Modification of tracheal tubes

M. Salim

Rawalpindi, Pakistan

Editor—Disposable tracheal tubes are commonly used in anaesthesia. Cuffed nasal/oral tubes of various sizes are made of PVC or silicon material. The cuffed tubes made by different manufacturers such as Portex or Mallinckrodte have an almost invisible tiny hole at the proximal end. Distally this hole ends blindly at the upper one third of the tube. These cuffed tubes can be easily reshaped by inserting a small wire (1–1.2 mm) in this hole (Fig. 1). The wire keeps the lumen of the tube patent even at 90°–120° bend and does not interfere with the connection or airflow. Insertion of the wire does not cause any damage to the tube, and injury to the trachea or larynx is unlikely.



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Fig 1 Wire being inserted into the proximal side hole.

 
These tubes can be moulded in any direction according to the patient’s need (Fig. 2). They are easily reshaped like preformed RAE (Ring, Aldair, & Elwyn) tubes, and can be turned to either the left or right side without kinking.1 These remoulded tubes cannot be differentiated from original RAE tubes. The bend can be located at any desired level over the chin or forehead, and will not interfere with surgical access.



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Fig 2 Reshaped endotracheal tubes after insertion of wire.

 
We have used these remoulded tubes successfully in 20 patients and no difference was found between the efficacy of the original RAE tubes and these tubes. The remoulded tubes are also cost-effective [one RAE tube adult size No. 8 costs approximately Rs 650/- (£7) whereas a simple cuffed tube is Rs 90/- only (£1)]. We strongly recommend anaesthetists in third world countries to use the cheaper remoulded tracheal tubes where desired.

We have recommended to the manufacturers that they provide a wire of 1–1.2 mm with these tracheal tubes (in the packing). Their response is awaited. The anaesthetist could then mould the tubes as required.

M. Salim

Rawalpindi, Pakistan

References

1 Salim M. Salim and Mahmood modification of RAE tubes. Br J Anaesth 2002; 88: 459[CrossRef][ISI][Medline]





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