Unusual pericuff leak around proseal-laryngeal mask airway corrected by clamping gastric drain port: A case report

ProSealTM-Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on Thames, UK) is commonly used for securing the airway with an added advantage over classic LMA as its gastric drain tube allows the insertion of Ryle’s tube and suctioning of gastric contents. The ProSeal LMA is designed in such a way that it allows controlled mechanical ventilation. During controlled mechanical ventilation, air leaks can occur because of positive airway pressures. Air leaks from the gastric drain port are almost always due to the malposition of PLMA. Here, we report a case of air leak from gastric drain port despite correctly placed PLMA and its successful management without removing the device.

Spontaneous Transection of a Retained 16 Year Old Nasogastric Tube

Introduction The insertion of nasogastric (NG) feeding tube or Ryle’s tube is a common procedure for treating patients in different medical or surgical conditions. One of its indications is in patients who can’t eat or swallow due to obstruction in upper digestive tract. Case Report We encountered a 71 year old female patient with stricture in mid to low esophagus, who presented with a retained NG tube in situ for more than 16 years. Post admission, an NCCT scan of neck, thorax and upper abdomen showed about 30cm long retained tube with its lower end in the body of stomach. Upper gastro-intestinal endoscopy was subsequently performed and the retained tube was carefully removed in toto. Discussion Insertion of nasogastric tube is a frequent and well tolerated day to day procedure though it can produce unexpected complications like stricture, perforation or haemorrhage and even spontaneous transection in a few patients with prolonged indwelling Ryle’s tube. Long term placement of nasogastric tube is thus not recommended to avoid complications.

Rare Complication of Nasogastric Tube Knotting around Endotracheal Tube in an Anesthetized Patient Undergoing Surgery

We report a case of successful management of a rare incidence and avoidance of complication of Ryle’s tube knotting around endotracheal tube. A vigilant anesthesia team prevented fatal complications of intraoperative accidental extubation and ventilation impairment which could have resulted into respiratory distress.

Assessing Nursing Enteral Nutrition Practices and Perspectives in An Intensive Care Unit of A Level Six Hospital in Kenya

Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the general intensive care unit, nurses' perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 6 hospital in Kenya. The study design used was crosses sectional descript study. Materials and Methods: thirty four questionnaires were distributed and the results analyzed. A database was prepared and analyzed.Results: all (100%) questionnaires were filled and returned. A majority (32) of staff nurses expressed awareness of nutrition guidelines. A large number (27) of staff nurses knew about existence of nutrition protocols in the ICU. Almost all nurses (82.4%) chose enteral nutrition as their preferred route of nutrition unless contraindicated. All staff nurses were of the opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay). Half (50%) were of the thought that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of a nasogastric tube (Ryle’s tube) was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle's tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle's tube position. The backrest elevation rate was 70%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle's tube feed is to be discarded after 24 h. The most preferred (48%) to upgrade their knowledge of enteral nutrition as a personal initiative and CME.Conclusion: Information generated from this study can be helpful in identifying nutrition practices gaps and may be used to review and revise enteral feeding practices where necessary. Keywords: Enteral nutrition, intensive care, nursing, tube feeding

A NOVEL TECHNIQUE OF RYLE’S TUBE FIXATION (PARTHA’S TECHNIQUE) FOR CONVENIENT INTRAOPERATIVE USE

Dear sir, Nasogastric tube (Ryle’s tube) insertion is one of the commonest ward procedures done for different indications. During selected surgical procedures, the insertion of such tubes is done in the preoperative ward. There are lot of reported difficulties during insertion in the intraoperative period.1 The Ryle’s tube is inserted in the classical manner but usually adjusted to enable the surgeon to do the gut surgery. The tube is usually fixed to the nose by a plaster wound round the tube. This technique is usually difficult to unwound if there is a need to reposition. In surgical and medical wards, the necessity for repositioning is not very significant. But during the intraoperative period, the surgeons always prefer to move the tube here and there to make the operative field better. This in turn causes much discomfort to the attending anaesthesiologist if the plaster is stuck in a traditional way. Hence, we propose a novel technique of fixation wherein we get the advantages of avoiding accidental removal but with the ease of frequent positional adjustment. A sixty-five-year-old male came for upper Gastro-intestinal surgery. The Ryle’s tube was inserted in the ward and fixed as given in fig 1. To adjust the position after removal of the plaster becomes a herculean task. Its more difficult to adjust the plaster with gloved hands. The plaster was removed before induction and fixed as described below. The first plaster (P1 in fig 2) was vertical and fixed the tube to the nose in a vertical fashion. The portion of the plaster which sticks to the tube should be around 50 % of the plaster length. Usually there is a small gap between the attachment of the tube and the nose. The next or the second plaster (P2 in fig 2) was transverse which fixed the vertical plaster to the nose. The transverse plaster never touched the Ryle’s tube. (Fig 2) If we need to adjust the position, the plasters can be easily loosened to adjust and fix again. The portion of the plaster in the gap can be lifted to loosen. There is no need for changing the plasters. Many a time, the surgeons may ask for repeated changes of position during the surgery. Hence this Partha’s technique of fixation suits repeated unfastening and regluing. There are reports of lost Ryle’s tubes2 after fixation in the wards. Lorente3 in his study of intensive care patients, found an incidence of accidental removal of Ryle’s tube as 4.48%. A single plaster use may be a cause of malposition. An extensive search of the literature did not reveal fixation techniques with their pros and cons. We have been using this technique for many years so far with minimal problems. This report is limited to the fact that it is not used much with no comparative studies to know its advantages and disadvantages.