Telescoping Tracheal Tubes into Catheters Minimizes Epistaxis during Nasotracheal Intubation in Children

2007 ◽  
Vol 106 (2) ◽  
pp. 238-242 ◽  
Author(s):  
Stacey Watt ◽  
Don Pickhardt ◽  
Jerrold Lerman ◽  
James Armstrong ◽  
Paul R. Creighton ◽  
...  
Keyword(s):  
Room Temperature ◽  
Nasotracheal Intubation ◽  
Tube Placement ◽  
Dental Surgery ◽  
Magill Forceps ◽  
Catheter Group ◽  
Group 5 ◽  
Median Area ◽  
Rubber Catheter ◽  
The Right

Background Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. Methods Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. Results The demographics of the three groups were similar. The estimated median area of the gauze in the catheter group that was covered with blood (0%) was significantly less than the areas in the control (40%) and warm (20%) groups. The incidence of clinically relevant bleeding (>or= 40% of the gauze area covered in blood) in the catheter group (5%) was significantly less than in the control (56%) and warm (39%) groups. The incidence of no detectable blood in the catheter group (59%) was significantly greater than in the control (21%) and warm (26%) groups. Conclusions Telescoping the endotracheal tube into a catheter significantly reduces epistaxis in children undergoing nasotracheal intubation.

scholarly journals Which nostril should be used for nasotracheal intubation with Airtraq NT?: the right or left? A randomized clinical trial

2019 ◽  
Author(s):  
ZEHRA İPEK ARSLAN AYDIN ◽  
NEŞE TÜRKYILMAZ
Keyword(s):  
Cricoid Pressure ◽  
Nasotracheal Intubation ◽  
Pressure Head ◽  
Cuff Inflation ◽  
Left Nostril ◽  
Clockwise Rotation ◽  
Vocal Cords ◽  
Magill Forceps ◽  
Head Flexion ◽  
The Right

Background and aim: Nasotracheal Airtraq, is specifically designed to improve the glottis view and ease the nasotracheal intubation process in normal and difficult cases. Materials and methods: After Ethics committee approval, we decided to enroll 40 patients with an ASA physical status of I or II, between 18-70 years of age undergoing elective maxillofascial, oral and double chin surgery to determine which nostril is more suitable for nasotracheal intubation with nasotracheal Airtraq. Patients were randomised into the right and left nostril groups. Results: Demographic and airway characteristics were similar among the groups. Nasotracheal intubation through the right nostril was shorter than that of the left nostril during nasotracheal intubation with the Airtraq NT (p<0.001). 90 anti-clockwise rotation of the tip of the tube was needed for directing the tube into the vocal cords in both right and left nostril groups (72% vs 88%). External laryngeal pressure and head flexion maneuvers can ease the intubation from the left nostril (p<0.001 vs p=0.03). Cuff inflation maneuver also can be helpful in some cases. We did not need any operator change or Magill forceps for any of the patients. Conclusion: Nasotracheal intubation via the right nostril can be safely and quickly performed with the Airtraq NT without the need of Magill forceps. We recommend the use of the 90 anti-clockwise rotation, external laryngeal pressure and head flexion maneuvers to direct the tube into the vocal cords first. On the other hand; cuff inflation maneuver also must be kept in mind. Keywords: Airtraq, nasotracheal, right nostril, 90 degree anticlockwise, cricoid pressure, head flexion

Nasotracheal Intubation

2002 ◽  
Vol 96 (1) ◽  
pp. 51-53 ◽  
Author(s):  
Tom Elwood ◽  
Duane M. Stillions ◽  
Dawn W. Woo ◽  
Heidi M. Bradford ◽  
Chandra Ramamoorthy
Keyword(s):  
Direct Laryngoscopy ◽  
Comparative Studies ◽  
Elective Surgery ◽  
Nasotracheal Intubation ◽  
The Other ◽  
Magill Forceps ◽  
Blinded Observer ◽  
Catheter Technique ◽  
Nasotracheal Tube ◽  
Rubber Catheter

Background Several techniques have been suggested to reduce the trauma of nasotracheal intubation, although no comparative studies exist. The authors evaluated red-rubber catheters as a guide to nasotracheal intubation. Methods Children presenting for elective surgery were randomized to undergo red-rubber catheter-guided nasotracheal intubation or to have the nasotracheal tube alone inserted. After general anesthesia and paralysis with vecuronium, the nares were prepared with topical vasoconstrictor. The nasotracheal tube was softened with warm water. In the catheter-guided group, the nasotracheal tube tip was fitted to the trailing end of the red-rubber catheter, and the two were advanced together. The red-rubber catheter was retrieved from the nasopharynx, disconnected, and removed. In the other group, the nasotracheal tube was advanced blindly into the nasopharynx. In both groups, intubation was then completed during direct laryngoscopy using Magill forceps. A blinded observer swabbed the pharynx and rated the severity of bleeding based on reference photographs. Results Age, weight, snoring history, and difficulty of intubation were not different between groups. Obvious bleeding was lower using the red-rubber catheter technique (10 vs. 29%, P = 0.013), which took longer to perform (74 vs. 56 s, P = 0.02). Conclusions Although the incidence of bleeding in both groups was similar, severity of bleeding was reduced in the catheter-guided group during nasotracheal intubation. Use of a red-rubber catheter may reduce the trauma associated with nasotracheal intubation.

