VENOUS CANULA

PAEDIATRIC DEPARTMENT
Nepalese Army Institute of Health Sciences

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 Parts:
 Outer polyethylene sheath
 Inner metal stillete

 Indications:
 Fluid administration
 Medications
 Blood products
 Blood sampling
 Various diagnostic and therapeutic procedure:
 Pleural tapping

 IVU

 Iv access required for more than 24 hours

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 SIZES
AGE GROUP SIZE COLOR

Pre Term 26G Purple

Newborn 24G Yellow

Child 22G Blue

Adolescents 20G Pink

adults 18G Green

“ 16G Brown

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 SITES
 Upper extremity (use distal site first)
Median antecubital vein at elbows
Dorsum of hand

 Lower extremity
Great saphenous vein at ankle
Median marginal veins
Veins of dorsal arch

 Scalp veins (rarely)

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 PROCEDURE
 Locate and stretch the vein
 Apply tourniquet proximal to vein
 Maintain asepsis
 Puncture the skin slightly distal or lateral to
the side of venipuncture with a needle
 Insert the cannula with bevel up
 Slowly advance till blood flows back freely
 Remove the needle simultaneously while
advancing the catheter into the way

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 Remove the torniquet
 Secure the cannula with tape

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 COMPLICATION
 Thrombophlebitis
 Cellulitis
 Embolism

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 MICRODRIP SET

DEPARTMENT OF PAEDIATRICS
NEPALESE ARMY INSTITUTE OF HEALTH SCIENCES

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 Clear, soft, cylindrical and calibrated
measured volume chamber with bold
graduation.

 Chamber injection port allows medication to

be injected into burette chamber for
medication mixture.

 Chamber vent allows air to enter chamber

through hydrophobic membrane to prevent
solution contamination.

 Burette sizes available: 110ml, 150ml

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 1 ml of it contains 60 drops.

 It contains Murphy chamber through which it

is possible to regulate the number of drops
falling per minute.

 A fluid level must be maintained in the

Murphy’s chamber. If the chamber gets full,
it has to be reset.
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 If you want to give 40 ml/hour fluid through
the micro-drip set, adjust it to set at just 40
drops/min.

 USES
Intravenous fluid administration
Drug administration
Parenteral nutrition

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TUBERCULIN SYRINGE

DEPARTMENT OF PAEDIATRICS
Nepalese Army Institute of Health Sciences
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 Mantoux Test:
 0.1 ml of tuberculin, which is a purified protein
derivative (PPD) is injected intradermal on the
volar aspect of forearm.

 A weal of 5 mm should be raised.

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  Standard dose is 5TU (equivalent to 1TU PPD with
RT Tween 80)

 PPD is obtained by culturing M tuberculosis H37RA

strain with Tween 80 on a synthetic protein free
medium Quinosol.

 NOTE:
 Positive Tuberculin Test may be seen in infants
vaccinated with BCG.

 In older children, interpretation of tuberculin test

is not altered by BCG.

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 Negative test does not rule out TB.
 Interpretation:
 induration is measured and read after 48 – 72

hours.
 A TST should be regarded as positive as follows:

In high-risk children

 HIV-infected children
 Severely malnourished children >5 mm

In all other children

 whether they have received a BCG
vaccination or not: >10 mm diameter

(Guidance for national tuberculosis programmes on the management of

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tuberculosis in children, WHO)
 American Academy of Paediatrics guidelines:

 Induration ≥ 5 mm

 Children in close contact with known or

suspected tuberculosis patient.

 Children suspected to have tuberculosis disease:

CXR suggestive of TB
Clinical evidence of TB
Children receiving immunosuppressive therapy
Children with immunosuppressive condition, eg
HIV infection.
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 Induration ≥ 10 mm

 Children < 4 years of age

 Children with other medical condition like

Hodgkin disease, lymphomas, DM, chronic renal

failure etc.
 Children born in high prevalence regions.

 Children exposed to high risk people like HIV

infected, drug users, migrant farm workers etc

 Induration ≥ 15 mm

 Children ≥ 4 years of age without any risk

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 BUTTERFLY NEEDLE
(SCALP VEIN SET)

DEPARTMENT OF PAEDIATRICS
Nepalese Army Institute of Health Sciences