What ET tube lube are you using?

RE: What ET tube lube are you using?

Anthony Todd — Sat, 15 Dec 2018 09:40:41 GMT

[quote user="Evelyn Barbour-Hill"]Yes, I expect you did.[/quote]

We made it a sensible rule after a patient vomited a large amount of food while recovering on the table......

RE: What ET tube lube are you using?

Evelyn Barbour-Hill — Fri, 14 Dec 2018 22:11:04 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]This seems so intuitive to me.[/quote]

We just waited until the patient started to raise it's head....

[/quote]

Yes, I expect you did.

RE: What ET tube lube are you using?

Anthony Todd — Fri, 14 Dec 2018 22:05:30 GMT

[quote user="Evelyn Barbour-Hill"]This seems so intuitive to me.[/quote]

We just waited until the patient started to raise it's head....

PS "Dental", or better just D/O, means anything involving teeth and the associated gums.

I prided myself in getting all the relevant clinical and dispensing notes on one line of a 6x4 record cards prior to computers. [not advised now]

My colleague used just to write "For op." which made it a tactful guessing game sometimes....

RE: What ET tube lube are you using?

Evelyn Barbour-Hill — Fri, 14 Dec 2018 19:25:49 GMT

[quote user="Anthony Todd"]After dentals we just hung the head over the edge of the table dripped onto newspaper, could see any excessive haemorrhage too [tied cat's back legs][/quote]

Still not quite sure what "dentals" means, but let it pass...

After a dental procedure (or pretty well any other GA procedure for that matter) we lift the head up and open the jaw widely so that I can inspect the whole cavity and remove any fluid or solid that shouldn't be there. Then I remove the throat pack under direct vision and inspect again for anything that shouldn't be there. Then I deflate the cuff and withdraw the tube and quickly inspect the tube for any traces of blood (very rarely finding any). Then in a cat I remove the mucus from the nasopharynx with the technique I've described before. Only then do I instruct the nurse to return the patient to its recovery kennel (unless of course it is too big for her to lift).

This seems so intuitive to me.

RE: What ET tube lube are you using?

Anthony Todd — Fri, 14 Dec 2018 16:21:20 GMT

[quote user="Lucy Fleming"]I compromise by making sure that before the cuff is deflated the patient is lying with their head lower than their thoracic inlet[/quote]

After dentals we just hung the head over the edge of the table dripped onto newspaper, could see any excessive haemorrhage too [tied cat's back legs]

RE: What ET tube lube are you using?

Anthony Todd — Fri, 14 Dec 2018 16:15:25 GMT

To return to the thread!

The key and vital thing, as has been said before, is not to inject a set volume into any ET cuff! You are dealing with very low pressures [respiratory] so if you inflate the cuff while squeezing the bag just until the pharting stops, plus a little bit, you always get an airtight seal; in fact humans can even use a pressure gauge to ensure minimal pressure.

[There are sophisticated procedures to replace a necrotic section of trachea post GA with a section of the small bowel in humans.........]

If your patient coughs after GA check your cuff pressure!

RE: What ET tube lube are you using?

Anthony Todd — Fri, 14 Dec 2018 16:02:44 GMT

[quote user="Iain Richards"]Why use lube? Surely with a good technique it slips in every time.[/quote]

We've got to start a tangent.....................

RE: What ET tube lube are you using?

Anthony Todd — Fri, 14 Dec 2018 16:01:18 GMT

[quote user="Michael Woodhouse"] Personally I use use saliva.[/quote]

I don't quite understand; can you post a video please.

RE: What ET tube lube are you using?

Lucy Fleming — Mon, 17 Sep 2018 15:33:11 GMT

[quote user="Neil Wheadon"]

[quote user="Lucy Fleming"]the patient is lying with their head lower than their thoracic inlet [/quote]

Maybe teaching folks to suck eggs, but a towel under the shoulder, not the neck, as all that does is raise the trachea like a funnel

[/quote]

Good point! We have a table with a sloping end so the hard thinking work is done for us

RE: What ET tube lube are you using?

Neil Wheadon — Mon, 17 Sep 2018 15:31:34 GMT

[quote user="Lucy Fleming"]the patient is lying with their head lower than their thoracic inlet [/quote]

Maybe teaching folks to suck eggs, but a towel under the shoulder, not the neck, as all that does is raise the trachea like a funnel

Neil

RE: What ET tube lube are you using?

Lucy Fleming — Mon, 17 Sep 2018 15:24:51 GMT

I compromise by making sure that before the cuff is deflated the patient is lying with their head lower than their thoracic inlet (they tend to start in that position but by the time they have been flipped a few times for x-rays etc I find they have often migrated backwards) so that anything that has made its way past the pharyngeal pack is at least heading towards the mouth under the influence of gravity...

RE: What ET tube lube are you using?

Martin Atkinson — Mon, 17 Sep 2018 12:57:21 GMT

[quote user="Evelyn Barbour-Hill"]But it doesn't stop stuff getting down the trachea as far as the cuff.... and of course as soon as the cuff is deflated all that and what's in the pharynx can just gurgle straight down...[/quote]It will stop a lot more going down there than would otherwise and dare I say it?....I used to leave the cuff inflated while the tube was retracted and it never caused any damage but my nurses won't allow me to do that now!!

RE: What ET tube lube are you using?

Evelyn Barbour-Hill — Mon, 17 Sep 2018 12:18:11 GMT

[quote user="Martin Atkinson"]Surely you can't argue about the benefits of that.[/quote]

Nnn..o. I can argue about the nonsense nurses are taught, though.

