2003 OPEN FORUM Abstracts
USE OF A MODIFIED SYRINGE TO DETERMINE ENDOTRACHEAL INTUBATION IN A NEONATAL MODEL
James E. Martin, RRT-NPS, CPFT, Susan R. Ogrinc, RRT, CPFT, Kathleen Bauer, RRT, Monica Fundzak, RNC, NNP. Departments of Pediatrics, Pulmonary Services, and Neonatology, MetroHealth Medical Center, Cleveland, Ohio
INTRODUCTION: Animal intubation is considered to be a valuable opportunity to assist students in mastering the skill of neonatal intubation. Conventional means of determining endotracheal intubation are often not used. Manual resuscitation is avoided to prevent gastric distention if the tube is inserted in the esophagus. This leaves the traditional means of detecting intubation by auscultation and the presence of end tidal carbon dioxide not practical. During spontaneous breathing condensation may appear on the inside lumen of the endotracheal tube, however, with a deeply sedated animal the water vapor may not always be present. Direct visualization is the gold standard to assess tube placement but repeated airway manipulation can cause injury. To assist in determining tube placement, a modified 3 mL syringe with a 15 mm I.D. adapter was constructed to identifying tube placement in a cat. Similar methods have been used in adult patients with great success.
METHODS: A trained veterinary staff member prepared the cats for intubation
by administering Rompun 1.5mg/lb and Ketamine 9.0mg/lb subcutaneous 20 minutes
before intubation. The cats were swaddled in a blanket and placed in a ventral
dorsal position with the head facing the participant. Voluntary class participants
consisting of Physicians, Medical Students, Registered Nurses, and Respiratory
Care Practitioners were given the opportunity to intubate after a thorough explanation
of the procedure. Intubations were performed with a 3.0 uncuffed endotracheal
tube after direct laryngoscopy with a miller #1 blade. Following the removal
of the stylet, the instructor placed the 15-mm I.D. connection over the endotracheal
connection. The barrel of the syringe was aspirated to detect if resistance
was present. Resistance indicated esophageal placement, while no resistance
indicated tracheal intubation. Based on the results a decision was made
on the placement of the tube. After recording the instructors' decision, direct
laryngoscopy was performed to confirm placement.
RESULTS: 29
attempts were made with 11 esophageal and 18 tracheal intubations confirmed by
direct visualization. With the modified syringe 11/11 esophageal intubations
were positive for resistance. 18/18 endotracheal intubations had no resistance. A
positive predictive value for both esophageal and endotracheal intubation was
100%.
| Esophagus | Trachea | Visual Confirmation | |
| Resistance | 11 | 0 | 11 esophagus |
| NO Resistance | 0 | 18 | 18 trachea |
CONCLUSION: The syringe technique was very successful in determining the placement of the endotracheal tube in the cat intubation model. The use of this technique can facilitate earlier recognition of endotracheal tube placement and may require less visual confirmation by the instructor.