Nasal intubation: Difference between revisions
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#Prepare Afrin in 10 cc syringe, nasal trumpet, nasal tube (or smaller ETT) without stylet, DL blade, McGills/long curved Kellys | #Prepare Afrin in 10 cc syringe, nasal trumpet, nasal tube (or smaller ETT) without stylet, DL blade, McGills/long curved Kellys | ||
#Afrin in both nostrils | #Afrin in both nostrils | ||
#Nasal trumpet into | #Nasal trumpet into right nostril to dilate nasal airway (R nostril = less bleeding, faster<ref>Boku et al. Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial. J Clin Anesth. 2014 Aug;26(5):390-4.</ref> | ||
#Insert tube in a postero-inferior direction (may feel some crunching along ethmoid, so be careful along that surface) | #Insert tube in a postero-inferior direction (may feel some crunching along ethmoid, so be careful along that surface) | ||
#DL to visualize tube insertion past vocal cords | #DL to visualize tube insertion past vocal cords | ||
Revision as of 21:33, 27 February 2017
Indications
- Severe cervical spine disease/instability
- Intraoral masses
- Trismus
Contraindications
Absolute
- Epiglottitis
- Significant midface fractures
- Basilar skull fractures
Relative
- Large nasal masses
- Nasal foreign body
- Recent nasal instrumentation
- Nasal or upper airway hematoma/infection
- Epistaxis
Awake Technique
- sniffing position (like oral ET)
- pretreat with lido, hurricaine, or 4cc nebulized lidocaine for 5 minutes
- Tube size = 1.0 mm smaller
- listen with stethoscope at end of tube (breath sounds become louder as tube approaches cords)
- when tube hits cords patient will cough, back up 1 or 2 cm. wait for beginning of inspiration, as patient begins inspiration advance 3-4 cm (tube should be 22-26cm in women, 23-28cm in men)
tips: occlude other nostril to hear better, cricoid pressure when advancing, use a small suciton catheter as a seldinger guide, precurve tube before insertion.
Sedated Technique
- Prepare Afrin in 10 cc syringe, nasal trumpet, nasal tube (or smaller ETT) without stylet, DL blade, McGills/long curved Kellys
- Afrin in both nostrils
- Nasal trumpet into right nostril to dilate nasal airway (R nostril = less bleeding, faster[1]
- Insert tube in a postero-inferior direction (may feel some crunching along ethmoid, so be careful along that surface)
- DL to visualize tube insertion past vocal cords
- McGills or Kellys to grasp tube tip and facilitate passing tube
See Also
References
- ↑ Boku et al. Which nostril should be used for nasotracheal intubation: the right or left? A randomized clinical trial. J Clin Anesth. 2014 Aug;26(5):390-4.