BLIND NASOTRACHEAL INTUBATION


INDICATIONS
  • Spontaneously breathing patient with an anticipated difficult airway
CONTRAINDICATIONS
  • Pediatric patient <10 years old
  • Midface trauma or basilar skull fracture
  • ↑ intracranial pressure
  • Anticoagulation or anticipated need for thrombolysis
  • Combative patient
  • Apnea
PROCEDURE
  • Preoxygenate.
  • Administer nasal anesthetic and vasoconstrictor.
  • Administer nasal lubricant.
  • Insert ET tube with bevel away from septum and gently advance until breath sounds are heard best through tube.
  • Advance the tube during inspiration.
  • If successful, there is usually associated coughing and/or stridor and cessation of vocalization.
  • Inflate cuff and confirm placement.
COMPLICATIONS
  • Epistaxis
  • Esophageal intubation
  • Sinusitis, turbinate damage