INSTRUMENTS

1. RYLE’S TUBE

Made of polyvinyl chloride (soft and kink-resistant)

Size: 10 F- 20 F
14 F- Green
16 F- Orange
18 F- Red
Length: 105-120 cm
Components-
i. Tip- blunt, to avoid trauma.
ii. Body- 4 markings:
40cm from tip  cardio-oesophageal junction
50cm from tip stomach
60cm from tip pylorus
65cm from tip duodenum
iii. Base- a cork is present at the base; lumen is adequate to contain the nozzle of a syringe.
iv. Drainage port
v. Multiple openings/ lateral eyes are present proximal to the tip to prevent complete
blockage of tube, aspiration of gastric contents and administration of medications.
Indications-
1. Stomach aspiration for gastric decompression. Eg: stomach and bowel surgeries,
paralytic ileus etc.
2. Feeding the patient to maintain good nutrition.
3. Gastric lavage: non-corrosive or alcohol poisoning
4. Cold lavage: in haematemesis
5. To give rest to stomach by keeping it empty. Eg: peritonitis etc.
Contraindications-
1. Acute corrosive poisoning
2. Stricture oesophagus
3. Severe facio-maxillary trauma
Complications-
1. Rhinitis, sinusitis, epistaxis
2. Upper respiratory tract infection
3. Aspiration pneumonia if R.T. is placed in trachea
4. Excessive gagging
5. Oesophageal perforation if R.T. insertion is done in corrosive poisoning.

2. FOLEY’S CATHETER

Foley's catheter Silicon catheter

Made of latex rubber

Size: 8F- 26F.
8-10F: Children
12-16F: Females
16-22F: Males
As size increases, diameter also increases.
Parts:
1. Two ports- Urine drainage port; balloon port.
2. Y-junction: insert the Foley’s catheter upto the Y-junction in males.
3. Tip of foley’s catheter- blunt and smooth
4. Small aperture- rests in urinary bladder.
5. Balloon- Inflatable balloon present near the tip, used for self-retention. Balloon capacity
may be 5-50ml.
Distilled water is used to inflate the balloon. Avoid using normal saline, which can form
crystals within the balloon and cause it to rupture leakage of urine, bladder wall
irritation and cystitis.
Indications- to drain urine out of the urinary bladder; Those patients who are unable to
voluntarily go to urinate or those who are bedridden.
1. Acute urinary retention- to empty the urinary bladder.
2. During and after any major surgery to monitor urine output.
3. To monitor hourly urine output in patients with shock, acute kidney injury, burns etc.
4. Neurogenic bladder and urinary incontinence.
5. Irrigation of urinary bladder.
6. Also used for haemostasis in epistaxis and bleeding piles.
Contraindications- penile injuries
Complications-
1. Infection
2. Trauma- bladder trauma, rupture of urethra
3. Urethral trauma/rupture
4. Bladder spasm
5. Catheter leakage

3. UROMETER WITH UROBAG

 Uses-

Urometer is used to accurately measure the amount of urine output per hour in critically ill
patients.
Capacity: 250ml.
Parts:
i. Cap
ii. Tapered connector- connected to urinary catheter
iii. Tube
iv. Hanger
v. Corrugated tube
vi. Volume chamber
vii. Urine bag: It is sterile and transparent; used for collecting urine; capacity= 2000ml
viii. Drain outlet
ix. Clamp
Indications-
Measuring hourly urine output in patients with acute kidney injury, septic shock, cardiogenic
shock, burns etc.

4. NASAL CANNULA

Parts-
i. two prongs
ii. tubing
Uses- used to provide supplemental oxygen, when oxygen requirements are low.
-Can deliver 1-6 lit of O2 (24-44% FiO2)
 -Generally used along with humidifier to prevent drying of nasal mucosa.

Disadvantage- may cause injury to nasal mucosa. Not a good choice for heavy mouth
breathers or patients having blocked nasal passages.
Indications- COPD, obstructive sleep apnea etc.

5. SIMPLE FACE MASK/ HUDSON MASK

Parts:
i. Mask- Made of soft pliable material covering the nose and mouth
ii. Flexible metal nose piece- for proper fitting
iii. Connector
iv. Tubing- connected to the connector on one side, and to the oxygen flowmeter on the
other, from where one can regulate the oxygen flow.
v. Elastic strap
vi. Two Small openings/ exhalation ports on the side of mask- allow proper mixing of O2
and room air, as well as CO2 elimination.
Uses- Can deliver 6-12 lit of O2/min (35-50% FiO2)
Indications- hypoxia due to respiratory disorders like pneumonia, acute asthma exacerbation;
myocardial infarction; supplemental O2 for patients with sepsis, post- operatively etc.

