Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determin...Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92);BSA (R = 0.92);weight (R = 0.91);age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.展开更多
A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,doub...A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.展开更多
AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction ...AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups.Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other.The duration of the procedure and the success rate for each group were evaluated.RESULTS:A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group(32.6±14.6 min)and the endoscopic group(16.5±7.8 min)among the cases classified as successful(P<0.05).The success rate was significantly different between the groups:88.6%in the fluoroscopic group and 100%in the endoscopic group(P <0.05).CONCLUSION:For patients with adhesive small bowel obstruction,long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.展开更多
Study Objective: Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employm...Study Objective: Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employment by anesthesia providers, and describe various deployment facilitators described in current literature. Measurements: An exhaustive literature review of the databases Medline, CINAHL, Cochrane Collaboration, Scopus, and Google Scholar was performed applying the search terms “gastric tube”, “complications”, “decompression”, “blind insertion”, “perioperative”, “intraoperative” in various order sequences. A five-year limit was applied to limit the number and timeliness of articles selected. Main Results: Patients are exposed to potentially serious morbidity and mortality from blindly inserted gastric tubes. Risk factors associated with malposition include blind insertion, the presence of endotracheal tubes, altered sensorium, and previous tube misplacements. Pulmonary aspiration risk prevention remains the only indication for anesthesia-related intraoperative use. There are no singularly effective tools that predict or verify the proper placement of blindly inserted gastric tubes. Current placement facilitation techniques are perpetuated through anecdotal experience and technique variability warrants further study. Conclusion: In the absence of aspiration risk factors or the need for surgical decompression in ASA classification I & II patients, a moratorium should be instituted on the elective use of gastric tubes.展开更多
Objective:To explore the influencing factors of patients with dysphagia after stroke who refuse to accept gastric tube implantation,and to provide intervention basis for improving the compliance of patients with gastr...Objective:To explore the influencing factors of patients with dysphagia after stroke who refuse to accept gastric tube implantation,and to provide intervention basis for improving the compliance of patients with gastric tube implantation.Methods:Asemi-structured interview method was used to conduct in-depth interviews with 11 patients who refused gastric tube placement,and the interview data were analyzed by Colaizzi analysis method.Results:The influencing factors of patients with dysphagia after stroke can be summarized into the following three themes:patient factors(patient's cognition of disease,patient's subjective pain perception and fear),family factors(patient's caregiver's cognition of disease,economic conditions)and medical factors(trust in medical staff,medical education methods).Conclusion:Medical staff should understand the influencing factors of dysphagia after stroke and take positive measures to improve the compliance of patients with gastric tube placement and ensure the treatment effect.展开更多
文摘Background: Accurate determination of the optimal insertion depth of a pediatric endotracheal tube (ETT) is quite important. The aim of this study was to create an easily available formula that can be used to determine the optimal insertion depth for a cuffed ETT even without depth marking with clear definitions of the upper and lower limits for the tip of ETT in the trachea in clinical practice. Methods: Eighty children under 12 years of age were enrolled. The depth marking of the cuffed ETT was placed at the vocal cords and both lungs were then auscultated using a stethoscope. The upper limit was radiographically defined as the position of the tip of the cuffed ETT being between the clavicles. The lower limit was defined as a distance of 5 mm above the carina. The relationship between the insertion depth and patient characteristics was analyzed to create a formula for optimal ETT insertion depth. Results: Sixty-nine ETTs were optimally placed in the trachea. There were good correlations between the optimal insertion depth of ETTs and patients characteristics (height (R = 0.92);BSA (R = 0.92);weight (R = 0.91);age (R = 0.88)). Using these patient characteristics, we created the following three formulas for calculation of the optimal insertion depth for pediatric cuffed ETTs: insertion depth (cm) = height (cm)/11 + 5.5, weight (kg)/3 + 9.5 or 11 + 3/4 × age (years). The rates of appropriate tube placement of both pediatric cuffed ETTs were 87.5% (Hi-Contour) and 85.0% (Microcuff). Conclusions: Our formula and graphs may be easy to determine the optimal insertion depth of cuffed ETT even without depth marking in clinical practice.
