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A simple technique to secure the endotracheal tube over an intubating fibrescope

Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India, E-mail: neema{at}sctimst.ac.in; praveenneema{at}yahoo.co.in

To the Editor:

We use the Intubation Fiberscope (Pentax FI-10P2; Tokyo, Japan) in patients with anticipated difficult airways and in situations where neck movement should be avoided during intubation, including all causes of atlantoaxial instability. The technique of intubation with the fibrescope consists of placing the shaft of the bronchoscope tube in the trachea under indirect vision, followed by railroading the endotracheal tube over the insertion tube. Before intubation, the endotracheal tube is loaded on the bronchoscope up to the proximal end of the insertion tube of the fibrescope. The endotracheal tube is then secured at the proximal end by sliding up the tube firmly, with its position being maintained by a twisting motion or use of adhesive tape. However, not infrequently, the endotracheal tube slides down the fibrescope shaft during bronchoscopy, and additional assistance may be required to secure its position during the endoscopic procedure to prevent interference and to facilitate proper positioning of the fibrescope within the trachea.

We have adapted a simple technique that easily and reliably secures the endotracheal tube at the proximal end of the insertion tube. The fibrescope controlbody has an instrument channel, the proximal end of which protrudes like a hook. From this instrument channel, the endotracheal tube may be easily secured by placing a rubber band at its proximal end around the 15 mm blue connector. Thereafter, the endotracheal tube is threaded over the shaft of the intubation fibrescope. Once positioned, the rubber band is rotated to achieve a figure-of-eight, and is then slid over the proximal end of the instrument channel (Figure). The rubber band firmly secures the endotracheal tube in place, and the tube can be released easily after the fibrescope has been correctly positioned. We have found this method of temporary securing of the endotracheal tube to be effective and reliable during fibreoptic intubation.

View larger version (82K): [in this window] [in a new window]   FIGURE The endotracheal tube is held in position by a rubber band sling, with a figure-of-eight around the blue connector and instrument channel inlet; the inset shows an enlarged view of the blue connector of the endotracheal tube and instrument channel on the control body of the intubation fibrescope.

Footnotes

Accepted for publication October 23, 2006.

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