A method of fixation of endotracheal tubes.
نویسنده
چکیده
Sir,—For prolonged intubation in a children's hospital we prefer to use uncuffed plastic tubes, either Warne* neonatal tubes inserted orally, or nasal/oral bevel tubes introduced nasally. Fixation of these tubes has always been a problem, as adhesive tape irritates the skin and loosens when wet with secretions. With nasal tubes, there is always the danger of dislodgement of the tube connector, with loss of the tube into the pharynx. The JacksonReest tube does overcome some of these difficulties, but we do not often use it because of the thick wall and the need to shorten the tube at the bevel end, which leaves a sharp edge. A new method of fixation has been devised, which has been in use in our intensive therapy unit for a year, and has proved very satisfactory in the opinion of both medical and nursing staff. The length of tube needed must be measured reasonably accurately before its insertion. This may be done by introducing the tube first, then cutting another at the right length and substituting this. The lettering on the Warne tubes forms a useful guide. Alternatively, one may use a formula (Manila et aT, 1971) or chart (Rees and Owen-Thomas, 1966) to judge the length required. A leather punch (obtainable from craft shops) is used, and holes (B, fig. 1) punched in the anterior and posterior walls of the tube at the measured leveL Further holes (A, fig. 1) are then punched about 3 cm proxirnally and at right angles to the first pair. The tube is trimmed, if necessary, beyond the second pair of holes, and scissors used to cut down the anterior and posterior walls of the tube as far as the first holes (fig. 1). A flange is thus formed, and the tube will split no further. A connector, usually of the Cardiff^ type, is fitted into the tube (fig. 2). Tapes are passed through the second pair of holes and attached to a cap made of tube-gauze of appropriate size.
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عنوان ژورنال:
- British journal of anaesthesia
دوره 44 9 شماره
صفحات -
تاریخ انتشار 1972