文摘A 40-year-old male underwent tube placement surgery for continuous ambulatory peritoneal dialysis(CAPD).A2-cm skin incision was made,and the peritoneum was reflected enough to perform secure fixation.A swannecked,double-felted silicone CAPD catheter was inserted,and the felt cuff was sutured to the peritoneum to avoid postoperative leakage.An adequate gradient for tube fixation to the abdominal wall was confirmed.The CAPD tube was passed through a subcutaneous tunnel.Aeroperitoneum was induced to confirm that there was no air leakage from the sites of CAPD insertion.Two trocars were placed,and we confirmed that the CAPD tube led to the rectovesical pouch.Tip position was reliably observed laparoscopically.Optimal patency of the CAPD tube was confirmed during surgery.Placement of CAPD catheters by laparoscopic-assisted surgery has clear advantages in simplicity,safety,flexibility,and certainty.Laparoscopic technique should be considered the first choice for CAPD tube insertion.
文摘AIM:To investigate and compare the decompression effect on small bowel obstruction of a long tube inserted using either endoscopic or fluoroscopic placement.METHODS:Seventy-eight patients with small bowel obstruction requiring decompression were enrolled in the study and divided into two groups.Intubation of a long tube was guided by fluoroscopy in one group and by endoscopy in the other.The duration of the procedure and the success rate for each group were evaluated.RESULTS:A statistically significant difference in the mean duration of the procedure was found between the fluoroscopic group(32.6±14.6 min)and the endoscopic group(16.5±7.8 min)among the cases classified as successful(P<0.05).The success rate was significantly different between the groups:88.6%in the fluoroscopic group and 100%in the endoscopic group(P <0.05).CONCLUSION:For patients with adhesive small bowel obstruction,long-tube decompression is recommended and long-tube insertion by endoscopy was superior to fluoroscopic placement.
文摘Study Objective: Establish complications and risk factors that are associated with blind tube insertion, evaluate the validity of correct placement verification methods, establish the rationales supporting its employment by anesthesia providers, and describe various deployment facilitators described in current literature. Measurements: An exhaustive literature review of the databases Medline, CINAHL, Cochrane Collaboration, Scopus, and Google Scholar was performed applying the search terms “gastric tube”, “complications”, “decompression”, “blind insertion”, “perioperative”, “intraoperative” in various order sequences. A five-year limit was applied to limit the number and timeliness of articles selected. Main Results: Patients are exposed to potentially serious morbidity and mortality from blindly inserted gastric tubes. Risk factors associated with malposition include blind insertion, the presence of endotracheal tubes, altered sensorium, and previous tube misplacements. Pulmonary aspiration risk prevention remains the only indication for anesthesia-related intraoperative use. There are no singularly effective tools that predict or verify the proper placement of blindly inserted gastric tubes. Current placement facilitation techniques are perpetuated through anecdotal experience and technique variability warrants further study. Conclusion: In the absence of aspiration risk factors or the need for surgical decompression in ASA classification I & II patients, a moratorium should be instituted on the elective use of gastric tubes.
文摘Objective:To explore the influencing factors of patients with dysphagia after stroke who refuse to accept gastric tube implantation,and to provide intervention basis for improving the compliance of patients with gastric tube implantation.Methods:Asemi-structured interview method was used to conduct in-depth interviews with 11 patients who refused gastric tube placement,and the interview data were analyzed by Colaizzi analysis method.Results:The influencing factors of patients with dysphagia after stroke can be summarized into the following three themes:patient factors(patient's cognition of disease,patient's subjective pain perception and fear),family factors(patient's caregiver's cognition of disease,economic conditions)and medical factors(trust in medical staff,medical education methods).Conclusion:Medical staff should understand the influencing factors of dysphagia after stroke and take positive measures to improve the compliance of patients with gastric tube placement and ensure the treatment effect.
