Kinking Of Tube Research Articles

The effectiveness of chest T-tube drainage in uniportal video-assisted thoracic surgery.

Uniportal incision located at 4th or 5th intercostal space represents a problem for the correct drainage of distal areas of pleural cavity. The T-shaped tube can drain both the extremities of pleural space. In this study, we evaluated the effectiveness of T-chest tube compared to classic chest tube after uniportal video-assisted thoracic surgery. We compared the effectiveness of T-tube and classic 28 CH chest drainage after different surgical procedures in uniportal video-assisted thoracic surgery: lobectomies, wedge resections and pleural and mediastinal biopsies. As primary end points, drained effusion and evidence of pneumothorax at postoperative day 1, subcutaneous emphysema, tube kinking, obstruction and necessity of repositioning or postoperative thoracentesis were considered. Pain at 6 and 24 h after surgery, pain at tube removal and mean hospitalization were analysed as secondary end points. A total of 109 patients were selected for the study, 51 included to the T-tube group while the other 58 ones to the control group with classic drainage. Patients with T-tube showed a significantly lower rate of pneumothorax (29.4% vs 63.8%; P < 0.001), tube kinking (5.9% vs 27.6%; P = 0.003) and need of repositioning (2.0% vs 12.1%; P = 0.043). No significant results were obtained in subcutaneous emphysema (P = 0.26), tube obstruction (P = 0.32), drained effusion (P = 0.11) and need of postoperative thoracentesis (P = 0.18). Patients with T-tube complained of <6 h after surgery (P < 0.001). Conversely, T-tube removal was reported to be more painful (P < 0.001). Chest T-tube can achieve significantly lower rate of postoperative pneumothorax, kinking and repositioning with less pain 6 hours after surgery compared to classic tube.

Endotracheal Tube Kinking in a Prone Patient with Endotracheal Tube Re-Attachment：A Case Report

Endotracheal Tube Kinking in a Prone Patient with Endotracheal Tube Re-Attachment：A Case Report

Straighten the neck when the tube is bent: Tackling endotracheal tube kink in the supine position.

Straighten the neck when the tube is bent: Tackling endotracheal tube kink in the supine position.

Rare Event of Intraoral Kinking of Endotracheal Tube Upon Prone Positioning in a Patient Undergoing Posterior Fossa Surgery

Prone position is commonly employed for many surgical procedures including neurosurgeries, spine surgeries, urological procedures, and in refractory ARDS patients. An endotracheal tube is a conduit to provide a secured airway to the patient. But in case of any equipment failure, it can cause catastrophic events. Intra-oral kinking is a rarer event. It can pose a major troubleshooting standstill owing to the inaccessible view of the kinked portion and the rarity of its occurrence to cross the clinician’s mind in the emergency scenario. We thus report this as the first such case of intraoral kinking against the soft palate in the prone position.

Oropharyngeal kinking of the tracheal tube during laparoscopic surgery.

Oropharyngeal kinking of the tracheal tube during laparoscopic surgery.

Failed endotracheal tube cuff deflation due to unusual kinking of inflation tube.

Failed endotracheal tube cuff deflation due to unusual kinking of inflation tube.

Role of Endotracheal Tube Cuff Deflation in Facilitating Passage of Nasogastric Tube.

BackgroundNasogastric tube insertion is a routinely performed technique in anesthetized and intubated patients. However, failure leads to repeated insertion attempts causing injury, which makes the situation cumbersome. Therefore, we introduce a simple technique of deflating endotracheal tube cuff for nasogastric tube insertion in such patients.MethodsEighty adult patients scheduled for elective abdominal surgeries were randomly allocated into two groups, Group A (nasogastric tube insertion without endotracheal cuff deflation) and Group B (nasogastric tube insertion with endotracheal tube cuff deflation) along with lateral pressure application at cricoid in both groups. The number of attempts required, overall success rate, the time taken, rescue maneuvers, and incidence of complications were compared between the groups.ResultsIn Group B, the total success rate for nasogastric tube placement was significantly higher than in Group A (80% vs 55%, p=0.016). Group B had a 55% first attempt success rate, but only 25% of patients in Group A had a first attempt success rate (p=0.014). The overall time for successful nasogastric tube placement was longer in Group A than in Group B (65.4 ± 28.72 seconds vs 43.5 ± 25.37 seconds, p=0.0005). The differences in nasogastric tube kinking and coiling between Group B and Group A were not statistically significant (20% vs 22.5%, 10% vs 27.5%, p = 0.78 and 0.08, respectively). Mucosal bleeding was substantially higher in Group A than in Group B (30% vs 10%, p=0.025, respectively).ConclusionsThis study showed that endotracheal tube deflation significantly increased the first-attempt success rate, overall successful placement of the nasogastric tube in intubated patients, and incidence of complications like mucosal bleeding decreased.

