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LETTER TO THE EDITOR

A Novel Method of Nasotracheal Tube Fixation in Pediatric Patients Undergoing Neurosurgical Procedure in the Prone Position

Department of Anesthesia; SGPGIMS; Lucknow, India; aagarwal{at}sgpgi.ac.in

To the Editor:

Unplanned tracheal extubation may be life threatening, particularly in children in the prone position. Various methods of endotracheal tube (ETT) fixation have been described, including stitching the ETT, placing a transparent dressing over the face to secure the ETT, and intranasal threading of an infant feeding tube to tie over the ETT (1–3). We secure nasal ETTs using a 5-cm segment from a polyvinyl chloride ETT. As shown in Figures 1 and 2, a horizontal slit through both walls is made in the middle of this 5-cm tube with a scalpel (Fig. 1A). A silk thread is passed through the tube and a loop of thread is pulled out through one of the slits with forceps (Fig. 1A). After nasal intubation, the ETT circuit connector is removed (Fig. 1B) and the 5-cm tube, along with thread and loop, is glided over the proximal end of the ETT (Fig. 1C). A double loop of silk thread is made and passed over the ETT. Both the ends of the silk thread are pulled, firmly griping the ETT. The ends of thread are fixed to the face with adhesive plaster (Figs. 1D and 2).

View larger version (29K): [in this window] [in a new window]   Figure 1. Nasotracheal tube fixation technique in pediatric patients undergoing a neurosurgical procedure in the prone position.

View larger version (131K): [in this window] [in a new window]   Figure 2. The total assembly in situ before fixation with adhesive tape.

ACKNOWLEDGMENTS

Authors thank Mr. Anil Kumar (senior artist, SGPGIMS, Lucknow, INDIA) for hand-made sketches.

REFERENCES

1. Horn B, Stevenson GW. A new method of endotracheal tube fixation for pediatric neurosurgical patients. Anesthesiology 1993;78:618–9.[Web of Science][Medline]
2. Mikawa K, Maekawa N, Goto R, et al. Transparent dressing is useful for the secure fixation of the endotracheal tube. Anesthesiology 1991;75:1123–4.[Web of Science][Medline]
3. Bhat VR, Venkateshwaran G. A secure method of nasotracheal tube fixation using an infant feeding tube. Anesth Analg 2004;99:1352–4.[Abstract/Free Full Text]
4. Lovett PB, Flaxman A, Sturmann KM, Polly B. The insecure airway: a comparison of knots and commercial devices for securing endotracheal tubes. BMC Emerg Med 2006;6:7.[Medline]

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