Disadvantages- may cause discomfort to the patient.

FiO2= 21%+ (4x flow of O2)

6. NON- REBREATHER MASK

Uses- to deliver high concentration oxygen: 12-15 lit/min (60-90% FiO2)

Parts-
Facemask
Reservoir bag
Tubing for oxygen supply
Adjustable nose clip
One-way valve in reservoir bag- to prevent exhaled air from entering the reservoir bag
Two one-way valves in the mask
Elastic strap
Indications- In emergency conditions like respiratory distress, severe hypoxia, chest trauma,
carbon monoxide poisoning, anaesthesia
Eg: severe respiratory distress due to pneumonia, acute heart failure, pulmonary oedema,
pulmonary embolism, status asthmaticus etc.

Advantages- Delivers high concentrationO2 up to 90%, non-invasive method of

administering oxygen, easy and simple to use, portable, cost-effective.
Disadvantages-
 1. Carbon dioxide retention, especially when the mask does not fit properly, or patient has
hypoventilation.
2. Oxygen toxicity- If used for a longer duration, higher O2 concentration may cause
oxygen toxicity.
3. Risk of aspiration.
4. Uncomfortable for conscious patient and may interfere with eating, drinking,
communicating etc.
5. Limited mobility of patient.

7. NEBULIZATION MASK

Parts:
i. medicine cup
ii. Facemask
iii. Elastic straps
Uses:
- To administer drugs like bronchodilators, inhaled corticosteroids, mucolytic agents in
aerosolized form.
- It is helpful to liquify mucous and causes expectoration.
Indications:
Bronchial asthma
COPD
Pneumonia
Allergic bronchitis
 8. AMBU BAG/ BAG-VALVE MASK
AMBU= Artificial manual breathing unit
It’s a resuscitation device
Delivers 100% O2 at high flow like 15 lit/min.
Parts:
i. Soft mask which creates a seal on the nose and mouth of patient to ensure adequate O2
delivery and proper ventilation.
ii. Self-inflating bag- made of plastic; volume= 1600ml
iii. Oxygen inlet and tubing
iv. Reservoir bag
v. Ventilator port- connected to AMBU bag or ET tube
vi. Fish-mouth expiratory valve allows exhaled air to escape and prevents inhalation of
room air.

SOURCE: LIFTL

Uses:
To administer high flow O2 with 100% FiO2
Provides positive end-expiratory pressure
Complications-
 Hyperventilation
 Gastric distention
 Aspiration
 Equipment failure due to inappropriate assembly
 9. TONGUE DEPRESSOR

- A tongue depressor is used for depressing the tongue to examine the mouth and throat.

Uses:
i. To visualize tonsils, pharynx and areas adjacent to pharynx.
ii. It is also useful to facilitate easy insertion of oral airway
iii. It is useful to test the gag reflex.

10 . INTRAVENOUS CATHETER

Parts-
1. Needle
2. Catheter
3. Bushing
4. Catheter hub with wings
5. Injection port cap
6. Luer port
7. Needle grip
8. Flashback chamber
9. Luer lock plug
Availability- various gauges (14-26 gauge)
Adults: 14-22 G
Paediatrics: 24-26 G
Colour coding-

Wide-bore cannula
Wide bore cannula- 14, 16, 18 G  Useful for massive blood transfusion or in trauma cases
where IV fluid resuscitation is indicated.
Gauge α 1/outer diameter and flow rate
Flow rate:

250ml/min 225ml/min200ml/min
100ml/min 60ml/min 40ml/min20ml/min10ml/min
Indications-
1. Blood sampling
2. To give IV fluids
3. To administer drugs/ medications
4. To give parenteral nutrition
5. To give blood transfusion
6. Before a surgery to give medications
 Complications-

- Phlebitis
- Infection- local/ systemic
- Haematoma/ haemorrhage at puncture site
- Vessel injury

11.INFUSION SET
Parts-
1. Spike
2. Drip chamber
3. Solution filter
4. IV tubing- PVC
5. Flow regulator/ Roller clamp
6. Rubber bulb connector
7. Needle

Uses-
 It is a sterile device used for passage of IV fluid into the vein via the intravenous catheter.
 The drip chamber prevents air entering the blood stream.
 IV flow rate and drops per minute are calculated as-

Infusion Drip Rate =

Total volume (in ml) X Drop factor (gtt/ml)
Time (in minutes)
Mnemonic- “TV MAKES YOU DEAF OVER TIME!!!”

12. THREE-WAY STOP COCK

- It is made of medical grade PVC.
- It has a smooth tap with 360 degrees rotation.
- It has one male luer lock port and two female luer lock ports.