Intraoperative Management of a Severely Kinked Endotracheal Tube and Difficult Airway.

This figure is a lateral cervical radiograph of a nasally intubated 16-yr-old patient with Crouzon syndrome obtained after completion of cranial fossa surgery for Chiari malformation and returning to supine from a prone position. The standard endotracheal tube was severely kinked in the nasopharynx, as shown in the image, and the location of the kinking is indicated with a red arrow. This was likely caused by the warming of the endotracheal tube and the patient’s unique pharyngeal anatomy. The tracheal intubation of the patient was difficult, requiring 11 attempts due to midface hypoplasia, obesity, macroglossia, and cervical spine instability. After the start of surgery, elevated airway pressures and the inability to pass a suction catheter suggested kinking of the endotracheal tube. Due to extremely difficult intubation, endotracheal tube replacement was not attempted. Because the severely kinked endotracheal tube limited inspiratory and expiratory airflow, adequate tidal volume was achieved by increasing peak inspiratory pressure.1 Intermittent measurement of plateau pressure with an expiratory hold yielded additional information about the pressure at the alveoli. Because expiration was passive, increasing the expiratory time facilitated exhalation and reduced the risk of breath stacking.2 A helium–oxygen mixture can also be used to improve ventilation by reducing gas density, increasing the likelihood of maintaining laminar flow across the point of obstruction, and improving bulk flow.3 If the patient can tolerate permissive hypercapnia, a reduction in minute ventilation is also an option to minimize turbulent flow. The use of a wire-reinforced tube is often recommended to prevent endotracheal tube kinking in such a patient.The authors declare no competing interests.

Intraoperative endotracheal tube kinking: clinical findings and early diagnosis.

Intraoperative endotracheal tube kinking: clinical findings and early diagnosis.

Retrospective Evaluation of the Use and Complications of Small-Bore Wire-Guided Thoracostomy Tubes in Dogs and Cats: 156 Cases (2007-2019).

BackgroundSmall-bore wire-guided thoracostomy tubes (SBWGTT) are commonly used in small animals for management of pleural space disease. We aimed to evaluate the indications, placement locations, types of complications, and complication rate of small-bore wire-guided thoracostomy tube placements in dogs and cats in a university setting.MethodsElectronic medical records of patients that underwent SBWGTT placement were reviewed. Signalment, disease, outcome, indication for thoracostomy tube, placement location, number of attempts, diagnostic imaging, number, and type (insertional, technical, and infectious) of complications were recorded. Logistic regression analysis was performed to determine risk factors for complications.ResultsA hundred fifty-six cases were identified between 2007 and 2019. Traumatic pneumothorax (33%), pyothorax (25%), and spontaneous pneumothorax (16%) were the most common indications for placement of a SBWGTT. Complications developed in 50 cases (32%). Technical and insertional complications accounted for 21.7% and 14.1% of all cases. Infectious complications were rare with 3.1% of all cases. Pneumothorax (19%), soft tissue swelling at insertion site (14%), and kinking of the chest tube (13%) were most common. Accidental lung perforation was reported in 5/50 complications (7%). Multiple chest tube placement attempts were associated with complications (OR = 6.01 CI: 2.13 to 16.93 p = 0.0007).ConclusionsComplications of SBWGTT placement occurred in one third of cases. Serious complications such as accidental lung perforation was reported in two cases. Complications were associated with number of attempts.

