Atraumatic nasal intubation

Trauma associated with nasotracheal intubation is comnion, from minor mucosal damage with epistaxis through to dislodgement of polyps, adenoids or turbinates with haemorrhage and o r airway obstruction or even False passages with penetration of cranial vault [I]. Previously I have used a technique involving the use of the fluted end of a red rubber catheter passed over the end of the tracheal tube [2]. This is effective but has the problem that one still has to visualise the oropharynx, pass the catheter out through the mouth then remove the catheter; the catheter has to be attached securely so that it doesn't fall off, but not sufficiently loose to be removable. As an alternative, passage of a Foley catheter to the end of the tube then inflated with saline (the saline discourages bulging), results in a smooth tapered end (Figs 1 and 2). As well as the smooth taper it allows ample application of lubricant. This can be passed much less traumatically with lessened danger of disturbing intranasal structures or creating false passages and absolutely no risk of obstruction of the tip with debris. Once in the oral cavity i t can be advanced 'blind' or under vision by laryngoscopy, the catheter being deflated and removed once passed through the cords, or it can be deflated at this stage and passed under fibre optic guidance. I have been using this technique as a routine and found it particularly useful for fibreoptic guided nasal intubation. Fig. 1.