Cut vs uncut tubes

[Ian Seppelt]

I suggest that Nick's case reveals inadequacies in the interhospital
transport process. Who was the attendant? Anaesthetic or ICU registrar
who should have known better? Junior doctor with no idea? Skilled
paramedic with intubation skills (who again should have known better)?
Or non-paramedic, who again would not be expected to have any idea.

In the context of a prehospital paramedic system and a good
interhospital retrieval system [which is the envionment I work in], I
maintain there is no place for cut tubes and a lot of potential problems
with tubes that are too short.

The only purpose for a cut tube is to prevent (inadequately trained)
people pushing it in to far [and that applies equally to doctors, nurses
and ambos].

Cheers, Ian

>>> nick at macartney.org 5/10/2007 3:06am >>>
While I agree to some extent with Ian, having been on the receiving end
of a
patient transferred from an icu with a tube in the right lower lobe
bronchus
- yes, not the right main bronchus, beware the law of unexpected
consequences.
A change made for an apparently good reason, might cause another
problem....
There is not the correct length of tube, and IMHO no formula will get
it
right at all times. Training is the key, but even then...
After all, my patient was transferred from one hospital to another.
Nick Macartney 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] 
On Behalf Of Ian Seppelt
Sent: 02 October 2007 06:24
To: atacc.doc at btinternet.com; Trauma & Critical Care mailing list
Subject: Cut vs uncut tubes

I'll disagree with Mark's last sentence. Pprovided the personnel are
appropriately trained there is NO problem with uncut tubes! Having been
on
the receiving end of cut tubes in rapidly swelling burnt patients I can
tell
you it is no fun at all having to change these tubes. The NSW
Ambulance
Service has only carried cut tubes from the beginning of the paramedic
service in 1976, but is about to (thankfully) abandon that and only
use
uncut tubes. The risks of inserting a tube that is too short, and
subsequently needs to be changed [and we see this at least once a
month], is
much greater than the risk of an endobronchial tube, in the hands of a
trained operator.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Senior Staff Specialist
Dept of Intensive Care Medicine
The Nepean Hospital, PO Box 63 Penrith NSW 2751 Director of Clinical
Research, Sydney West AHS Clinical Lecturer, University of Sydney

>>> atacc.doc at btinternet.com 21/09/2007 2:53am >>>
HI Tug,
Although a longer tube and your catheter mount will increase the dead
space,
in adults this volume will have little effect as compared to the
overall
tidal volume of 6-7ml/|Kg. 
Children are a very different affair and ideally with small children
and
babies (<25Kg and below to pick a number!) your breathing system
should
connect directly to the tube, as even 10-15mls could be significant.

Uncut ET tubes are always a controversial area. In major facial
trauma,
burns or other conditions producing major swelling then they are
appropriate, but in most other circumstances they can produce problems
with
endobronchial postioning, migration and kinking.

Mark F
UK

----- Original Message ----
From: "tuganddawn at talktalk.net" <tuganddawn at talktalk.net>
To: trauma-list at trauma.org 
Sent: Thursday, 20 September, 2007 12:45:54 PM
Subject: Dead space


Hello everyone,

   I recently had a conversation with a Paramedic colleage who
suggested that if you intubate a patient (prehospital) with an uncut
ETT
you should not use a cobb connector (the corrugated plastic tubing
betweeen BVM and tube) because of the excessive dead space created.
Though I appreciate that we are using manual ventillation I disagreed
with this in adult patients due to the relatively small size of these
connectors.
   I appreciate that this is an extremely basic question but I am
curious to see what the consensus is.
   Thanks for your time and patience ladies and gents and look forward
to your responses.

  Take care and Kindest Regards

FF Tug Crumpton SR para
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