Tips on securing a nasal ETT! and other advise :) - page 2

by HappyParamedicRN 3,212 Views | 11 Comments

Hi all, I am currently working full time as a paramedic and am looking for any good tips on securing nasal tubes. I also have a couple other questions. I had a male patient last night that I had to nasally tube secondary... Read More


  1. 1
    Quote from HappyParamedicRN
    Hi all,

    I am currently working full time as a paramedic and am looking for any good tips on securing nasal tubes. I also have a couple other questions.

    I had a male patient last night that I had to nasally tube secondary to respirtory failure from CHF... Needless to say the nare bled making the patient's face wet, he was also very diapheretic making securng the tube with tape difficult. I tried drying the area, but that didn't help. I basically had to have one of the EMTs hold it the entire time. I was happy that I got the nasal tube since that was only my second time ever attempting one, but it was very difficult to keep it in place especially once the patient woke up fighting prior to sedation and during the 2 floor carry down! We cannot RSI iin my system so no sedation until the tube is in.

    I tried orally intubating him, but I goosed it, which of course added to the headache with vomiting now mixing in with the pulmonary edema. DOH! We had suction ready and I was able to hold his head to the side so I do not think he aspirated any. He also of course woke up after some BVM ventilations temporarily making oral intubation more difficult since his gag returned and his RR picked up. I tried oral intubation, but could not see the cords or even cartlidge despite him being in the sniffing position, but he was also not relaxed any longer. I tried a boogie, but I could not get it to go into the trachea, kept going right into the esophagus. I am not sure if he was just really anterior or what. The nasal tube was a pecie of cake, but I would think if he was that anterior that I would have had trouble with that as well????

    Also I have very small hands (small gloves are loose on me) and I read somewhere that people with smaller hands sometimes do better using a pedi handle even on adult patients... Do any of you know if this is true?

    Thanks for any help!

    Happy
    I first have to say...what a GREAT CALL....that is the kind of call that made me love being a medic. Challenging and requires you keep thinking and adapting. Wakes up? Nasal him again...should be twice as easy the second time. Anterior intubations are often easier nasal tubes...natural curve of the anatomy. remember you can also nasal intubate while doing a laryngoscopy to watch the tube go thru the cords....and ask the old timers about using your FINGERS inserted in the mouth to guide a nasal tube into the trachea. not if pt is biting of course.

    I wear size 8 (big) gloves and I carry a ped handle with a 3 miller on it with me for ALL my adult intubations...just my preference....
    HappyParamedicRN likes this.
  2. 0
    Quote from foraneman
    I first have to say...what a GREAT CALL....that is the kind of call that made me love being a medic. Challenging and requires you keep thinking and adapting. Wakes up? Nasal him again...should be twice as easy the second time. Anterior intubations are often easier nasal tubes...natural curve of the anatomy. remember you can also nasal intubate while doing a laryngoscopy to watch the tube go thru the cords....and ask the old timers about using your FINGERS inserted in the mouth to guide a nasal tube into the trachea. not if pt is biting of course.

    I wear size 8 (big) gloves and I carry a ped handle with a 3 miller on it with me for ALL my adult intubations...just my preference....
    Yes it was a call that kept me on my toes even though it was at like 2 in the morning! Especially since I am on a paramedic/intermediate truck and our intermediates cannot intubate. I would not want to have to re nasally intubate him since my own nose felt violated pushing the tube into his, OUCH! The call went fine in the end, we saved him consideeing when we found himhis HR was about 20 secondary to hypoxia! Another minute or so before we got there and he wuld have been dead!

    The only thing that was not so fun was the carry down, bet you do not miss that!


    Happy


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