Effect of External Ventricular Drain Care Guidelines on Nursing Practice and Complications among Patients with Post-Traumatic Hydrocephalus

Background: External Ventricular Drain (EVD) care is considered as an advanced specialized nursing skill for neurological patients. EVD care guidelines plays a vital role in improving nurses’ practices regarding care of patients with EVD. The complications associated with EVD are strongly linked with nursing care as well as their level of practices. Unfortunately, in clinical settings most of nurses have incompetent EVD care practices. So, there is a dire need to adopt EVD care guidelines to improve their practices regarding EVD care. Objective: To assess the effect of external ventricular drain care guidelines on nursing practice and complications among patients with post traumatic hydrocephalus. Methodology: A quasi experimental study included 120 registered nurses and 80 patients selected with a purposive sampling technique. A 10 weeks educational intervention consists of PowerPoint lectures on EVD care guidelines of American Association of Neuroscience Nurses (AANN), audio visual demonstration (AVD) and hands on workshop practice sessions were given by the expert of relevant field to registered nurses on caring of patients with (EVD). Data on nurses’ practices and complications among patients were collected two times before and after the intervention via validated tools. Results: The study revealed a significant (p&lt;0.001) change in nurses’ practices and patients’ complications after External ventricular drain (EVD) care guidelines implementation. The practices had been competent as 79 (65.8%) from 8(6.7%). The complication of meningitis in pre-guidelines implementation was 30 (75%) and post-guidelines implementation it was 13(32.5%).The kinking of tube was reduced from 4 (10.0%) to 3(7.5%). After guidelines implementation the rest of complications of EVD were also reduced among patients. Conclusion: External ventricular drain (EVD) care guidelines of American Association of Neuroscience Nurses (AANN) significantly improve registered nurses practices which ultimately reduced the complications of EVD among patients. Key words: Post Traumatic hydrocephalus, External ventricular Drain care guidelines, Registered Nurses, Practice, Complications, Patients

Effect of External Ventricular Drain Care Guidelines on Nursing Practice and Complications among Patients with Post Traumatic Hydrocephalus

Background: External Ventricular Drain (EVD) care is considered as an advanced specialized nursing skill for neurological patients. EVD care guidelines plays a vital role in improving nurses’ practices regarding care of patients with EVD. The complications associated with EVD are strongly linked with nursing care as well as their level of practices. Unfortunately, in clinical settings most of nurses have incompetent EVD care practices. So, there is a dire need to adopt EVD care guidelines to improve their practices regarding EVD care. Objective: To assess the effect of external ventricular drain care guidelines on nursing practice and complications among patients with post traumatic hydrocephalus. Methodology: A quasi experimental study included 120 registered nurses and 80 patients selected with a purposive sampling technique. A 10 weeks educational intervention consists of PowerPoint lectures on EVD care guidelines of American Association of Neuroscience Nurses (AANN), audio visual demonstration (AVD) and hands on workshop practice sessions were given by the expert of relevant field to registered nurses on caring of patients with (EVD). Data on nurses’ practices and complications among patients were collected two times before and after the intervention via validated tools. Results: The study revealed a significant (p&lt;0.001) change in nurses’ practices and patients’ complications after External ventricular drain (EVD) care guidelines implementation. The practices had been competent as 79 (65.8%) from 8(6.7%). The complication of meningitis in pre-guidelines implementation was 30 (75%) and post-guidelines implementation it was 13(32.5%).The kinking of tube was reduced from 4 (10.0%) to 3(7.5%). After guidelines implementation the rest of complications of EVD were also reduced among patients. Conclusion: External ventricular drain (EVD) care guidelines of American Association of Neuroscience Nurses (AANN) significantly improve registered nurses practices which ultimately reduced the complications of EVD among patients. Keywords: Post Traumatic hydrocephalus, External ventricular Drain care guidelines, Registered Nurses, Practice, Complications, Patients

Adverse events of emergency surgical front of neck airway access: an observational descriptive study.

