Securing the Nasotracheal Tube?

[Surgerati]

I'd like to get your opinions on securing the nasotracheal tube in the operating room.

1. Who secures the tube at your institution?

a. We make the OMS interns do it.... then we redo it.... i know anesthesiologists do it at some places....

2. How do you secure it?

a. We use silk tape, foam tape and the insert from a foam donut and then of course.. more tape.....

3. Is anyone aware of any preformed ready-to-go devices on the market?

a. I found one online by xodus medical when I googled nasotracheal tube immobilizer. Has anyone used this one and can report on it?

Frankly, I'm tired of wasting time in securing and/or re-securing the tube after the shoddy work of my interns and I'm looking to try something new.

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[Michael Scarn]

Why don't you just be a good upper and teach the interns how to do it properly.
Problem solved.

 

[Surgerati]

Thank you for the advice. I would appreciate more comments related to the questions.

 

[GTFOOMICT]

Haha this reminds me of being an extern. Try your hardest, 110%, and dammit, the et tube still isn't correct!

 

[recovering OMFS]

Suture to the nasal septum with 3-0 silk.

 

[ObviousGuy]

Suture to the nasal septum with 3-0 silk.

What perio residency did you go to? I always use 22 gauge wire in the nasal septum. Everyone knows wire holds stronger.

Actually, the tube is taped to a rolled up blue towel on the forhead and the tape goes around the head circumferentially. Luckily at my program the uppers weren't dicks and in all reality the NTT placement wasn't a huge issue.

Is it going to move? No. Then it's good enough
Is it going to come out of the trachea/nose? No. Then it's good enough
Will it cause nare necrosis? No. Then it's good enough.


Who secures it? Usually the OMS resident - doesn't matter who
How is it secured? with tape on a head wrap
Preformed devices? $$$$$ Just use a towel and silk tape

 

[Surgerati]

I don't suture or wire anything to the nasal septum unless I'm doing nasal surgery or a nasal fracture reduction (doyle splints) simply because any septal complication (hematoma,epistaxis, perforation,etc) would be indefensible if the justification for doing so was only to secure a nasotracheal tube and I wouldn't want that done to me simply to immobilize the tube.

I don't like the towel method because of the excessive amount of tape used and the indentions left on the patients forehead postoperatively due to pressure.

In certain hospitals anesthesiology policies dictate who secures the tube in the OR (anes vs oms/ent/prs). Sounds odd, but it is a reality.

OR time costs money, a concept usually taken for granted in residency, and in my experience securing a nasotracheal tube is overly time consuming.

I'm most interested in the variety of methods out there. Thanks for the replies.

 

[fonze]

Depends which attending does the case with you. Some prefer it the way you describe. The others like us to:
1. Place a pillow case around the head with the excess folded over on itself and silk tape it around the fore head
2. The long bit hanging off the head is then repeatedly folded (tightly) and placed on the forehead and taped.
3. The ETT is then taped to this
I actually prefer the 2nd method. You can pull really hard and it’s not going anywhere. The only thing that sucks is taking it off.

 

[recovering OMFS]

What perio residency did you go to? I always use 22 gauge wire in the nasal septum. Everyone knows wire holds stronger.

Actually, the tube is taped to a rolled up blue towel on the forhead and the tape goes around the head circumferentially. Luckily at my program the uppers weren't dicks and in all reality the NTT placement wasn't a huge issue.

Is it going to move? No. Then it's good enough
Is it going to come out of the trachea/nose? No. Then it's good enough
Will it cause nare necrosis? No. Then it's good enough.


Who secures it? Usually the OMS resident - doesn't matter who
How is it secured? with tape on a head wrap
Preformed devices? $$$$$ Just use a towel and silk tape

I didn't go to any perio residency, just 6 years of OMS followed by fellowship and few years in practice and few hundreds a year cases requiring nasal intubation were I used 3-0 silk to secure the tube, in my experience it is the most reliable way. After moving the face side to side few times the tape usually moves and is no longer holding the tube, just my 2 cents.