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African Journal of Emergency Medicine (2011) 1, 181–182
African Federation for Emergency Medicine
African Journal of Emergency Medicine
www.afjem.comwww.sciencedirect.com
Ujuzi
(Practical Pearl/Perle Pratique)
Eric Hodgson
Departments of Anaesthesia, Critical Care and Pain Management, Addington Hospital and Nelson R Mandela School of Medicine,Ethekwini-Durban, KwaZulu-Natal, South Africa
Received 5 October 2011; accepted 5 October 2011
Available online 20 October 2011
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KEYWORDS
Nasal;
Endotracheal intubation
mail addresses: iti20178@mw
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Abstract
ª 2011 African Federation for Emergency Medicine. Production and hosting by Elsevier B.V. All rights
reserved.
Ujuzi is intended to be a regular feature for colleagues toshare practical interventions, innovations and novelties that
have proved useful in the management of patients in the pre-hospital environment or Emergency Centre. As the editor, Ihave written the first article but this page is intended as a for-um so please send me any contributions you may have by
emailing [email protected]
Nasal intubation: avoiding epistaxis
Nasal intubation is a useful technique of airway control partic-ularly in children and infants. The usefulness of the techniquemay be offset by the occurrence of epistaxis caused by damage
to the nasal turbinates. Epistaxis may not only be uncomfort-able and distressing but may worsen any airway obstruction
n for Emergency Medicine.
. All rights reserved.
an Federation for Emergency
lsevier
that may be present and obviates the use of a subsequent fibre-optic technique.
Fig. 1 (a) Parker Flex-Tip� endotracheal tube. (b) LMA
Fastrach� endotracheal tube.
182 E. Hodgson
Epistaxis may be minimised by:
(1) Assessing nasal patency prior to intubation: The patient is
asked to inhale fully then exhale through the nose ontothe back of the assessing clinician’s hand. The nostrilwith the greatest airflow (usually the right) should be
used for intubation.(2) Choice of endotracheal tube1: The Parker Flex-Tip�
(SSEM-Mthembu) (Fig. 1a) and LMA Fastrach� (Mar-
land Medical) (Fig. 1b) have tips that slide rather thanscrape over the turbinates.
(3) Jacque’s catheter2: A soft rubber Jacques’ catheter canbe passed through the nose and out through the mouth.
The tip of the conventional endotracheal tube may thenbe placed inside the proximal end of the Jacques’ cathe-
ter protruding from the nose. The tube can be advanced
with the turbinates protected by the soft rubber. Oncethe tip of the tube is in the oropharynx the cathetercan be pulled off through the mouth and the tube
advanced into the trachea.
References
1. Sanuki T, Hirokane M, Matsuda Y, et al. The Parker Flex-Tip�tube for nasotracheal intubation: the influence on nasal mucosal
trauma. Anaesthesia 2010;65:8–11.
2. Watt S, Pickhardt D, Lerman J, et al. Telescoping tracheal tubes
into catheters minimizes epistaxis during nasotracheal intubation in
children. Anesthesiology 2007;106:238–42.