AimEmergency front of neck access (eFONA), such as scalpel cricothyroidotomy, is a rescue technique used to open the airway during “cannot intubate, cannot oxygenate” situations. However, little is known about the adverse events associated with the procedure. This study aimed to describe the adverse events that occur in patients who undergo eFONA and their management.MethodsThis retrospective observational cohort study included emergency patients who underwent eFONA between April 2012 and August 2020. We described the patients’ characteristics and the adverse events during or immediately after the procedure.ResultsAmong 75,529 emergency patients during the study period, 31 (0.04%) underwent an eFONA. The median (interquartile range) age was 53 (39–67) years, and 23 patients (74.2%) were men. Of all cases, 13 (41.9%) experienced adverse events. Of these, three cases (23.2%) were cephalad misplacement of the intubation tube, one case (7.7%) was cuff injury, one case (7.7%) was tube obstruction due to vomiting, and one case (7.7%) was tube kink. In cases with these adverse events, the initial attempt of eFONA failed, and alternative immediate action was necessary to secure the airway.ConclusionThis single‐center retrospective observational study described several adverse events of eFONA. In particular, it is important to understand the possible life‐threatening adverse events that lead to failure of securing airways such as cephalad displacement, tube obstruction, and tube kink and respond promptly to ensure a secure definitive airway for patients’ safety.

Awake percutaneous tracheostomy in neurosurgical patients: clinical cases and literature review

Transoral or combined transnasal-transoral approach is sometimes used for tumor resection in patients with skull base and vertebral neoplasms. In such cases, percutaneous tracheostomy before surgical intervention is advisable. Tracheostomy facilitates surgical access, eliminates intraoperative risk of endotracheal tube kinking and provides airway protection from aspiration in early postoperative period in case of bulbar disorders, hypopharynx and tongue edema. The authors present two patients with massive proliferation of pathological tissue in nasopharynx and oropharynx that excluded tracheal intubation before tracheostomy. These patients underwent awake percutaneous tracheostomy.

Modified Gastric Biopsy Forceps as a Flexible Stylet-Assisted Nasogastric Tube Insertion in Anesthetized and Intubated Patients: A Prospective Randomized Controlled Study

Background: Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. The authors hypothesized that gastric biopsy forceps could be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Materials and Methods: Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results: The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (p=0.013). The overall success rate was higher in the stylet group (100% versus 85%, p=0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85±9.62 versus 62.4±59.38 seconds, p=0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% versus 32.5%, p=0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% versus 17.5%, p=0.057). No other complications were observed in either groups. Conclusion: The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications. Keywords: Nasogastric tube; Insertion; Stylet; Gastric biopsy forceps; Success rate

A rare cause of intraoral endotracheal tube kinking in obstructive hydrocephalus.

A rare cause of intraoral endotracheal tube kinking in obstructive hydrocephalus.

Using a roller pump for establishing extra-corporal membrane oxygenation (ECMO) - technical considerations for times of crisis.

Objective:The COVID-19 pandemic requires thinking about alternatives to establish ECMO when often-limited hardware resources are exhausted. Heart-lung-machines may potentially be used for ECMO but contain roller pumps as compared to centrifugal pumps in ECMO-circuits. We here tested roller pumps as rescue pump for ECMO-establishment.Methods:We set up in vitro circuits on roller pumps from C5 heart-lung-machine with 5 l/minutes flow. In two series, we placed either PVC or silicon tubing for an ECMO circuit into the roller pump. We assessed the mechanical stress on the tubing (aiming to run the pump for at least 1 week), measured the temperature increase generated by the friction and assessed flow characteristics and its measurement in simulated situations resembling tube kinking and suction.Results:The roller pumps led to expected and unexpected adverse events. PVC tubing burst between 36 and 78 hours, while silicon tubing lasted for at least 7 days. At 7 days, the silicone tubing showed significant signs of roller pump wear visible on the outside. The inside, however, was free of surface irregularities. Using these tubings in a roller pump led to a remarkable increase in circuit temperature (PVC: +12.0°C, silicone +2.9°C). Kinking or suction on the device caused the expected dramatic flow reduction (as assessed by direct measurement) while the roller pump display continued to show the preset flow. The roller pump is therefore not able to reliably determine the true flow rate.Conclusion:Roller pumps with silicone tubing but not PVC tubing may be used for running ECMO circuits. Silicone tubing may endure the roller pump shear forces for up to 1 week. Thus, repeated tubing repositioning may be a solution. Circuit heating and substantial limitations in flow detection should increase attention if clinical use in situations of crisis is considered.

