MILA esophagostomy tube placement using a tunnel/introducer device скачать в хорошем качестве

MILA esophagostomy tube placement using a tunnel/introducer device

Prepare the following items: • MILA esophagostomy tube with introducer • #11 blade • Scissors • Hemostats • Non-absorbable suture (2-0 or 3-0 Ethilon) Prepare the patient: 1. Anesthetize and intubate patient, positioning in right lateral recumbency 2. Clip a wide area on the left side of neck 3. Aseptically prepare the skin using surgical scrub Prepare the E-tube 1. Remove the Y-piece from the end of the e-tube 2. Cut the last 3-4 cm off the e-tube, as this section will have stretched when fit over the Y-piece 3. Measure from the 6-8th rib space to the estimated tube exit site on the neck. Mark tube accordingly with a permanent marker OR note number on E-tube. Placement: 1. Place the end of the e-tube into the esophagus 2. Continue to advance e-tube until resistance is met at the lower esophageal sphincter 3. Identify the jugular vein and ensure the tip of the trocar is dorsolateral to this vessel 4. Adjust the trocar until you are satisfied with the tube exit site 5. Prepare to dissect down to the trocar using a #11 scalpel blade 6. Firmly hold the trocar to prevent rotation when cutting down over the tip 7. Use point of the scalpel blade to cut tissue over tip of trocar 8. Only a small incision is needed to allow the trocar to exit the skin 9. Once the tissue over the tip is cut, push the skin down and trocar up to advance through the incision 10. Grasp end of trocar with hemostat to prevent retraction 11. Attach free end of the e-tube to the ridged end of the trocar 12. Advance the e-tube over the ridge so that it comes in contact with the tapered portion of the trocar 13. The tube should not be able to be pulled off the trocar 14. Gently pull the trocar through the skin by gently pulling on the hemostats 15. You can also gently push the other end to help advance the trocar through the skin 16. If you skin incision is small, you may find some resistance when the tapered portion of the trocar nears the skin 17. The skin incision may need to be elongated to allow passage of the tapered end through the skin 18. Once the trocar and tend of e-tube have been pulled through the skin, continue to slowly pull the tube 19. Continue to pull the e-tube until you see and feel it flip. This tells you the tube is angled correctly into the esophagus 20. Adjust the length of the tube in the patient according to your initial measurement to the 6-8th rib space 21. Cut the trocar off the end of the e-tube and trim e-tube to desired length 22. Reattach the Y-piece Complete the procedure: 1. Confirm correct placement with a radiograph 2. Secure the tube to the skin with non-absorbable suture (purse string and Chinese finger trap) 3. Apply triple antibiotic ointment around the skin incision and bandage as normal