TUBES

Nasogastric tube most often used ia Levine tube

Ryles tube

Identification points

·      The tube used most often has blunt end with multiple opening near the lower end which is closed.

·      The Ryles tube has a metal ball around which the tube is moulded. 

     This acts as weight for introducing the tube.

     The tube is made rubber (so that it becomes flexible) and also of transparent protex (because it may cause less irritation).

Marking of Ryles tube

The tube has four marks: mark 1when the tip enters the stomach (40 cm);
second mark 2 when the tip arches antrum (50cm);
mark 3 at 57 cm,  when it indicates the entry into the pylorus;
and mark 4 (at 65cm) indicates entry into the duodenum.

How is Ryles tube introduced?

The patient is asked to sit up. 

The tip is placed in the nose and fed in till it reaches pharynx and the patient is asked to swallow

till the tube reaches the desired mark.

Uses

·      Ryles tube is used to aspirate stomach juices in postoperative period.

·      It is also used to aspirate in cases of acute abdomen–intestinal obstruction, perforation, appendicular mass, acute cholecystitis and strangulated hernia.

·      It is also used in gastric acid-secretion tests.

·      Ryles tube is used in gastric feeding of unconscious patient.

·      It is used to perform gastric lavage.

·      It is also used to confirm the diagnosis of pernicious anaemia.

Stomach tube

Identification points

·      It is wide-bore rubber tube. 

    The tube end is rounded to allow introduction in the body without injury, the upper end has a funnel to allow pouring of lavage fluid.

·      Wash out occurs when this end is lower than the patient.

Uses

Stomach tube is used in the management of alcohol poisoning,

organophosphorus compound poisoning,

barbiturate poisoning and

opium or morphine poisoning.

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TUBES AND CATHETERS

TUBES, CATHETERS AND DRAINS

TUBES

Without endotracheal tubes, modern anaesthesia would be unthinkable. 

The traditional tubes of the Magill pattern are made of red mineralized rubber.

Except these, all have an inflatable cuff near the distal tip to protect the lower respiratory tract from soiling as well as providing an air-tight seal. 

Each number refers to the internal diameter of the tube in millimeters.

            These in the past have been made of rubber and recycled in practice by autoclaving. 

All these instruments and nasogastric tubes are now made of non-reactive plastic marerial and come pre-sterilized in packs. 

These tubes are all disposable and thus do not require recycling.

The tubes in use are:

·       Cuffed oral endotracheal tube

·       Uncuffed oral endotracheal tube

·       Negus tracheostomy tube

·       Chevalier-Jackson tracheostomy tube

Tracheostomy tube

Identification points of tracheostomy tube

·       It has the outer tube that is taped to the neek and always stays in the trachea.

·       An inner tube that can be taken out for cleaning.

·       An abdurator required at the time of introduction.

The Chevalier-Jakson inner tube case locked when in position.

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METAL CLIPS AND STAPLERS

METAL CLIPS

Metal clips include Mitchell’s, Kifa metal clips and Cushing’s. First two are used for skin closure.

Cushings are used for vessal closure in brain surgery

Advantages of metal clips

· Apposition is better.

· Good cosmetic result is achieved.

· Less chances of infection as suture hole is not made.

Disadvantages

· It is more expensive.

· Metal clips require special instruments (applicator and extractor).

When should the clips be removed?

Clips should be removed usually at 6days, i.e. earlier than sutures ( usually removed after 8-10 days)

Staplers are being used in surgery for

Anastomosis(Colectomy-Gastrectomy)

Vessal stapling before cutting(splrnectomy adrenalectomy)

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