nasal intubation

[Preemienurse23]

Do any of your units nasally intubate?

[figiwigi]

Our unit routinely nasally intubates. At delivery we will use oral intubation however if they need a tube change / or self extubate etc we frequently nasally intubate. We have packs set up for re-strapping and on average the whole process take about 5 minutes. We find it is more effective that oral as we have had an increase in palate erosion / dental damage and we use the neobar system to secure the oral tubes which are not all that effective

[Preemienurse23]

We have started to use the neobars along with taping. I don't know if it has helped with unplanned extubations, but I'm not too fond of them.

[NICURN29]

We have two docs who nasally intubate. Their rationale is that the tube is more stable, with less play, which can cut down on problems like tracheomalacia and can help prevent the babies from self-extubating, thereby leading to fewer reintubations. We also have a doc who thinks it's barbaric and won't do it. In a really unstable kid or a really agitated kid, I like having the nasal tube because I agree that it is more stable and less likely to slip on out.

[kiwibubs]

In our unit we routinely nasally intubate, and only use oral intubation when nasal proves to difficult. We don't routinely sedate our ventilated babies so find the nasal tube much more stable and much easier to position babies who are moving about.

[PICNICRN, BSN, RN]

We do not usually see nasal intubations in our NICU except for the occasional Pierre Robin baby. I think the VAP protocol is VERY much against this! We do see it occasionally in the PICU with facial traumas or craniofacial surgery kiddos. Like Steve said... I think it is a pretty old and archaic practice.

[cc_nurse]

My full time employer does strictly oral intubation-my PRN employer has a host of physicians that prefer nasal intubations, for same reasons stated in previous posts. I only saw one done and it looked brutal, not that oral tubes aren't awful enough:uhoh21:

[lvnurs9]

I'm just curious... how, exactly, do you nasally intubate? I mean, how does a 3.0 or 3.5 ETT FIT in a 35 weekers nose?!?

[slcpicu]

All of our neonates that come back from cv surg are nasally intubated.

[kiwibubs]

I'm just curious... how, exactly, do you nasally intubate? I mean, how does a 3.0 or 3.5 ETT FIT in a 35 weekers nose?!?

We use as small as a 2.0 depending on weight, i find intubation a necessary nasty either way but if you have a skilled person completing the task, it can be a very smooth procedure.

I am not sure about USA policies or protocols, just thought i would share what we do in our unit in New Zealand.

[elizabells, BSN, RN]

I'm just curious... how, exactly, do you nasally intubate? I mean, how does a 3.0 or 3.5 ETT FIT in a 35 weekers nose?!?

Scope in the mouth, tube down the nose, Magill forceps in the mouth to guide it between the cords. Wacked-out taping method. We'll go down to a 2.5 on the wee ones, medium kids get 3.0s, and the chunksters get 3.5s. Once in a while we'll see a 4.0, but usually in the rare orally intubated kids.

[Rufa]

Thought you may like to hear about my last hospital stay where I was intubated through my nose while still fully awake.

I was in the emergancy department with a severe allergic reaction,my tongue was so swollen that it was taking up all my mouth and throat,I couldnt swollow,talk and I was struggling for breath.

I was told I was going to be put to sleep to help me breath and was taken to theatre where they continued to try and find an acess to my veins.

A central line pack was opened and I was prepared for a Femural line,but at the last min a line was found in my finger.

I was then told a camera was going to be put down my nose,and due to the fact I am allergic to Lidnocaine a long cotton bud was dipped in a bowl of liquid and rub around my nose getting deeper and deeper untill it would no longer reach.

Then a flexable black tube was put down my left nostril,all was fine and I felt nothing untill they started to struggle to get any further than the bottom of my nose,then the chocking started.

I heard them say they could not see a thing and eventually it must have gone down because I heard them asking for a (I thought I heard them say catherta)

Next thing I knew I was being chocked and struggling for breath,I tried to reach up and grab the tube out but they held my hands down and someone held my head back on the trolley.

In a few mins (what seemed like a life time) they said all done you are safe now.

I was given a light sedation of diazipan.

It was the worse thing I have ever experianced,not only the intubation but the sheer panic I was in the whole 24hrs it was in.

although my sats were fine,I felt that I was not getting enough air and was Breathing through a straw and having to suck air in from uphill.It didnt help that a mask was put over the tube and the plastic kept blocking off the hole unless it was right over the masks tube.The experiance of trying to breath through my mouth ( I am a mouth breather)was strange as nothing came in but the sounds came from the tube in my nose,the same for coughing.

I was uncomfortable and didnt dare move.

Had there not have been a ballon inflated down the tube I would have pulled it out the next day as like I said I was panicing.

When the tube was removed that was also very painfull and I suffered a running bleeding nose for the next few days and I developed a chesty cough,something I never get.

Well there it is ,a patients view of nasel intubation while still awake.

Does anyone have any idea why it was done awake?

I hope I never have to have it done again,but at the end of the day it did save my life.

I only came home last night from hospital and thought I would share my thoughts while they were still fresh.

I live in Shropshire in England.

[preemiex2]

I've only seen nasal intubations on our unit twice and they were both post-op tracheal reconstructions. Our ENT team thinks the tube doesn't move as much with nasal intubation as oral so the grafts have more time to heal successfully. Nasal intubations are ugly and seem barbaric on our tiny ones. It was nice to get both kiddos extubated and back to normal.