The Science Journal of the American Association for Respiratory Care

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. 

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