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Novel technique in difficult percutaneous tracheostomy.

Gupta B, Kaur M, D'souza N, Sinha C - Saudi J Anaesth (2011)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi, India.

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We describe a technique using a standard nasogastric tube (NGT) that allows precise and safe placement of tracheostomy tubes in patients under emergency situation of false passage... An endotracheal tube (ETT) which had been withdrawn upto glottis was pushed caudally so that it occupied the distal end of the trachea, sealing off the rent created by dilation of the tracheostomy tract... The ETT served as a guide for the Ryle’s tube into the trachea... The ETT was again withdrawn upto the glottis so that the Ryle’s tube could be visualized through the rent in the trachea... Oral end of the Ryle’s tube was taken out through the tracheal stoma with distal end in distal end of trachea [Figure 2]... After the tracheostomy tube is in place, the NGT is removed... Oxygenation and ventilation was continued during the whole procedure [Figure 3]... Its use, however, requires some expertise and experience that will not be in the armamentarium of all and besides its availability at the bedside is limited... So we devised an easy and readily available technique to overcome the airway emergency situation... With routine, scheduled tracheostomy tube changes, the situation may be similar... Alternative “guidewires-red rubber catheter, suction catheter” techniques are less beneficial because they are too flexible and may not provide an adequate guide for the tube into the trachea... Limitation to this technique is that the inner tube has to be removed for railroading of tracheostomy tube over Ryle’s tube.

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Insertion of Ryle’s tube through the ETT
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Figure 0001: Insertion of Ryle’s tube through the ETT

Mentions: An endotracheal tube (ETT) which had been withdrawn upto glottis was pushed caudally so that it occupied the distal end of the trachea, sealing off the rent created by dilation of the tracheostomy tract. A Ryle’s tube with its tip cut was inserted through the ETT already in situ [Figure 1]. The ETT served as a guide for the Ryle’s tube into the trachea. The ETT was again withdrawn upto the glottis so that the Ryle’s tube could be visualized through the rent in the trachea. Oral end of the Ryle’s tube was taken out through the tracheal stoma with distal end in distal end of trachea [Figure 2]. The NGT serves as a guidewire for the tracheostomy tube, which is then advanced gently over the NGT and into the trachea. After the tracheostomy tube is in place, the NGT is removed. Oxygenation and ventilation was continued during the whole procedure [Figure 3]. Initially when the NGT passed through the ETT, its proximal end passed under the ventilator attachment and later when NGT oral end was out of tracheal stoma supplemental oxygen was hooked into the NGT to help ameliorate hypoxia. The fiberoptic endoscope is an excellent method for the proper placement of tracheostomy tubes[2] and prevention of false passage. Its use, however, requires some expertise and experience that will not be in the armamentarium of all and besides its availability at the bedside is limited. So we devised an easy and readily available technique to overcome the airway emergency situation. With routine, scheduled tracheostomy tube changes, the situation may be similar. Alternative “guidewires-red rubber catheter, suction catheter” techniques are less beneficial because they are too flexible and may not provide an adequate guide for the tube into the trachea.[3] Limitation to this technique is that the inner tube has to be removed for railroading of tracheostomy tube over Ryle’s tube. False passage can be a challenging and a frightening procedure for the physician. In a difficult tracheostomy scenario or during creation of a false passage, tracheostomy tube can be railroaded over the Ryle’s tube.


Novel technique in difficult percutaneous tracheostomy.

Gupta B, Kaur M, D'souza N, Sinha C - Saudi J Anaesth (2011)

Insertion of Ryle’s tube through the ETT
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3101742&req=5

Figure 0001: Insertion of Ryle’s tube through the ETT
Mentions: An endotracheal tube (ETT) which had been withdrawn upto glottis was pushed caudally so that it occupied the distal end of the trachea, sealing off the rent created by dilation of the tracheostomy tract. A Ryle’s tube with its tip cut was inserted through the ETT already in situ [Figure 1]. The ETT served as a guide for the Ryle’s tube into the trachea. The ETT was again withdrawn upto the glottis so that the Ryle’s tube could be visualized through the rent in the trachea. Oral end of the Ryle’s tube was taken out through the tracheal stoma with distal end in distal end of trachea [Figure 2]. The NGT serves as a guidewire for the tracheostomy tube, which is then advanced gently over the NGT and into the trachea. After the tracheostomy tube is in place, the NGT is removed. Oxygenation and ventilation was continued during the whole procedure [Figure 3]. Initially when the NGT passed through the ETT, its proximal end passed under the ventilator attachment and later when NGT oral end was out of tracheal stoma supplemental oxygen was hooked into the NGT to help ameliorate hypoxia. The fiberoptic endoscope is an excellent method for the proper placement of tracheostomy tubes[2] and prevention of false passage. Its use, however, requires some expertise and experience that will not be in the armamentarium of all and besides its availability at the bedside is limited. So we devised an easy and readily available technique to overcome the airway emergency situation. With routine, scheduled tracheostomy tube changes, the situation may be similar. Alternative “guidewires-red rubber catheter, suction catheter” techniques are less beneficial because they are too flexible and may not provide an adequate guide for the tube into the trachea.[3] Limitation to this technique is that the inner tube has to be removed for railroading of tracheostomy tube over Ryle’s tube. False passage can be a challenging and a frightening procedure for the physician. In a difficult tracheostomy scenario or during creation of a false passage, tracheostomy tube can be railroaded over the Ryle’s tube.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, All India Institute of Medical Sciences, J.P.N.A Trauma Centre, New Delhi, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We describe a technique using a standard nasogastric tube (NGT) that allows precise and safe placement of tracheostomy tubes in patients under emergency situation of false passage... An endotracheal tube (ETT) which had been withdrawn upto glottis was pushed caudally so that it occupied the distal end of the trachea, sealing off the rent created by dilation of the tracheostomy tract... The ETT served as a guide for the Ryle’s tube into the trachea... The ETT was again withdrawn upto the glottis so that the Ryle’s tube could be visualized through the rent in the trachea... Oral end of the Ryle’s tube was taken out through the tracheal stoma with distal end in distal end of trachea [Figure 2]... After the tracheostomy tube is in place, the NGT is removed... Oxygenation and ventilation was continued during the whole procedure [Figure 3]... Its use, however, requires some expertise and experience that will not be in the armamentarium of all and besides its availability at the bedside is limited... So we devised an easy and readily available technique to overcome the airway emergency situation... With routine, scheduled tracheostomy tube changes, the situation may be similar... Alternative “guidewires-red rubber catheter, suction catheter” techniques are less beneficial because they are too flexible and may not provide an adequate guide for the tube into the trachea... Limitation to this technique is that the inner tube has to be removed for railroading of tracheostomy tube over Ryle’s tube.

No MeSH data available.