Nasal intubation: Difference between revisions
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==Indications== | ==Indications== | ||
*Severe cervical spine disease/instability | *Severe cervical spine disease/instability | ||
*Intraoral masses | |||
*Trismus | |||
==Contraindications== | ==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) | #sniffing position (like oral ET) | ||
#pretreat with lido, hurricaine, or 4cc nebulized lidocaine for 5 minutes | #pretreat with lido, hurricaine, or 4cc nebulized lidocaine for 5 minutes | ||
| Line 15: | Line 26: | ||
tips: occlude other nostril to hear better, cricoid pressure when advancing, use a small suciton catheter as a seldinger guide, precurve tube before insertion. | 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 | #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 | ||
| Line 22: | Line 33: | ||
#DL to visualize tube insertion past vocal cords | #DL to visualize tube insertion past vocal cords | ||
#McGills or Kellys to grasp tube tip and facilitate passing tube | #McGills or Kellys to grasp tube tip and facilitate passing tube | ||
==See Also== | |||
*[[Intubation]] | |||
==References== | |||
<references/> | |||
Revision as of 21:52, 19 April 2015
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 R 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.