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Tube Position (tube + position)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

An Evaluation of a Blind Rotational Technique for Selective Mainstem Intubation

ACADEMIC EMERGENCY MEDICINE, Issue 10 2004
Aaron E. Bair MD
Abstract Objectives: Although rare, massive hemoptysis and major bronchial disruptions are associated with high mortality. Selective ventilation of the uninvolved lung can increase the likelihood of survival. Specialized devices used for single lung ventilation are often not readily available and can be difficult to place in the emergency department. The authors evaluated a blind rotational technique for selective mainstem intubation using either a standard endotracheal tube (ET) or a directional-tip endotracheal tube (DTET). Methods: This was a prospective, randomized trial on 25 human cadavers. The desired side of mainstem intubation was determined by randomization. Each cadaver was used for four ET, four DTET, and four control intubations. In the ET group, the trachea was intubated. The tube was then rotated 90° in the direction of the desired placement and advanced until resistance was met. In the DTET group, the technique was identical, except the trigger was activated to flex the tip during advancement. In the control group, an ET was advanced in neutral alignment until resistance was met. A bronchoscopist blinded to the desired placement determined tube position. Comparison testing was performed using Pearson's chi-square test. Results: When attempting to intubate the left mainstem, use of the ET with the rotational technique was successful 72.3% of the time (95% confidence interval [95% CI] = 57% to 84%). Intubation of the left mainstem using the DTET was successful 68.5% of the time (95% CI = 54% to 81%; p = 0.67). Attempts to selectively intubate the right mainstem using the rotational technique were highly successful in both groups: 94% for the ET (95% CI = 84% to 99%) versus 97.8% for the DTET (95% CI = 89% to 100%). Among controls, the right mainstem was intubated 93% of the time (95% CI = 86% to 97%). Conclusions: In a cadaveric model, the left mainstem bronchus can be selectively intubated with moderate reliability using this rotational technique. Use of a DTET confers no significant advantage. The ability to generalize these findings to living subjects is unknown. [source]

Effectiveness of the auscultatory and pH methods in predicting feeding tube placement

JOURNAL OF CLINICAL NURSING, Issue 11-12 2010
e San Turgay
Aims and objectives., This study was designed to determine the effectiveness of the auscultatory and pH methods in predicting feeding tube location in critically ill patients. Background., There is confusion about how nurses should asses feeding tubes location at the bedside. The most common method for determining tube location is the auscultatory method. It is known that auscultation is an unreliable method and additional data relating to bedside methods are needed to assist nurses in making a decision regarding tube location. Design., A methodological study. Methods., The sample consisted of 44 new insertions of feeding tubes. Data from a total of 44 auscultations relating to tube position and gastrointestinal aspirates for pH were obtained from 32 critically ill adult patients ranging in age from 38,87 years. Results from the auscultatory and pH tests were compared with the location of the tube as determined by radiography. A total of 44 feeding tube applications were investigated using the auscultatory and pH methods and concurrently with X-rays to determine the feeding tube position. Nurses used the auscultatory method to predict tube position, a concurrent researcher aspirated fluid from the feeding tube, and samples were tested for pH within five minutes of radiographs taken to determine tube location. pH was measured with a test strip. Results., Mean pH level in the gastrointestinal aspirates was 4·23 (SD 1·20). Approximately 89% of the pH strip readings from gastrointestinal fluid were between 0,5. A pH of <5 successfully identified 90·4% of the 44 feeding tube cases. Conclusion., The pH method is effective in determining the feeding tube position, but the auscultatory method is not effective in determining the feeding tube position. Relevance to clinical practice., Simple bedside assessment of gastrointestinal aspirate pH is useful for predicting feeding tube position. [source]

Radiological validation of tracheal tube insertion depth in out-of-hospital and in-hospital emergency patients

ANAESTHESIA, Issue 9 2009
W. Geisser
Summary We performed a 5-year, retrospective study using records of 1081 patients admitted to the trauma emergency room at a University Hospital to investigate the occurrence of tracheal tube malpositioning after emergency intubation in both the inpatient and outpatient settings, using chest radiographs and CT scans in the trauma emergency room. Prehospital patients and inpatients referred from peripheral hospitals were compared. This study showed that tracheal tube misplacements occur with an incidence of 18.2%, of which almost a third (5.7%) were placed in a main bronchus. We further show that tracheal intubation in emergency patients approximates the misplacement rates in the prehospital or in-hospital settings. We speculate that the skill level of the operator may be critical in determining the success of tracheal intubation. Based on our findings, all efforts should be made to verify the tube position with immediate radiographic confirmation after admission to the emergency room. [source]