'The nasogastric tube tie'

INDICATIONS

This technique can be a useful 'last resort' approach to securing an oral endotracheal tube, for example in the edentulous patient (no dental floss tie) with a bushy beard (no tape) presenting for c-spine surgery (no tie around the neck)!


EQUIPMENT

You will need your laryngoscope, a Magill forceps and a nasogastric or tracheal suctioning tube.


TECHNIQUE

Here is how this technique works:

After intubating in the usual fashion, place a lubricated nasogastric or tracheal suction tube through either nostril. The tube should be inserted just far enough for the tip to lie in the oropharynx. Remember that at this stage your ET tube is not secured, so avoid any tension on the tube by using a tube support or assisstant to hold the tube.

Insert the laryngoscope and visualize the tube tip in the oropharynx. There is no need to perform a full laryngoscopy.

Grasp the tube with the Magill forceps and pull its end out through the mouth.

Start taping the two strands of the tube together beginning distally and working your way towards the patient. Stop the taping at a point where the tube loop inside the atient is neither too tight or too lose. Too lose and the ET tube won't be adequately secured in the end, too tight and the tube loop might cause tissue ischemia secondary to pressure.

In a final step. 'buddy-strap' the ET tube to the nasogastric tube loop that you created.

Remember to have scissors available to cut the tube loop for extubation!


OTHER CONSIDERATIONS

Since this method secures the ET tube with a loop around the soft palate, it is important to avoid any drag or pull on the ET tube since this might cause tissue ischemia. For the same reason this way of securing the ET tube should probably not be used for a prolonged time, e.g. in an ICU setting.