Evaluation of 99mTc-Label led Vitamin K4 as an Agent for Testicular Imaging

1991 ◽  
Vol 30 (01) ◽  
pp. 35-39 ◽  
Author(s):  
H. S. Durak ◽  
M. Kitapgi ◽  
B. E. Caner ◽  
R. Senekowitsch ◽  
M. T. Ercan
Keyword(s):  
Soft Tissue ◽  
Room Temperature ◽  
Normal Subjects ◽  
Left Testis ◽  
Wide Range ◽  
Activity Ratios ◽  
The Right ◽  
Radioactivity Levels

Vitamin K4 was labelled with 99mTc with an efficiency higher than 97%. The compound was stable up to 24 h at room temperature, and its biodistribution in NMRI mice indicated its in vivo stability. Blood radioactivity levels were high over a wide range. 10% of the injected activity remained in blood after 24 h. Excretion was mostly via kidneys. Only the liver and kidneys concentrated appreciable amounts of radioactivity. Testis/soft tissue ratios were 1.4 and 1.57 at 6 and 24 h, respectively. Testis/blood ratios were lower than 1. In vitro studies with mouse blood indicated that 33.9 ±9.6% of the radioactivity was associated with RBCs; it was washed out almost completely with saline. Protein binding was 28.7 ±6.3% as determined by TCA precipitation. Blood clearance of 99mTc-l<4 in normal subjects showed a slow decrease of radioactivity, reaching a plateau after 16 h at 20% of the injected activity. In scintigraphic images in men the testes could be well visualized. The right/left testis ratio was 1.08 ±0.13. Testis/soft tissue and testis/blood activity ratios were highest at 3 h. These ratios were higher than those obtained with pertechnetate at 20 min post injection.99mTc-l<4 appears to be a promising radiopharmaceutical for the scintigraphic visualization of testes.

The Esophageal Detector Device: Accuracy and Reliability in Difficult Airway Settings

1996 ◽  
Vol 11 (1) ◽  
pp. 60-62 ◽  
Author(s):  
Christopher E. Kapsner ◽  
David C. Seaberg ◽  
Charles Stengel ◽  
Kaveh Ilkhanipour ◽  
James Menegazzi
Keyword(s):  
Emergency Medicine ◽  
Pulmonary Edema ◽  
Difficult Airway ◽  
Laboratory Investigation ◽  
Respiratory Arrest ◽  
Tube Placement ◽  
Mainstem Bronchus ◽  
Anatomic Location ◽  
The Right ◽  
Attending Physician

AbstractIntroduction:The esophageal detector device (EDD) recently has been found to assess endotracheal (ET) tube placement accurately. This study describes the reliability of the EDD in determining the position of the ET tube in clinical airway situations that are difficult.Methods:This was a prospective, randomized, single-blinded, controlled laboratory investigation. Two airway managers (an emergency-medicine attending physician and a resident) determined ET-tube placement using the EDD in five swine in respiratory arrest. The ET tube was placed in the following clinical airway situations: 1) esophagus; 2) esophagus with 1 liter of air instilled; 3) trachea; 4) trachea with 5 ml/kg water instilled; and 5) right mainstem bronchus. Anatomic location of the tube was verified by thoracotomy of the left side of the chest.Results:There was 100% correlation between the resident and attending physician's use of the EDD. The EDD was 100% accurate in determining tube placement in the esophagus, in the esophagus with 1 liter of air instilled, in the trachea, and in the right mainstem bronchus. The airway managers were only 80% accurate in detecting tracheal intubations when fluid was present.Conclusions:The EDD is an accurate and reliable device for detecting ET-tube placement in most clinical situations. Tube placement in fluid-filled trachea, lungs, or both, which occurs in pulmonary edema and drowning, may not be detected using this device.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

Comparison of a Colorimetric End-Tidal CO2 Detector and an Esophageal Aspiration Device for Verifying Endotracheal Tube Placement in the Prehospital Setting: A Six-Month Experience

