The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

BITE BLOCKS: REVIEW OF AVAILABLE EXPERIENCE

Ed Hoisington, RRT, Lucy Kester, MBA, RRT, James K. Stoller, M.D., Cleveland Clinic Foundation, Cleveland, Ohio

Introduction: Because inadvertent biting on the endotracheal tube with resultant tube occlusion is a common problem associated with oral intubation, devices called "bite blocks" have been developed and have been available since the 1970's. Despite their ubiquitous use, little attention has been given to the successes and potential hazards associated with bite blocks. In the context of reported past bite block-related complications (i.e., tube occlusion) and a recent complication we witnessed (i.e., cinching of the pilot balloon line), we reviewed the spectrum of available bite block devices and report experience regarding their use. Study Purpose: To review available bite block devices and available experience regarding their advantages and disadvantages.

Methods:
We conducted a search of the literature over the past 10 years, consulted respiratory therapy text books and the AARC's Buyer's Guide, and explored the internet for information regarding the effectiveness of available bite blocks to prevent oral endotracheal tube occlusion as well as associated complications of their use.

Results:
Until recently, the two most commonly used methods to prevent biting endotracheal tube are insertion of tongue depressors wrapped with gauze or tape (1, below) and the Guedel oral airway (2, below). Although the use of gauze and tape has the advantage of low expense, potential hazards include absorption of oral contaminants and bacteria, and allergic reactions to the tape. To our knowledge, only two commercially manufactured bite blocks are currently available. One device, equipped with a handle for insertion (3, below) is placed between the patient's molars to keep pressure off the endotracheal tube. A second device (4, below) wraps around the endotracheal tube, thereby keeping pressure off the tube. Our recent experience with this latter device suggests that caution should be exercised when securing a wrap-around device to ensure that over-tightening does not crimp the endotracheal tube or the pilot balloon line.

Conclusions:
1. Use of a bite block is often essential for preventing occlusion of the endotracheal tube by the patient's biting.
2. Our survey suggests that however simple, available devices are few and can incur risks, including crimping the endotracheal tube and the pilot balloon line.
3. These complications invite consideration of other devices designed to avert the current hazards. (See Original for Figure)

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