oral vs. nasal intubation

  1. Just wondering what practice your unit uses for intubation, oral vs. nasal. We intubate our babies orally (unless of course there is some sort of anatomical defect that does not allow this). There is one hospital that we send babies out to for PDA ligations that always sends back the babies nasally intubated.
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  2. 14 Comments

  3. by   ginger58
    Where I used to work the NNPs always intubated orally but sometimes the neos would go nasally if the tube needed more stability.
  4. by   dawngloves
    I've only seen it with older neonates. Have to say I prefer it. Much more stable.
  5. by   BittyBabyGrower
    I hate nasal intubation, but we do use it on some of the bigger kids that extubate all the time due to oral secretions.
  6. by   SteveNNP
    I've never seen a nasally intubated baby. Sounds scary and damaging!
  7. by   Gompers
    Quote from SteveRN21
    I've never seen a nasally intubated baby. Sounds scary and damaging!

    I've only seen it in pictures. I think in certain countries they prefer nasal over oral intubation in neonates - isn't it popular in Canada? Anyone?

    We've only done it once or twice, in older chronics who really needed trachs but the parents wouldn't consent yet. It just made their tubes much more stable, I definitely agree about that! The reason our docs didn't like it was because they didn't like seeing higher pressures on the vent - they'd have to use a much smaller tube for nasal intubation and thus needed higher pressures. Even though they knew it was just a numbers game, it still upset them to see such high PIPs. We actually liked it a lot though - so much easier to tape and no "tromboning" which is usually a problem with those older chronics because of the huge cheeks they've gotten from the inevitable steroid use...

    I wish we'd use it on the big PPHN kids - they always have such gooey Pavulon-induced drooly mouths. And those are EXACTLY the kids you don't want to accidentally extubate! I mean, with babies that sensitive, that close to coding at any moment, a clean, stable nasal ETT just makes so much more sense to me, personally.
  8. by   RNinNB
    Our neo. likes our babies to be nasally intubated. He will go nasally in most cases. Our peds know he prefers nasally, but will go with what they are comfortable with, usually resulting in an oral tube.
  9. by   iceNICUnurse
    We have them nasally 90% of the time.
    They are much more stable nasally and they almost never go out by accident.
    I dont like oral tubes, the tape gets wet from saliva and the baby is constantly sucking on the tube. Better to have the tube nasally and a pacifier in the mouth.

    I hate it when I get a kid back from surgery with an oral tube.

    I think nasal intubation is much harder to do but our neos have a lot of experience and almost never have any problems getting them in.
  10. by   Jolie
    In the first unit I worked (in Chicago), virtually every baby was nasally intubated. We had a standard method of taping the ETT that held it very securely, so much so that I can't remember a baby being inadvertently extubated. We occasionally had to electively re-intubate due to growth or clogging of the tube with secretions, but almost never due to accidental intubation. I didn't realize it was done any other way until I moved to another Level III unit a few hundred miles away where every baby was orally intubated. I never got quite comfortable with that, as accidental extubations were common.

    I agree that oral intubation is technically easier to accomplish, but our neos and NNP's were quite proficient at oral intubation.
  11. by   twinkletoes53
    We intubate orally all the time, unless a baby has birth defects that prevent us from doing so. We use Neobars to secure the ET tubes. If an infant is nasally intubated for a long time, would that cause damage to the nasal septum? Also, when the time comes to extubate, would that nare and passage be edematous at first, due to the presence of the tube? Would it affect the infant's ability to maintain an adequate airway once he is off the vent?
  12. by   LilPeanut
    We usually only nasally intubate on kids who have anatomic reasons to do so.

    Septum breakdown is a huge issue with these kids who are vents for months and months.
  13. by   cherokeesummer
    We had one today but the RN changed it back to orally, made sense! She said that it may have been obstructing some of his O2 b/c his nares were so small. Seemed to do much better once it was oral again.

    Amy
    Mommy of one 17 month bugga bear
    Semster 6 of 6 - RN school/Preceptor in NICU
  14. by   skysurfer
    Quote from LilPeanut
    Septum breakdown is a huge issue with these kids who are vents for months and months.
    There is a breakdown of a whole lot of other things, too, if a baby is intubated for months and months.......
    We usually intubate our infants via nasal airway, simply because its
    tolerated better by the infants and the fixation is more easy and
    accurate. The infant is still able to train his/her suck-swallow rhythm
    and can be calmed with a pacifier if necessary. We also administer glucose for painrelief that way.
    However, in cases where a nasal intubation is not possible, we use the
    neobar ETT holder for securing the tube. In all other (nasal) cases, we
    have our very own technique of securing the tube. I would say its
    "bomb-proof" and i have pictures that show how we secure our tubes.http://www.intensivmedicus.de/downlo...usfixation.pdf
    It is a safe way to intubate, if youre trained. Ive been told by a physician that comes from england, that there is a historical reason that in europe we prefer to intubate nasally (only small children) whereas in the english speaking countries they prefer to intubate orally. It is not a common practice for "youngsters"(young physicians) to intubate here in europe. It is only done by experienced residents. In the US,however, it is often performed by RTs, Nurses or young physicians which are less trained, he said......
    For all those who are interested in this, i have an english version also, which i could mail to you privately...

    cheers Norbert aka Skysurfer
    Last edit by skysurfer on Apr 1, '07

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