1997 ◽  
Vol 12 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Richard J. Schaller ◽  
J. Stephen Huff ◽  
Allan Zahn
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Tube ◽  
Sensitivity And Specificity ◽  
Nasotracheal Intubation ◽  
Prehospital Setting ◽  
Tube Placement ◽  
Emergency Department Physician ◽  
Significant Difference ◽  
End Tidal ◽  
Chi Square Analysis

AbstractIntroduction:Hand held, colorimetric, end-tidal CO2 detector devices are being used to verify correct endotracheal tube (ETT) placement. The accuracy of these devices has been questioned in situations of cardiac arrest. The use of the esophageal detector device (EDD) is an easy alternative for detection of ETT placement, and may be more accurate in situations of cardiac arrest.Hypothesis:The use of the esophageal aspiration device in comparison with a colorimetric end-tidal CO2 detector is more accurate in detecting proper ETT placement and easier to use in the prehospital setting than is the colorimetric end-tidal CO2 detection device.Methods:This was a prospective alternating weeks, 6-month study in a prehospital setting. Participants included all patients older than 18 years who were intubated by the Portsmouth, Virginia Emergency Medical Services (EMS) personnel from 01 July 1993 through 31 December 1993. The aspiration device used, also known as an esophageal detector device (EDD), was a 60 ml, luer-lock syringe attached to a 15 mm ETT adapter. Its efficacy was compared with an already accepted method of ETT position detection, the colorimetric endtidal CO2 detector. Each device was used on alternating weeks, and correct ETT placement was determined by the receiving emergency department physician using standard techniques. Chi-square analysis and Fisher's Exact test were used to compare parameters, time of device use, and ease of use. Sensitivity and specificity were calculated, and provider preference was assessed using a survey instrument administered following completion of the study.Results:There were 49 patients who met the inclusion criteria, but six were excluded because of situational circumstances rendering use of the device a possible compromise of patient care. Twenty-five patients were in the EDD group, and 18 were in the endtidal CO2 detector group. There was no statistically significant difference detected between groups for the gender ratio, underlying condition, CPR in progress, perceived difficulty of intubation, or percentage of nasotracheal intubation. The EDD was significantly easier to use (p<0.005). There was no statistically significant difference in time required for use of end-tidal CO2 detector device versus the EDD. The sensitivity and specificity for correct tracheal placement using the EDD was 100%, and the sensitivity for correct tracheal placement using the end-tidal CO2 detector device was 78%. Use of the EDD was preferred over use of the end-tidal CO2 detector device by 75% of participating EMS providers. One case of nasotracheal intubation with an ETT placement above the cords raised the question of accuracy of this device in situations where direct visualization is not utilized.Conclusion:The EDD was accurate in all cases of orotracheal intubation, and was easier to use than was end-tidal CO2 detector device. It was preferred by 75% of participating EMS providers. In cases in which the ETT may be above the vocal cords, caution must be used with interpreting the results obtained by use of the EDD.

scholarly journals Ileal strangulation around mesovarium in a newborn foal

2019 ◽  
Vol 75 (08) ◽  
pp. 6288-2019
Author(s):  
ROLAND KUSY ◽  
BEATA NOWICKA ◽  
BEATA ŻYLIŃSKA ◽  
MARIOLA BOCHNIARZ ◽  
ROMAN DĄBROWSKI
Keyword(s):  
Small Intestine ◽  
Acute Abdominal Pain ◽  
Postoperative Recovery ◽  
Tube Placement ◽  
Oxygen Supplementation ◽  
Intratracheal Administration ◽  
Somatic Development ◽  
Endotracheal Tube Placement ◽  
The Right ◽  
Observation Period

The article presents a case of a newborn foal (32 hours of life) with an acute abdominal pain. The foal was sent to the clinic after 24 hours of conservative treatment in the field. Physical examination revealed acute obstruction of the small intestine. The patient was admitted for emergency surgery. General multimodal anaesthesia with endotracheal tube placement and oxygen supplementation was performed. During medial laparotomy, about one meter of necrotic small intestine was resected, and the right ovary was removed. This surgical procedure was performed under general infusion multimodal anaesthesia with intratracheal administration of a mixture of oxygen and air. Postoperative recovery was uneventful, and no complications were observed. During the 5-month observation period, no disturbances in the somatic development and general condition of the patient were found.

scholarly journals Monitoring System of The Temperature for Mini Fish Storage using Internet of Things

2021 ◽  
Vol 324 ◽  
pp. 01011
Author(s):  
Eko Prayetno ◽  
Tonny Suhendra ◽  
Jeremya Lukmanto Saputra
Keyword(s):  
Internet Of Things ◽  
Human Brain ◽  
Monitoring System ◽  
Room Temperature ◽  
High Protein ◽  
Test Results ◽  
Error Level ◽  
The Right ◽  
Monitoring Temperature

