Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage

Kim, Yong Chul; Lee, Seung Hwan; Noh, Gyu Jeong; Cho, Sang Yoon; Yeom, Jong Hoon; Shin, Woo Jong; Lee, Dong Hoon; Ryu, Je Seon; Park, Young Sun; Joon, Kyung; Lee, Sang Chul

doi:10.1097/00000539-200009000-00038

Cited by 83 publications

(77 citation statements)

References 6 publications

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“…In addition, ample use of lubricants; nasal decongestion with cocaine, epinephrine, or oxymetazoline; and warming of the tube may be used to facilitate tube passage. 40,41 The management of nasotracheal injury depends on its severity. Mucosal abrasions, tears, and hematomas usually resolve with conservative management, such as nasal humidification and nasal pressure.…”

Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tracheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined.

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Section: Injury By Anatomic Sitementioning

confidence: 99%

Complications of Airway ManagementDiscussion

Pacheco-Lopez¹,

Berkow

Hillel³

et al. 2014

Respir Care

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“…A number of strategies have been suggested to potentially decrease the risk of epistaxis. These include immersing the NTT in a bottle of warm sterile water or saline (thermo-softening) to soften the tube prior to use (4,5); the use of soft flexible nasotracheal tube (such as the Portex ® Ivory PVC cuffed tube, Sims Portex Ltd., Kent, UK) (6); the use of a Parker-Flex tip ETT (7), application of a vasoconstricting nasal spray to the nasal mucosa prior to intubation (8); generous use of a lubricant to facilitate entry of the NTT through the nose (9); telescoping the NTT through a redrubber catheter (10); using the right nostril (11), preselecting the nare prior to placing the NTT using nasopharyngoscopy (12); and using a bronchoscope as an intubation guide (13). Other complications in addition to hemorrhage and inability to place the NTT are additionally possible including perforation of the pyriform fossa causing subcutaneous and/or mediastinal emphysema (14).…”

Section: Discussionmentioning

confidence: 99%

Unanticipated Difficult Nasal Intubation Due to a Prominent Anterior Tubercle of the First Cervical Spine

Watton¹,

Hung²

2016

J Anesth Perioper Med

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Nasal intubation is frequently used for airway management in patients undergoing many surgical procedures. This is a case report of an unanticipated difficult nasal intubation due to a prominent anterior tubercle of the first cervical spine vertebra (C1) resulting in aspiration of blood and hypoxemia following intubation. The subsequent airway management of the rescheduled elective case is also described. The specific difficulties in securing the airway for nasal intubation are described as well as the management strategies to circumvent this anatomical variant. This case report will be of interest to health care practitioners providing airway management via the nasal route for different populations.

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“…Suggestions to reduce the incidence of nasal mucosal trauma are numerous: tracheal tube guidance; using a gastric tube or a suction catheter [13,14]; or softening the tracheal tube by heating in warm water [15] have been reported. Mechanical dilation [16] and application of adrenaline [17] have also been used to prepare the nasopharyngeal passages and minimise epistaxis during nasotracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

The Parker Flex‐Tip™ tube for nasotracheal intubation: the influence on nasal mucosal trauma

et al. 2009

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SummaryWe tested our hypothesis that use of the Parker Flex‐Tip™ tracheal tube could reduce the incidence of nasal mucosal trauma during nasotracheal intubation when compared with a conventional tip tracheal tube. One hundred and two patients, who were scheduled for elective oral surgery in which nasotracheal intubation was indicated to optimise the surgical approach, were recruited into this study. Either a Flex‐Tip tracheal tube or a conventional tip tracheal tube was chosen randomly for each nasotracheal intubation. The incidence of epistaxis using the Flex‐Tip tracheal tube (6 (11.8%)) was significantly lower than that with the conventional tip tracheal tube (18 (35.3%); p = 0.009). Nasal pain due to intubation, rated on a 100‐mm visual analogue scale, was less intense with the Flex‐Tip tracheal tube (median, (10th–90th percentile) 19 (12–28) mm compared with the conventional tip tracheal tube (30 (22–35) mm; p < 0.001). The Flex‐Tip tracheal tube thus appeared to reduce the incidence of nasal mucosal trauma during nasotracheal intubation and the incidence of post‐intubation nasal pain, compared with the conventional tip tracheal tube.

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Thermosoftening Treatment of the Nasotracheal Tube Before Intubation Can Reduce Epistaxis and Nasal Damage

Abstract: Thermosoftening treatment of a nasotracheal tube with warm saline before intubation can effectively reduce epistaxis and nasal damage. This technique is safe, easy, and suitable for all types of tubes and does not require additional implements.

Cited by 83 publications

References 6 publications

Complications of Airway ManagementDiscussion

Complications of Airway ManagementDiscussion

Unanticipated Difficult Nasal Intubation Due to a Prominent Anterior Tubercle of the First Cervical Spine

The Parker Flex‐Tip™ tube for nasotracheal intubation: the influence on nasal mucosal trauma

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