Penggunaan Remifentanil pada Pasien Pediatrik dengan Meningokel yang Dilakukan Tindakan Eksisi Meningokel

Meningocele is failure of the neural tube to close during first trimester pregnancy which is the most common conditions in pediatrik patient. Correction is performed under prone position with carefull anesthestic procedure. The physiology of neonates and infants are different from that of adults. Immaturity of their vital organ systems narrows the safety margin of perioperative management including anesthesia. Remifentanil is becoming increasingly popular for this purpose. Remifentanil has favorable characteristics for anesthesia in neonates such as rapid onset, potent analgesic effect, and rapid elimination. A baby boy 7 months old, 7 kg, with meningocele lumbosacral underwent meningocelectomy. The patient was given remifentanil 1 mcg/kgbw/iv in one minute and continuous 0.05-0.1 mcg/kgbw/mnt. Induction with propofol iv, atracurium before intubation. Stability hemodynamic during the operation, no episode of bradycardia and patient extubated early after the operation. Remifentanil is an ultra-short-acting opioid, with rapid onset, produces profound analgesia, rapid offset and good stability of hemodynamic during the operation. The operations are carried out prone, careful positioning is paramount to avoid complications like dislodging or kinking of the endotracheal tube, corneal abrasion or perioperative neuropathy. Using remifentanyl in this case report given good hemodynamic stability dan rapid emergence.

A rare cause of complete airway obstruction caused by a defective pilot tube of a reinforced endotracheal tube

BackgroundThe common causes of failure to inflate the lungs after placement of an endotracheal tube include mechanical obstruction of the tube by tight gauzes, tongue blade, tube kinking, patient biting on the tube, obstruction of the lumen by blood or foreign body, bronchospasm, haemothorax, tension pneumothorax or equipment malfunction.Case presentationWe report a case of complete airway obstruction due to herniation of the pilot inflation line into the lumen at the proximal end of a reinforced tube when the tracheal cuff was inflated. Prior to use, the endotracheal tube was tested and functioned normally. The patient was uneventfully reintubated with a new endotracheal tube. With the endotracheal tube, device problems often involve the pilot balloon and cuff assembly and leaks are more common.ConclusionThis case report highlights an unusual cause of complete proximal lumen obstruction due to a manufacturing defect which could have caused a critical incident in the theatre.

Harvesting the Liver From a Donor With a Biventricular Assist Device (BiVAD)—An Unexpectedly Challenging Procedure: A Case Report

BackgroundOrgan procurement from deceased donors is usually a standard procedure. Nevertheless, the performing surgeon is often confronted with demanding situations, such as atherosclerotic or aneurysmatic aortic disease or even other pathologies, which may alter the surgical steps. We report on an interesting case of solid organ harvesting from a donor with a biventricular assist device (BiVAD) due to global heart failure. Case ReportA 42-year-old male donor with a BiVAD, enlisted for heart transplantation, died of intracerebral hemorrhage. Dressing the surgical field was challenging because the extracorporal portions of all 4 tubes and the pump device rested on the donor's body, covering his whole abdomen. To ensure enough space, the pump and tubes had been covered with sterile swabs and drapes. The second surgical assistant was tasked with holding the device slightly deviated to the left and the ankle elevated at 45°, to avoid any tube kinking. The dissection of the main vessels distally was performed using the standard technique. No encirclement of the proximal aorta beneath the diaphragm was necessary, as the cardiac output could be arrested by clamping the left ventricle's outflow tube. Once the perfusion was completed, the procedure continued in the standard fashion. ConclusionSo far, the literature has no data on organ harvesting from deceased donors with BiVAD. Although such a retrieval is quite challenging and requires an experienced team, the transplantation of the corresponding organs can be performed without any further special technical problems.