CATHETER-GUIDED NASOTRACHEAL INTUBATION
ADVANTAGES
Decrease in severity of nasopharyngeal bleeding compared to using softened nasoendotracheal tube alone
Minimizes epistaxis in children
DISADVANTAGES
Intubation takes longer
(12-19 seconds longer than warmed and room temperature tubes)
CONTRAINDICATIONS
Latex allergy
Coagulopathy
Impedement of the nasotracheal region (polyps, abscesses, foreign bodies)
Fracture at the base of the skull
Transphenoidal surgeries may leave a defect in the skull, increasing the risk for perforation with a nasal tube
Lefort 2 & 3 fractures- disruption of cribriform plate
TECHNIQUE
Assess for the more patent nostril.
Apply a topical vasoconstrictor.
The trailing end of the catheter is fitted around the tracheal tip of the nasal endotracheal tube.
Both are advanced through the nasopharynx.
When the red rubber catheter meets the oropharynx, use Magill's forceps to withdraw the catheter.
Use a tugging motion to withdraw and disconnect the red-rubber catheter from the nasotracheal tube.
Complete the intubation using direct laryngoscopy and Magill's forceps.