Tube tip top tip

I’m not sure what this offers over purpose-built supraglottic airways, but effective ventilation may be achieved after failure of mask ventilation by siting a tracheal tube with its tip in the pharynx and the cuff inflated with 20 mls. The tube ‘is gently inserted 10—14cm, dependent on patient size, or until any resistance is felt, in caudal direction by letting the tip of the tube follow the palate and the posterior pharyngeal wall (in order to place the tip of the tube posterior to the epiglottis)’. As long as the tube tip or Murphy eye is not in the oesophagus, ventilation should be possible. The hand position maintains a jaw thrust while closing the mouth and occluding the nostrils.

BACKGROUND: Mask ventilation occasionally fails. Alternative readily available and simple methods to establish ventilation in these cases are needed.

METHODS: Retrospective description of cases in which a new technique, tube tip in pharynx (TTIP) ventilation, was employed for restoring ventilation in case of failed facemask ventilation during induction of anaesthesia. The technique involves a standard endotracheal tube and can be performed single-handed: A standard endotracheal tube was placed via the mouth with the tip in the pharynx and the cuff was inflated. By placing the fourth and fifth fingers below the ramus of the mandible, the third finger below the lower lip, the second finger above the upper lip and on one side of the nose and the first finger on the other side of the nose, an open airway is restored. Chin lift is inherent in the grip, thus contributing to opening of the airway.

RESULTS: In all four cases of failed mask ventilation the anaesthetist could establish an open airway and subsequent ventilation without the need for an assistant. There were no indications of gastric insufflation.

CONCLUSION: The TTIP technique established ventilation in all four patients after abandoned facemask ventilation. The technique only involves one person and an endotracheal tube and warrants to be included in the armamentarium of anaesthetists. Further prospective studies are needed to refine the technique and delimit its indications.

Tube tip in pharynx (TTIP) ventilation: simple establishment of ventilation in case of failed mask ventilation
Acta Anaesthesiol Scand. 2005 Feb;49(2):252-6

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