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Tuesday, May 23, 2006

Resourcefulness...

Historically, veterinary medicine has had to be very resourceful in order to accomplish the things that we need to in our daily work.

Of course, things are a lot different these days than they were 20 years ago, but we still find ourselves having to improvise for common every day needs. Part of the reason is because items that we need aren't made for veterinary medicine, or these things are just too expensive for many veterinary practices to purchase.

Most practices aren't huge hospitals and the prices that veterinarians charge don't even come close to what is charged for the same service in human practice. This makes for a very large discrepancy in many areas (including wages) between human and veterinary medicine.

So here is one of the things that we make out of recycled materials that we have in our hospital.

An endotracheal tube tie.

While you may not think that you need to know how to do this I must advise you that this little device can be quite useful around the house.

*smile*

It can be used to secure and bundle multiple electrical cords (like what is behind your computer desk), or as a tie for any other similar items that you want to be secured around the house.



How To Make an Endotracheal Tube Tie


An endotracheal tube is inserted into the patient’s trachea to establish a patent airway and to administer oxygen and gas anesthetics to patients undergoing general anesthetic procedures. At the end of the endotracheal tube is an inflatable cuff which is inflated to seal the trachea.

The trachea is sealed via an inflatable cuff to prevent any fluids from draining into the lungs and to control the amount of oxygen and gas anesthesia that is being delivered to the anesthetized patient. Since the inflated cuff is applying pressure against the delicate wall of the trachea it is paramount that the endotracheal tube is stabilized. If the tube is twisted or removed while the cuff is inflated it is possible that the wall of the trachea could be torn. Stabilization of the endotracheal tube is critical in all patients, but it is especially important in the feline patient. Death frequently occurs in the patient that suffers from a torn tracheal wall.

Over the years many devices have been used to stabilize the endotracheal tube for dogs and cats. There are innumerable sizes and shapes from a variety of dog and cat heads and muzzles. With the exception of a rubber type of string that is used as a tie; a standardized piece of equipment for this specific purpose has yet to be developed and manufactured.

As a general rule, many veterinary practices still use a piece of string or roll gauze to tie the endotracheal tube into place while others use a piece of IV tubing as a tie. Some have used rubber bands that are held in place by hemostats. None of these devices or methods has been 100% satisfactory in ease of use or performance.

By using common materials that are found within the veterinary practice, you can create an efficient, waterproof, and easily adjustable endotracheal tube tie that will fit any anesthetized patient that is in your care.



Source: Indexed Visuals



Source: Henry Feldman,MD and Lori Feldman, DVM



Source: Trinity Trach-Tube Ties


Tools and Materials Needed

• Scissors (serrated if possible)
• Hemostats (small)
• Used IV line
• Two tuberculin syringes




Procedure

1. Gather the materials that you will need.

2. Cut the IV tubing to the length that you want. As a general rule, 18 to 20” will be of sufficient length for most animals, but you can cut it to any length that you want. You may choose to have varying lengths for small, medium, and large animals.

3. Cut the finger rests off of the end of the tuberculin syringes. Cut as close as possible to the rests. Caution: the plastics that are used in syringe manufacturing are quite durable and may be difficult to cut. Use care in cutting the finger rests off so that you do not cut your fingers or hands.

4. Insert the nose of a very small pair of hemostats into the hollow portion of the finger rests. Firmly grasp the two loose ends of the IV tubing and pull them through the hollow portion of the syringe’s finger rests.

5. Slide the rests towards the opposite end forming a loop.

6. Repeat step 4 with the second set of finger rests and slide it towards the first set of rests stopping in the middle of the IV tubing so that a second loop is formed.

7. Your endotracheal tube tie is now complete.

8. Using the first loop that you formed, place it around your endotracheal tube and slide the first finger rest down until it is snug against the endotracheal tube. The rest should be placed on the side of the endotracheal tube that will be next to the patient’s hard palate.

9. After intubating your patient, place the second loop over the muzzle with the lower portion placed behind the upper canine teeth; slide the second set of finger rests down until it is snug against the muzzle.

10. For cats you will place the second loop behind the ears and tighten it against the base of the skull.



1. cut section of IV line

2. finger rests that have been cut from the syringes





1. first loop

2. second loop





The tie is now attached to the endotracheal tube.





The endotracheal tube tie that I have described has been put to practical use on a daily basis at the veterinary practice where I work. It has been used in hundreds of procedures without a single failure in its performance. I personally recommend this method of securing an endotracheal tube for several reasons:
1. It is not easily broken.

2. It does not slip or loosen during use.

3. It is waterproof, which makes it invaluable during dental prophylactic procedures.

4. It can be easily loosened and the endotracheal tube can be removed quickly and efficiently if necessary.

5. It does not restrict blood circulation to the tissues that it comes into contact with.

6. It can be used on any size of patient and on multiple species including dogs, cats, and ferrets.

7. If it becomes worn or broken it can be easily replaced.

8. It is very economical and recycles used materials.


Many general anesthetic procedures are performed on a daily basis in a veterinary practice. Whether or not the procedure is a success is partially dependent upon the care of the anesthetized patient while the procedure is being performed. Stabilization of the endotracheal tube is the first step towards that ultimate goal.


later...

6 Comments:

Blogger Dreaming again said...

ok, if I had to put this into practice, I think I'd faint!

But, interesting information none the less!

You know, when I was in girlscouts, we went to a vet hospital, and I saw an xray of a dogs diseased heart and passed out cold. My mom had to drive 40 miles to go get me. She's not let me forget it. *grin* Somehow, I don't think I'd survive vet school!

May 23, 2006 9:34 PM  
Blogger It's me, T.J. said...

That is really funny Peggikaye.

But you know what? If you can survive parenthood, you can live through anything!

*laugh*

later...

May 23, 2006 10:02 PM  
Anonymous Moof said...

Now, what I would like to know is if you're the one who figured out how to make those little goodies from scratch ... ?

:o)

May 24, 2006 3:27 AM  
Blogger Pattie said...

This brings me back to my nursing days....
*sigh*
Great pictures, and a very interesting post, TJ

May 24, 2006 4:57 AM  
Blogger Sue said...

LOL. You certainly couldn’t be accused of having boring and dull posts – from sex offenders to how to make an endotracheal tube tie … (hah, perhaps the two are connected and you've thought of another use for that tie). I wonder what tomorrow will bring ….

May 24, 2006 7:50 AM  
Blogger It's me, T.J. said...

I can't take credit for the original invention of the tie Moof. Veterinary medicine is known for 'gleaning' information and 'helpful tips' from one another. Who knows who the original inventor is.

Once medicine is in your blood Pattie it never seems to leave does it?

Sue... do you think that I have some sort of Freudian thing going on here?

Who knows... Maybe I do.

There is one thing that I can think of that I would like to use this little tie for but as it states in my reasons for its recommendation of use:

5. It does not restrict blood circulation to the tissues that it comes into contact with.

I don't think that it would work very well for that.

*evil grin*

later...

May 24, 2006 11:05 AM  

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