Uses-
- It is used for simultaneous administration of medications and fluids.
- Also used for withdrawing blood samples.
- Also useful for aspirating ascitic/ pleural fluid.
Advantages- It prevents multiple needle insertions.
13. OROPHARYNGEAL AIRWAY/ GUEDEL AIRWAY

It is a basic airway adjunct.

Parts:
 Flange- sits at the entrance of mouth
 Curved body to rest over the tongue/palate
 Tubular air channel
 Tip
Size selection- Flange of the OPA should be measured from angle of the mouth and tip
should be at the angle of mandible. If its too large, it will touch the posterior pharynx and will
induce gag reflex.
Uses-
 Lifts the tongue off the posterior pharyngeal wall to prevent airway obstruction, bite
block
 Assists oropharyngeal suctioning
Indications-
Unconscious patient
Contra-indications-
Conscious and unco-operative patient; alternative: nasopharyngeal airway
Insertion technique-
- Insert the OPA upside down into the oral cavity.
- Gently rotate it 180 degrees and push back over the tongue.
Removal- when patient starts gaining consciousness, gently pull it out following the curve to
avoid coughing/ gag reflex.
Colour code-
Size 1- white
Size 2- green
Size 3- yellow
Size 4- red
Size 5- Blue
Size 6- Orange

14. LARYNGOSCOPE
Uses-

- For direct laryngoscopy for visualization of larynx.

- During endotracheal intubation to visualize vocal cords.
- It is available in various sizes.
Parts-
Handle which houses the batteries
Base
Tongue spatula
Blade- two types: Mackintosh (curved), Miller (straight)
Light outlet and bulb
Tip of laryngoscope

15. ENDOTRACHEAL TUBE

- It is a transparent, flexible, curved tube inserted into trachea to keep the airway patent.
- Made-up of polyvinyl chloride.
Parts-
Connector- fits to an AMBU bag or ventilator tubing
Curved tube
Vocal cord guide- black line that should be placed at the level of opening of vocal cords.
Radio-opaque strip- for visualization of position of ET tube on Chest X-ray.
Cuff- to provide a seal against the tracheal wall; it prevents leakage of gases. It prevents
matter from entering the trachea.
Tip of the tube- soft, atraumatic, beveled tube; to be placed at the carina of trachea.
Murphy’s eye- to facilitate gas exchange in case the tip of ET tube gets blocked due to
mucous, blood, pus etc.
Size of ET tube-
Adult female- 7.5 mm
Adult male- 8.5 m
indicates internal diameter
Complications- difficult/ failed intubation, trauma, bleeding, cuff perforation etc.
16. SUCTION CATHETER

It is a long, flexible tube; made of PVC.

Uses-
To remove secretions, blood, mucous from a patient’s airway.
It helps to keep the airway clear, prevents mucous build-up.
Suctioning can be done from mouth, nose, endotracheal tube, tracheostomy tube,
oropharyngeal airway.

17. NELATON CATHETER

- Single-use catheters for short-term, intermittent catheterization.
- Made of medical grade PVC.
Parts-
Tip- rounded tip with two lateral eyes

Tubing- kink resistant

Connector- funnel shaped for easy connection to urine bags.
Radio-opaque line for easy X-ray visualization.
Available in various sizes.
Use- for urinary drainage in patients with urinary retention.

18. TRACHEOSTOMY TUBE

- To provide an airway via a stoma created surgically or using percutaneous dilatation.
- Made of PVC
- Uses:
- Airway protection
- Facilitate positive pressure ventilation
- Suctioning of secretions
Parts-
Outer tube
Inner tube
Flange- it lied against the patient’s neck, allows tube to be secured in position with help of
sutures.
Obturator- using during insertion, removed later.
Complications-

During insertion- haemorrhage

Tube occlusion
Granulation tissue formation with obstruction or bleeding
Airway stenosis
Tracheomalacia
Types of tracheostomy tubes-
Cuffed/ uncuffed
Plastic/ metal
Size- generally 7 or 7.5
SR.NO. INSTRUMENT
1. Ryle’s tube
2. Foley’s catheter
3. Urometer with urobag
4. Nasal cannula
5. Simple face mask (Hudson
mask)
6. Non-rebreather mask
7. Nebulization mask
8. Artificial manual breathing
unit (AMBU) Bag
9. Tongue depressor
10. Intravenous catheter
11. Infusion set
12. Three way stop cock
13. Oropharyngeal airway
14. Laryngoscope
15. Endotracheal tube
16. Suction catheter
17. Nelton catheter
18. Tracheostomy tube