Inappropriate fixation of an endotracheal tube causing cuff malfunction resulting in difficult extubation

Insertion of cuff inflation line into pediatric tracheal tubes related to oral and nasal tracheal intubation depth

BACKGROUND

In clinical practice, the cuff inflation line of cuffed pediatric tracheal tubes often interferes with securing tracheal tubes.

METHODS

The insertion site of the cuff inflation lines and the lengths of four different brands and nine sizes of commonly used cuffed pediatric tracheal tubes were measured and compared in vitro with oral and nasotracheal intubation depths as calculated by different formulas for pediatric patients aged from birth to 16 years. Motoyama's recommendation was used for age-related size selection of cuffed pediatric tracheal tubes.

RESULTS

The proportion of the distance from the tracheal tube tip to the insertion site of the cuff inflation line varied considerably between the tracheal tubes (Microcuff: 48.5-60.7%; Parker: 48.7-73.2%; Ruesch: 59.1-77.8%; and Shiley: 46.0-60.3%). Using different formulas for oral or nasotracheal intubation depth, the insertion site of the cuff inflation line was placed within the oral or nasal cavity or within an area 1 cm beyond the teeth or the nostrils in almost all tracheal tubes tested. Positioning the insertion site 2 cm from the proximal end of the tracheal tubes resulted in a cuff line-free tube area of ≥1 cm in all orally and almost in all nasally inserted tracheal tubes, considering maximum recommended tracheal intubation depths.

CONCLUSION

The cuff inflation line in almost all commonly used cuffed pediatric tracheal tubes interferes with securing the tracheal tube due to its insertion site into the tracheal tube. This potentially carries the risk of kinking, obstruction, or damage to the cuff inflation line with ensuing failure to deflate or inflate the cuff. The proposed position of the insertion of the cuff inflation line 2 cm from the proximal end of the tracheal tube would ensure a 1-cm-wide cuff line-free circular area beyond the oral or nasal cavity in nearly all assessed tracheal tube sizes.

Comparison of three fixation methods for orotracheal intubation in 95 adults

BACKGROUND

The present study aimed to compare three fixation methods for orotracheal intubation.

METHODS

Through literature retrieval, the effects of the adhesive/twill tape method, fixator method, and adhesive/twill tape-fixator alternation method on patients with tracheal intubation in the intensive care unit (ICU) were compared.

RESULTS

The fixator and alternation methods were more effective in protecting the tongue mucosa and teeth. The alternation method was superior to the other two methods in maintaining the position of the endotracheal intubation. However, the difference in facial and lip injuries between the three methods was not statistically significant.

CONCLUSION

The fixator method can significantly reduce intraoral injury and is more suitable for older people with weak tongue mucosa and loose teeth. These are worth popularizing among a wider group.