Fish is one of the high-protein foods that are very helpful for the development of the human brain. Then, it is necessary to maintain the freshness of the fish for consumption. At this time, fishers and fishmongers preserve the freshness of fish by using Ice in the fish storage. However, it is considered ineffective due to improper ice change time. Therefore, monitoring temperature is very important and helpful to find the right time when replacing the Ice used to ensure the quality of fish. The development of this device uses Arduino ESP32, DHT21 Sensor, Micro SD Module, Internet of Things system, monitoring using Blynk Application and notifications using Telegram App. DHT21 sensor test results obtained a data conformity level (Error Level) of 2%. At the fish storage room temperature, there is the lowest temperature of 10.50 oC and ice temperature conditions in the storage of 0 oC. Therefore, the best state to keep fish fresh that researchers want is 0 oC to 2 oC at ice temperatures or 11.50 oC obtained in testing the time it takes to replace Ice by about 10 hours.

Finite Element Prediction of Temperature Variation of Material and Dies in Aluminum Forging

2020 ◽  
Vol 830 ◽  
pp. 93-100
Author(s):  
Jae Dong Yoo ◽  
Tae Min Hwang ◽  
Man Soo Joun
Keyword(s):  
Aluminum Alloy ◽  
Temperature Rise ◽  
High Speed ◽  
Room Temperature ◽  
High Strain ◽  
Cold Forging ◽  
Multi Stage ◽  
Aluminum Forging ◽  
The Right ◽  
Finite Element Prediction

Investigation into behaviors of aluminum alloy to be metal formed at the room temperature is conducted in this study. An index is used to evaluate the sensitivity of temperature, that is, index of relative normalized temperature rise to steel called normalized temperature rise index per steel which helps researchers to obtain some insight on new materials based on experiences of steel forging. An investigation to an aluminum alloy shows that the index is quite high, implying that temperature effect as well as rate-dependence effect on the forming processes of aluminum alloy at the room temperature cannot be neglected. Some details of thermomechanical predictions of a relatively high-speed automatic multi-stage forging process of a yoke with highly deformed region are given to reveal the importance of temperature and/or strain rate even in cold forging of aluminum alloy parts with high speed and high strain. All manuscripts must be in English, also the table and figure texts, otherwise we cannot publish your paper. Please keep a second copy of your manuscript in your office. When receiving the paper, we assume that the corresponding authors grant us the copyright to use the paper for the book or journal in question. Should authors use tables or figures from other Publications, they must ask the corresponding publishers to grant them the right to publish this material in their paper. Use italic for emphasizing a word or phrase. Do not use boldface typing or capital letters except for section headings (cf. remarks on section headings, below).

Influence of venipuncture point and port chamber site on the risk of catheter fracture in right internal jugular port placements

2019 ◽  
Vol 20 (6) ◽  
pp. 666-671 ◽  
Author(s):  
Kazuya Matsunari ◽  
Kota Watanabe ◽  
Norihiro Hishizume ◽  
Hidefumi Fujisawa
Keyword(s):  
Lower Risk ◽  
Jugular Vein ◽  
Curvature Radius ◽  
Central Venous ◽  
Port Placement ◽  
Port Implantation ◽  
Catheter Group ◽  
Tip Position ◽  
The Right ◽  
Catheter Fracture

Background: For subcutaneously implanted central venous ports, some complications due to prolonged placement have been reported. We investigated the appropriate puncture points and port placement sites to prevent catheter fracture in right internal jugular port placement. Methods: This retrospective study included 709 patients who underwent right internal jugular vein puncture and port implantation in the right precordium between 1 May 2012 and 31 March 2018. The cases were divided into undamaged catheter group and damaged catheter group comprising normal and fracture cases, respectively. The catheter angle, distance from the clavicle, tip position, and curvature radius were measured from fluoroscopic images obtained at the time of implantation. The t-test was used in statistical analysis. Results: Median angles were 91.6° in the undamaged catheter group and 58.0° in the damaged catheter group. Median distances were 26.0 mm in the undamaged catheter group and 36.6 mm in the damaged catheter group. Median tip positions were 51.6 mm in the undamaged catheter group and 37.5 mm in the damaged catheter group. Median curvature radii were 9.2 R in the undamaged catheter group and 7.1 R in the damaged catheter group. Significant differences were found in the angle, height, and curvature radius between the two groups. Conclusion: Our results indicate that a venipuncture as close to the clavicle as possible (less than 3 cm) and a gentle catheter curve (close to 90° angle) are associated with a lower risk of catheter fracture.

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