bleeding after nasal intubation

[greengrass]

I generally thought that I was pretty smooth with nasal intubations.  However, lately, I have encountered one bleeding incidence where I almost lost the airway.  I usually apply Afrin to the nares, soften the tube in warm water, lube it and dilate the nostrils before I intubate.  Even with these, I had an episode of uncontrolled bleeding through the nose that when I DL the patient, I almost couldn't see anything.  Someone suggested red rubber catheter.  Does anyone have experience with it?  How do we use it?  Any better ideas? Thanks!

[jafo1964]

I was just wondering what ETT size you used. Most of us make the mistake of trying to push in a much larger ETT. It is recommended that the ETT be atleast less in dia by 1 mm than the correct oral ETT. Adult males should get only a 7 mm and female adults 6mm. Appropriate size adjustments to be made acoording to age

Other wise there is very little you can do in the face of profuse bleeding due to injury to the Little's area.
Good powerful working suction - Yaunkers in mouth
Another suction with soft catheter through the other nostril
and intubate at the earliest

regs

[Dr. Mian]

Seems like you take all the right precautions.  I agree with the previous post that it is prudent to use smaller diameter ETT's (by .5 to 1 size); this can sometimes be problematic with peds as ETT is more prone to mucous plug.  Bleeding sometimes will still occur.

[dhanvantri]

some points i feel very useful for nasal intubation,apart from one size smaller ETT are
  1. red rubber endotracheal tubes cause less damage as there is no murphy's eye and mucosal damage from cuff during insertion in the nostril is also less
  2.bevel should be away from septum during insertion in the nostril.so our tubes with left sided bevel r more useful for left nostril.if for the right nostril then we have to turn the tube so that bevel faces right side during insertion
  3.never force the tube in case of resistance.just roatate with screwing movements with gentle pressure
  4.i personally do a direct laryngoscopy view the larynx and then insert the nasal tube,so any complication i can still secure the airway very fast with oral intubation

[yogenbhatt1]

A Portex Nasal tube is very soft, the same material as in North Polar Tube. Majority time we do not get a nasal portex tube.
In this case, it is best to use the standard Portex tube. Take some warm water and dip the tube just before inserting( The tube should not be too hot), apply good amount of jelly and insert.
The soft tube goes in very nicely, only, one may need a Magille's Forceps to direct it.
Dipping the tube in warm water makes the tube very soft. Try it next time.