DRUGS & INSTRUMENTS

Ryle’s tube
 Indications
 nasogastric introduction for nutrition
 aspiration of intestinal secretion
 Distal end coned with stainless steel balls to assist
passage of the tube during intubation
 Length : 105 cms
 radio-opaque line, marked at 50, 60 and 70 cms from
the tip for accurate placement
 Four lateral eyes
 Manufactured from Non-toxic, Non-irritant medical
grade PVC
 Colour coded funnel end connector for easy
identification of size
Size in
FG Colour
16 Orange
6 Light Green

18 Red

8 Blue

20 Yellow
10 Black

22 Violet
12 White

24 Light Blue
14 Green
How to introduce ?
Bone marrow biopsy needles
Bone marrow aspiration needle
 Bone marrow examination
 pathologic analysis of samples of bone
marrow obtained by
 bone marrow biopsy (trephine biopsy)
 bone marrow aspiration
 Bone marrow aspiration yields semi-liquid
bone marrow
 can be examined under a light microscope
 analyzed by
 flow cytometry & chromosome analysis
 polymerase chain reaction (PCR)

 Trephine biopsy yields a narrow,

cylindrically shaped solid piece of bone marrow
 is examined microscopically (sometimes with the aid of
immunohistochemistry) for cellularity and infiltrative
processes
 Aspiration Biopsy
Advantages •Fast •Gives cell and
•Gives relative quantity stroma constitution
of different cell types •Represents all
•Gives material for cells
further study, e.g. •Explains cause
molecular genetics and of "dry tap"
flow cytometry

Drawbacks Doesn't represent all Slow processing

cells
 Indications
 Diagnosis of a number of conditions
 leukemia
 multiple myeloma
 anemia and pancytopenia

 Investigation PUO specifically in patients with

AIDS. marrow may reveal
 Tuberculosis & Mycobacterium avium
intracellulare
 Histoplasmosis
 Leishmaniasis
 disseminated fungal infections
 Contraindications

 severe bleeding disorder - only absolute

contraindication
 may lead to serious bleeding after the procedure
 If a skin or soft tissue infection over the hip, a
different site should be chosen for bone marrow
examination
 Bone marrow aspiration and biopsy can be
safely performed even in the setting of extreme
thrombocytopenia
 Site of procedure
 Bone marrow aspiration and trephine biopsy
usually performed on
 posterior iliac crest
 an aspirate can also be obtained from the sternum
 A trephine biopsy should never be
performed on the sternum, due to the risk
of injury to
 blood vessels
 Lungs
 heart
 PROCEDURE

 Informed consent for the procedure

 The skin is cleansed
 Local anesthetic - lidocaine is injected – 10 mL
of 1% Xylocaine
 May also be pretreated with analgesics and/or
anti-anxiety medications
 Aspirate is performed first
 An aspirate needle is inserted through the skin
until it abuts the bone
 Then, with a twisting motion, the needle is
advanced through the bony cortex (the hard
outer layer of the bone) and into the marrow
cavity – not > 1 c.m.
 Once the needle is in the marrow cavity, a
syringe is attached and used to aspirate ("suck
out") liquid bone marrow – 0.3 mL of bone
marrow is aspirated. A volume greater than 0.3 mL may
dilute the sample with peripheral blood
 Subsequently biopsy is performed if indicated.
A different, larger trephine needle is inserted
and anchored in the bony cortex. The needle
is then advanced with a twisting motion and
rotated to obtain a solid piece of bone marrow.
Piece removed along with the needle
 Entire procedure takes 10-15 minutes
 If several samples are taken, the needle is
removed between the samples to avoid blood
coagulation
 After the procedure
 asked to lie flat for 5-10 minutes to provide
pressure over the procedure site
 assuming no bleeding is observed, the patient
can get up and go about their normal activities
 Paracetamol or other simple analgesics can be
used to ease soreness, which is common for 2-
3 days after the procedure.
 Any worsening pain, redness, fever, bleeding or
swelling may suggest a complication. serious
complications are extremely rare
 avoid washing the procedure site for at least 24
hours after the procedure is completed
 Coaxial needles

Biopsy needle

single shaft needle

cutting needle
Lumbar puncture needle
LUMBAR PUNCTURE
Contraindications to lumbar puncture
• local skin sepsis
• bleeding diatheses, e.g. anticoagulant therapy
• papilloedema or other signs of raised
intracranial pressure
• suspicion of intracranial or cord mass
• congenital neurological lesions in lumbrosacral
region
Complications of Lumbar Puncture:

• Uncal or tonsillar herniation

• Reversible tonsillar descent
• Spinal coning in patients with rostral
subarachnoid block
• Postdural puncture headache
• Cranial neuropathies
• Nerve root irritation, herniation, and
transection
• Low back pain
• Implantation of epidermal tumors
• Infections
• Bleeding complications
• Intracranial bleeding
• Traumatic lumbar puncture
• Spinal hematomas
• Other complications
– Vasovagal syncope
– Cardiac arrest
– Seizures
– Subarachnoid cyst
– Low pressure state in children with
ventriculoperitoneal (V-P) shunt
– Pseudo-pseudotumor cerebri (incorrect measurement
of opening pressure)
– Incorrect lab analysis of cerebrospinal fluid
Types of brain
herniation:
Supratentorial
herniation
1.Uncal
2.Central (transtentorial)
3.Cingulate (subfalcine)
4.Transcalvarial
Infratentorial
herniation
5.Upward
•upward cerebellar
•upward
transtentorial
6.Tonsillar (downward
cerebellar)
 FNAC Needle
Aspiration Needle
 Breast Biopsy
• Fine Needle Aspiration
• Core Needle Biopsy (trucut biopsy )
• Vacuum Assisted Biopsy
• Open Surgical Biopsy

Fine Needle Aspiration Trucut biopsy

90% detection rate 67% detection rate

Can not give a histological able to give a histological

diagnosis diagnosis. Results correlated
100% with the final histology
Easy to perform Not so easy
less traumatic More traumatic