[quote user="Martin Atkinson"] it also acts to reduce the risk of aspiration of vomit during any anaesthetic and fluids during a dental procedure.[/quote]

A little bit, yes, of course. But it doesn't stop stuff getting down the trachea as far as the cuff.... and of course as soon as the cuff is deflated all that and what's in the pharynx can just gurgle straight down...

Of course for any dental procedure, or indeed anything intra-oral, you should have a proper pharyngeal pack in place. But that has nothing to do with the need, or not, for a cuff on the tube.

RE: What ET tube lube are you using?

Martin Atkinson — Mon, 17 Sep 2018 11:45:24 GMT

[quote user="Evelyn Barbour-Hill"]The purpose of the cuff is not to prevent aspiration, it's to close up the difference between trachea inside diameter and tube outside diameter so that what the patient is breathing is pretty reliably getting on for 100% what's supplied by the tube.[/quote]That is the primary purpose but it also acts to reduce the risk of aspiration of vomit during any anaesthetic and fluids during a dental procedure. Surely you can't argue about the benefits of that.

RE: What ET tube lube are you using?

Chris Geddes — Mon, 17 Sep 2018 10:47:35 GMT

[quote user="Iain Richards"]Any (proper) anaesthetists on the forum? [/quote]

I don't know. But if you or anyone else is interested in this topic, anaesthetist Ian Self is doing a talk on airway management at LVS. In sponsored stream, as Docsinnovent are sponsoring, but of course content entirely independent. Not on the agenda yet but will be soon...

RE: What ET tube lube are you using?

Evelyn Barbour-Hill — Mon, 17 Sep 2018 00:26:31 GMT

Ah, Stephen, the old ones are still the best.....

[quote user="Martin Atkinson"]My nurses have been taught that if you pack the pharynx properly with swabs then there will be no fluid aspiration so a cuff is unnecessary.[/quote]

Who teaches nurses this stuff? The purpose of the cuff is not to prevent aspiration, it's to close up the difference between trachea inside diameter and tube outside diameter so that what the patient is breathing is pretty reliably getting on for 100% what's supplied by the tube.

If you're going to pack the pharynx, use a proper pharyngeal pack, which has a string to the outside, not something commonly seen on a swab although I suppose it can be arranged.

RE: What ET tube lube are you using?

Stephen Courtney — Sun, 16 Sep 2018 16:55:09 GMT

As an aside regarding personal lubrication, did you hear about the naive newly weds who got confused between KY jelly and window putty?

All their windows fell out.

RE: What ET tube lube are you using?

Martin Atkinson — Sat, 15 Sep 2018 10:36:41 GMT

My nurses have been taught that if you pack the pharynx properly with swabs then there will be no fluid aspiration so a cuff is unnecessary. This in practice, especially in a cat, is not as easy as it sounds and there is then an additional risk of leaving a swab in. Shouldn't happen but it has with fatal consequences but then a correctly inflated and managed ET tube shouldn't cause any damage either!

RE: What ET tube lube are you using?

Iain Richards — Sat, 15 Sep 2018 09:24:21 GMT

[quote user="Chris Geddes"]

Here's why:

http://veterinarymedicine.dvm360.com/idea-exchange-more-benefits-lubricating-endotracheal-tube-cuffs

[/quote]

Not exactly peer reviewed in a vet journal though. I'd be concerned about foreign material blocking a small airway especially in cats. However I have to concede that I'm gong on what I was taught and newer materials might have overcome this. Any (proper) anaesthetists on the forum?

RE: What ET tube lube are you using?

Joyce Whitehead — Fri, 14 Sep 2018 20:27:55 GMT

I’ve never used any lubrication on ET tubes, and can’t say I feel there is any problem getting tubes in.

RE: What ET tube lube are you using?

Clive Ansell — Fri, 14 Sep 2018 17:20:22 GMT

I don't use any form of lubricant (For ET tubes), don't like the idea of introducing any more foreign material than necessary, or painting the tracheal lining with KY or similar. Never had any problems.

RE: What ET tube lube are you using?

Bob Russell — Fri, 14 Sep 2018 17:15:06 GMT

We don't keep the same tube of KY in the operating theatre for long. It gets changed frequently, the rest moving into the consulting room for glove lubrication, generally for places that are very far from sterile!!

RE: What ET tube lube are you using?

Martin Atkinson — Fri, 14 Sep 2018 16:59:31 GMT

[quote user="Chris Geddes"]Major difference is that VetLube is sterile (yes, I know the pharynx isn't sterile before anyone points that out - doesn't necessarily mean you want to introduce more pathogens) and it's easier and less messy to apply as it comes in spray form.[/quote]First thing the more initimate areas that are stereotypically the site for use of KY jelly don't seem to suffer from a lack of sterility (I wouldn't of course know this from personal experience).

Secondly, it beats me how spray is less messy than a blob from a tube. KY works perfectly, cheap and cheerful.

RE: What ET tube lube are you using?

Chris Geddes — Fri, 14 Sep 2018 16:01:14 GMT

[quote user="Aisling McGrath"]

Silly question perhaps. But should we be using a specific lubricant for ET tubes? One of our new nurses has said in her previous practice they only used Millpledge VetLube for ET tubes and nothing else.

[/quote]

Just to clarify - the VetLube is made by Docsinnovent and distributed by Millpledge in the UK.

Major difference is that VetLube is sterile (yes, I know the pharynx isn't sterile before anyone points that out - doesn't necessarily mean you want to introduce more pathogens) and it's easier and less messy to apply as it comes in spray form.

RE: What ET tube lube are you using?

Evelyn Barbour-Hill — Fri, 14 Sep 2018 15:59:19 GMT

[quote user="Aisling McGrath"]Silly question perhaps. But should we be using a specific lubricant for ET tubes?[/quote]

Saliva and mucus from the pharynx. Just swirl the tube around for a second or two.