Nasal tubes after stopping anti platelets or anticoagulation

[spike7585]

What's your thoughts on doing nasal intubations on patients who recently stopped plavix/eliquis/etc.

If cardiology cleared them to have a surgery after stopping for say 5 days, would you be comfortable doing a nasal endotracheal tube at that point? I know when they bleed, it can be a hot mess so wondering if there are any actual guidelines regarding this

Thanks

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[anaesthetic]

What's your thoughts on doing nasal intubations on patients who recently stopped plavix/eliquis/etc.

If cardiology cleared them to have a surgery after stopping for say 5 days, would you be comfortable doing a nasal endotracheal tube at that point? I know when they bleed, it can be a hot mess so wondering if there are any actual guidelines regarding this

Thanks

Not sure if I’ve seen guidelines for this. We do it occasionally for high carotids, sometimes with OMFS doing the subluxation. A lot of these patients are on aspirin/Plavix for multiple reasons, most of the time held but occasionally not.

I put red rubber tubing over the nasal RAE tip and pull both through until the red rubber comes out of the mouth. Then I remove the red rubber from the tip, DL/VL, and place the tube. Occasionally get an anterior airway: just inflate the balloon to lift the ETT up, then deflate as you advance. I rarely have to use the Magill forceps.

I’ve had zero bleeding for a couple of years now using this technique.

 

[Biochemist21]

Not sure if I’ve seen guidelines for this. We do it occasionally for high carotids, sometimes with OMFS doing the subluxation. A lot of these patients are on aspirin/Plavix for multiple reasons, most of the time held but occasionally not.

I put red rubber tubing over the nasal RAE tip and pull both through until the red rubber comes out of the mouth. Then I remove the red rubber from the tip, DL/VL, and place the tube. Occasionally get an anterior airway: just inflate the balloon to lift the ETT up, then deflate as you advance. I rarely have to use the Magill forceps.

I’ve had zero bleeding for a couple of years now using this technique.

I love the red rubber trick; been doing that for several years now. I genuinely think it does decrease bleeding because you're really just pulling the tube through the nose rather than pushing it in. It's the only way I do nasal intubations now.

The "inflate the balloon to life the ETT up" is a new one to me. Gonna try that next time I'm in a bar-fight-broken-mandible-OMFS room. Thanks.

 

[2Fast2Des]

I love the red rubber trick; been doing that for several years now. I genuinely think it does decrease bleeding because you're really just pulling the tube through the nose rather than pushing it in. It's the only way I do nasal intubations now.

The "inflate the balloon to life the ETT up" is a new one to me. Gonna try that next time I'm in a bar-fight-broken-mandible-OMFS room. Thanks.

What is this red rubber thing? Never heard of it

 

[MirrorTodd]

What is this red rubber thing? Never heard of it

Basically, shove the tip of the ETT into the top end of a red rubber catheter. It’s a tight fit, so the red rubber catheter won’t slip off. Then push the catheter through the nares and out the mouth, then pull it all through and pull the red catheter off the tip of the ETT. Supposed to be less traumatic.

 

[2Fast2Des]

Basically, shove the tip of the ETT into the top end of a red rubber catheter. It’s a tight fit, so the red rubber catheter won’t slip off. Then push the catheter through the nares and out the mouth, then pull it all through and pull the red catheter off the tip of the ETT. Supposed to be less traumatic.

Where do you find this red rubber catheter? Urology uses it?

 

[MirrorTodd]

Where do you find this red rubber catheter? Urology uses it?

Probably, it’s always just appeared when I asked for it.

 

[Biochemist21]

@2Fast2Des

Yea, it's technically a urology catheter although I think I've seen it used for everything except for urology stuff.