Nasotracheal Intubation

Jolie, BSN · Jul 30, 2007

Hi all,
I know several of you use primarily NT intubation in your units from some of your posts.... I have just started out in a new unit, and this is all they use. I'm having a hard time believing that NT intubation is more stable and comfortable. I can't see how shoving a 2.5 ETT down the nare of a 450gm 23 weeker is less traumatic and more comfortable than a quick ET intubation:madface:. I have yet to see oral aversion caused by ETTs that couldn't be corrected. We used to use ETT's with premade tube holders in my last unit, and maybe had one or two accidental exubations. So what's the rationale behind this method?

I started out in a unit that used NTTs exclusively, and had a hard time getting used to OTTs later on in my career. I was never taught that nasal intubation made any difference in oral skills, but I can say that in my experience, NTTs are much more stable and are far less likely to be dislodged inadvertently.

I'm sure that in the next several months, you will learn and see a lot of practices that differ from what you are used to. I found that to be a great advantage to working in many different units in different geographic areas of the country. You will be well-versed in the "practical" aspects of patient care. Just don't forget the importance of evidence-based care!

babynurselsa, RN · Jul 30, 2007

I have primarily worked in units that only utilized only oral intubation. I have friends that worked in units that utilized Nasal intubation.

Some benefits I can see is not damaging the palate, avoiding oral aversion, not damaging future tooth buds.

I HAVE seen several kiddos over the years that ended up with oral aversion to the point of requiring a g-tube.

It can be tough going to a new place where things are 180 from whatever you have ever known. I am very receptive IF there is a rationale (other than "that is the way we have always done it") And I can see benefit to the patient and positive outcomes.

Good Luck

prmenrs, RN · Jul 30, 2007

I have not seen Nasotracheal intubation since ~ 1973 or so. Archaic IMO. And really bad for future ENT well-being.

SteveNNP, MSN, NP · Jul 30, 2007

I have not seen Nasotracheal intubation since ~ 1973 or so. Archaic IMO. And really bad for future ENT well-being.

AMEN Sister!!:yelclap:

prmenrs, RN · Jul 31, 2007

hehehe lol

Sweeper933 · Jul 31, 2007

Our unit has always used ET tubes since the unit first opened (around 1968...). We even still secure them the same way we did back them. We have a pretty low self-extubation rate, usually just on the bigger kids who move around a ton. From what our OTs have told me in the past, the babies on our unit who have developed oral aversion have done so d/t other reasons like abnormally frequent emesis or something like that.

Mimi2RN, ASN, RN · Jul 31, 2007

I can't imagine it would be comfortable having an ETT stuck up your nose. I know exactly how the babies feel when I insert an NG. They do tolerate NG's once they are in, but the insertion is miserable.

We use Neobars instead of taping ETT's in place, with much better results.

RainDreamer, BSN, RN · Jul 31, 2007

I haven't been a NICU nurse very long, but I've only ever seen endotracheal intubation in the unit I work.

I can't see how that could be more comfortable either, yikes.

fergus51 · Jul 31, 2007

I've worked with both and MUCH prefer NTs...

The main reason is for feeding and comfort. Like a previous poster, I have seen some really bad cases of oral aversion with orally intubated kids. Really bad. Also, babies who are nasally intubated can still use pacifiers!!!! We all know the benefits of non-nutritive sucking. In my experience kids who are nasally intubated are much calmer than those who are orally intubated and require much less sedation and pain meds (I seem to recall the op saying he gives a lot of those). I'm all for giving them when necessary, but I think it's better to use a pacifier and get the same results cause then you don't have to worry about any potential problems with using narcotics and anxiolytics on a developping premie's brain and you don't have to worry about withdrawal problems later. If NTs were so uncomfortable, you'd think that we'd have to use more pain meds to calm the babies and that hasn't been my experience at all.

I think this might be symptomatic of second unit syndrome. I truly think whatever a nurse started out doing in their first unit will always seem best to them.

fergus51 · Jul 31, 2007

I can't imagine it would be comfortable having an ETT stuck up your nose. I know exactly how the babies feel when I insert an NG. They do tolerate NG's once they are in, but the insertion is miserable.

I think that's the key. The intubation can be easier when it's oral, but I find the babies are much happier the rest of the time when it's nasal. Since the intubation itself takes very little time, I'd rather have that be less pleasant in exchange for more comfort for the baby while it's intubated.

LilPeanut, MSN, RN, NP · Aug 1, 2007

What ENT problems does nasal intubation cause?

I have never seen nasal intubation. Our orally intubated kids can use pacis still.

I've see a few problems with neobars. We don't use them on our unit typically. they seem to have more play than our traditional taping method. We've also had problems with kids who get vec'd or for some other reason start swelling, the bars can really start digging into the face.