8. CSF leakage
 Foley Catheter
• Indications:
1. Urinary retention (pass smaller
bore catheter first e.g. 12 F)
2. Bladder outlet obstruction e.g.
BPH, urethral stricture/stenosis
3. Urine output monitoring
4. Neurological bladder
dysfunction e.g spinal shock,
neurogenic bladder etc
5. Collection of sterile specimen
for diagnostic purposes
6. Instillation of medications,
chemotherapeutic agents
7. Imaging study of lower urinary
tract
 Foley Catheter
• Contraindications:
1. Urethral trauma – blood at meatus, high riding prostate, bruising
2. Cautious in patients with urethral strictures

• Complications:
1. Urethral trauma
2. CA-UTIs
3. Leakage
4. Obstruction due to encrustation
5. Pyelonephritis
6. Renal and bladder calculi
7. Bacteremia
8. Fistula formation
 Foley Catheter

• Latex coated One chamber for drainage. Usually

used in hematuria
• Silicone coated
 Foley Catheter
• 16-18 Fr – normally used in adults
• 22-24 Fr – gross hematuria (so that clots don’t obstruct lumen)
• Inflate balloon with distilled water only
• Don’t use N/S as it can crystallize and block so balloon wont deflate

• Types of urinary catheters:

1. Indwelling
2. Intermittent
3. External – in elderly males usually
 Intravenous Cannulas
• Indications:
1. Fluid and electrolyte
replacement
2. Administration of medicines
3. Drawing blood samples
4. Administration of blood/blood
products
5. TPN
6. Chemotherapy
7. Radiological contrast
administration
 Intravenous Cannulas
• Complications: • Pouiselle’s Law:
1. Infection Rate of flow in cannula α 4th
2. Hematoma power of radius
3. Thrombophlebitis and α 1/length
4. Air embolism
5. Arterial prick
6. Double prick and needle into
s/c tissue
7. Nerve injury
Intravenous Cannulas
Intravenous Cannulas
Inhalers
 Miscellaneous
Peak Flow Meter: Incentive Spirometer:
Diagnosis of asthma Breathing exercises to
Diagnosis of asthma help improve lung
exacerbation and its severity function
Response to treatment
Miscellaneous
Direct Laryngoscope
Uses:
Diagnostic:
1. Examination of larynx, hypopharynx, hidden
areas of larynx (at IDL)
2. Taking biopsy
3. Insertion of ETT
Therapeutic:
1. Removal of foreign body
2. Removal of benign lesions of larynx (polyps,
papilloma)
*hold it in non-dominating hand*
Complications:
minor damage to soft tissue causing sore throat
later, injuries to larynx, pharynx causing scarring,
ulceration and abscesses.