Arise Tube- A Novel Double-Lumen Suction Tube for Oesophageal Atresia

Abstract

Abstract Background: Airway compromise is a major criterion that determines the outcome of care in oesophageal atresia (OA). The maintenance of dry throat through suction of the airway and throat is a vital step to the survival of neonates with OA. This prevents aspiration of saliva and mucus plugging of the airway which can compromise pulmonary function. Pre-operative aspiration pneumonitis increases the morbidity and possible mortality of neonatal OA. The Replogle® tube is usually not readily available and costly for caregivers in most centres in the low-income countries. Objective: To introduce a local adaptation of suction tubing for clearance of the airway in OA. Method and Case Series: The Abdur-Rahman Ilorin Suction oEsophageal (ARISE) suction tube is constructed with a size 6 Fr feeding tube which was tunnelled from a side opening into the lumen of a 10 Fr feeding tube. The distance of the pouch from the incisor is first measured and multiple fenestrations (1 cm apart) are made on the wall of the outer tubes sparing about 2 cm from the measured length near the incisor. Three side fenestrations are made 1.5 cm apart from the tip on the side of the inner tube. The ARISE tube is placed in the upper OA pouch to suck saliva and prevent aspiration in the neonate. The tip of tube is positioned about 0.5 cm above the blind end of the oesophageal pouch. The inner (small lumen) tube is connected to a low-pressure suction machine at 0.2KPa (−15 to −35 cm H2O) for continuous drainage of saliva and the outer (big lumen) tube functions as air vent and irrigation channel. This protects the mucosal from being sucked into the inner tube lumen. Irrigation of tube is done with 2–3 ml of 0.9% saline every 4 h and as necessary. Result: This ARISE suction tube allowed adequate and continuous suction of the pouch and throat with the baby being calm, and caregivers also stress free. The patient maintained good arterial oxygen saturation and there was no aspiration into the airway. Conclusion: The ARISE double-lumen suction tube can easily be constructed in many resource-poor health institutions where OA is managed. This will improve the pre-operative management of neonatal OA in such environment making the baby’s condition optimal for surgical intervention.