We read with interest the article by Sanuki et al, comparing nasal mucosal trauma between the Parker Flex-Tip nasotracheal tube and the conventional tracheal tube. Although a difference in the incidence of nasal mucosal trauma was observed between the two polyvinyl chloride (PVC) tubes, we would question the use of a PVC nasotracheal tube as standard practice for nasotracheal intubation. We believe that the use of more pliable material, such as the Mallinckrodt Satin nasotracheal tubes, is more common and also results in less trauma due to the softer nature of the material. Therefore, a more suitable comparison would be between the Parker Flex-Tip and a more pliable nasotracheal tube. We feel that the results of Sanuki et al offer minimal significance which maybe translated into clinical practice.
The use of an adjunct to guide the nasotracheal tube has been investigated previously and has shown to reduce the incidence of mucosal trauma.1In our experience, the use of the softer Mallinckrodt Satin tracheal tube, in combination with size Ch12 Jaques catheter as an adjunct, is a less traumatic alternative. The lubricated closed tip of the 4mm diameter Jaques catheter is inserted through the nose initially. The distal end of the catheter is attached to the tip of the nasotracheal tube (size 6.0 mm - 7.0 mm), which is then pushed along the nasal pathway (see Figure 1). The Jaques catheter is then removed using a Magill forceps followed by intubation in the conventional way. The catheter acts as a dilator, tube-tip guard and a guide for the tracheal tube through the nasal passage, and thereby reduces the risk of nasal mucosal damage. We propose the Jaques catheter as a simple and cheap adjunct (£0.84 each), allowing easy passage of nasotracheal tubes through the nasal turbinates.
Therefore, we think that a more appropriate comparison for the assessment of nasal trauma by the Parker Flex-Tip would be against the softer tracheal tubes in combination with a guiding catheter, such as the Jaques catheter.
Dr Helen Muir
Dr Baskar P Manickam
Department of Anaesthetics
Darlington Memorial Hospital
County Durham and Darlington NHS trust
Darlington
DL3 6HX
Baskar.Manickam@cddft.nhs.uk
References
- Enk D, Palmes A, Van Aken H and Westphal M. Nasotracheal Intubation: A Simple and Effective Technique to Reduce Nasopharyngeal Trauma and Tube Contamination. Anesthesia &Analgesia 2002; 95: 1432-1436.
