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  • Nasal Intubation Without That Nasty Bleeding

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    dr wael sadaqa
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    Dr: Wael Sadaqa Md , Ass Proff Faculty of medicine Al-Najah National University Head of Anesthesia Department Al-Najah National University Hospital / Nablus / Palestine Dr Abed Nazal .. consultant anesthesia and ICU Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia . the procedure for intubation involves achieving neuromuscular blockade followed by passing the ETT into the trachea . The problem with nasal intubation, especially in children, is not only stirring up severe cases of epistaxis, partial turbinectomy. Obstruction of the ETT with foreign body , but also contamination of the ETT with blood or secretions and inadvertently performing a partial adenoidectomy as evidenced on occasion by finding a chunk of adenoid in the end of the endotracheal tube. To avoid causing this mess, we followed these 8 steps. 1) Afrin spray to bilateral nares about ten minutes prior to induction of anesthesia . 2) Have a finger of a sterile gloves size 7.5 or 8 , as well as a Magill forceps on the clean intubation equipment area on your anesthesia machine ready to go. 3) Preoxygenate the patient well, then induce general anesthesia and paralyze the patient as per your routine. 4) consider squirting some 2% Lidocaine jelly in both nares at the time of induction. 5) insert the end of your nasal ETT in the gloves finger as shown the the picture , and pass through the nares. 6) when you see the end of the ETT in the oropharynx Grasp the gloves finger, gently tug it up and out of the mouth . 7) by the help of forceps catch the end of the ETT tube and insert it into the trachea . 8) Confirm placement (loss of phonation, breath sounds, end-tidal CO2) and secure tube . I've never caused a nasal bleed using this technique. During training at Al-Najah National University Hospital we insist upon all of upon the residents nasally intubating our patients using the following technique.

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    Dr: Wael Sadaqa Md , Ass Proff Faculty of medicine Al-Najah National University Head of Anesthesia Department Al-Najah National University Hospital / Nablus / Palestine Dr Abed Nazal .. consultant anesthesia and ICU Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia . the procedure for intubation involves achieving neuromuscular blockade followed by passing the ETT into the trachea . The problem with nasal intubation, especially in children, is not only stirring up severe cases of epistaxis, partial turbinectomy. Obstruction of the ETT with foreign body , but also contamination of the ETT with blood or secretions and inadvertently performing a partial adenoidectomy as evidenced on occasion by finding a chunk of adenoid in the end of the endotracheal tube. To avoid causing this mess, we followed these 8 steps. 1) Afrin spray to bilateral nares about ten minutes prior to induction of anesthesia . 2) Have a finger of a sterile gloves size 7.5 or 8 , as well as a Magill forceps on the clean intubation equipment area on your anesthesia machine ready to go. 3) Preoxygenate the patient well, then induce general anesthesia and paralyze the patient as per your routine. 4) consider squirting some 2% Lidocaine jelly in both nares at the time of induction. 5) insert the end of your nasal ETT in the gloves finger as shown the the picture , and pass through the nares. 6) when you see the end of the ETT in the oropharynx Grasp the gloves finger, gently tug it up and out of the mouth . 7) by the help of forceps catch the end of the ETT tube and insert it into the trachea . 8) Confirm placement (loss of phonation, breath sounds, end-tidal CO2) and secure tube . I've never caused a nasal bleed using this technique. During training at Al-Najah National University Hospital we insist upon all of upon the residents nasally intubating our patients using the following technique.

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    Nasal Intubation Without That Nasty Bleeding

    Uploaded by

    dr wael sadaqa
    Dr: Wael Sadaqa Md , Ass Proff Faculty of medicine Al-Najah National University Head of Anesthesia Department Al-Najah National University Hospital / Nablus / Palestine Dr Abed Nazal .. consultant anesthesia and ICU Maxillofacial surgical procedures often require nasotracheal intubation as an alternative method for achieving general anesthesia . the procedure for intubation involves achieving neuromuscular blockade followed by passing the ETT into the trachea . The problem with nasal intubation, especially in children, is not only stirring up severe cases of epistaxis, partial turbinectomy. Obstruction of the ETT with foreign body , but also contamination of the ETT with blood or secretions and inadvertently performing a partial adenoidectomy as evidenced on occasion by finding a chunk of adenoid in the end of the endotracheal tube. To avoid causing this mess, we followed these 8 steps. 1) Afrin spray to bilateral nares about ten minutes prior to induction of anesthesia . 2) Have a finger of a sterile gloves size 7.5 or 8 , as well as a Magill forceps on the clean intubation equipment area on your anesthesia machine ready to go. 3) Preoxygenate the patient well, then induce general anesthesia and paralyze the patient as per your routine. 4) consider squirting some 2% Lidocaine jelly in both nares at the time of induction. 5) insert the end of your nasal ETT in the gloves finger as shown the the picture , and pass through the nares. 6) when you see the end of the ETT in the oropharynx Grasp the gloves finger, gently tug it up and out of the mouth . 7) by the help of forceps catch the end of the ETT tube and insert it into the trachea . 8) Confirm placement (loss of phonation, breath sounds, end-tidal CO2) and secure tube . I've never caused a nasal bleed using this technique. During training at Al-Najah National University Hospital we insist upon all of upon the residents nasally intubating our patients using the following technique.

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    Nasotracheal intubation A simple and effective technique to reduce nasopharyngeal trauma, bleeding, and ETT tube contamination.

    Dr: Wael Sadaqa Md , Ass Proff Faculty of medicine Al-Najah National Uni ersity !ead of Anesthesia De"artment Al-Najah National Uni ersity !os"ital # Na$lus # Palestine

    Ma%illofacial sur&ical "rocedures often require nasotracheal intu$ation as an alternati e method for achie in& &eneral anesthesia ' the "rocedure for intu$ation in ol es achie in& neuromuscular $loc(ade follo)ed $y "assin& the *++ into the trachea ' +he "ro$lem )ith nasal intu$ation, es"ecially in children, is not only stirrin& u" se ere cases of e"ista%is, "artial tur$inectomy' ,$struction of the *++ )ith forei&n $ody , $ut also contamination of the *++ )ith $lood or secretions and inad ertently "erformin& a "artial adenoidectomy as e idenced on occasion $y findin& a chun( of adenoid in the end of the endotracheal tu$e' +o a oid causin& this mess, )e follo)ed these - ste"s' ./ Afrin s"ray to $ilateral nares a$out ten minutes "rior to induction of anesthesia ' 0/ !a e a fin&er of a sterile &lo es si1e 2'3 or - , as )ell as a Ma&ill force"s on the clean intu$ation equi"ment area on your anesthesia machine ready to &o' 4/ Preo%y&enate the "atient )ell, then induce &eneral anesthesia and "araly1e the "atient as "er your routine' 5/ consider squirtin& some 06 7idocaine jelly in $oth nares at the time of induction' 3/ insert the end of your nasal *++ in the &lo es fin&er as sho)n the the "icture , and "ass throu&h the nares' 8/ )hen you see the end of the *++ in the oro"haryn% 9ras" the &lo es fin&er, &ently tu& it u" and out of the mouth '

    2/ $y the hel" of force"s catch the end of the *++ tu$e and insert it into the trachea ' -/ :onfirm "lacement ;loss of "honation, $reath sounds, end-tidal :,0/ and secure tu$e ' <= e ne er caused a nasal $leed usin& this technique'

    Durin& trainin& at Al-Najah National Uni ersity !os"ital )e insist u"on all of u"on the residents nasally intu$atin& our "atients usin& the follo)in& technique'

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