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Techniques for Nasal Intubation

Blind Technique

Fiberoptic Nasal Intubation


Techniques for Nasal Intubation

Nasal intubation is a rarely required emergency intubation technique and it is much less frequently used now than it was before the widespread use of muscle relaxants.  Within an algorithm for emergency airway management it is always performed in spontaneously breathing patients, never after the administration of muscle relaxants (rapid sequence intubation).  It can be ideal in patients with oral pathology (bypassing the mouth altogether) or in patients with short safe apnea times in whom rapid sequence intubation is being deliberately avoided. Nasal intubation using endoscopic (or fiberoptic) imaging is extremely valuable in emergency patients who have laryngo-tracheal pathology, such as burns, caustic injury, or laryngeal cancers.  Imaging allows assessment of these airways while the patient is spontaneously breathing and prior to attempted tube passage from above, In some of these cases it is preferable to establish a surgical airway below the level of the lesion as a primary means of airway management.


In patients with predicted difficult orotracheal intubation, and in those with mechanical issues about the tongue and mouth (i.e., angioedema, Ludwig’s angina, tongue hematomas, jaw fracture, etc.), going through the nose bypasses the mouth altogether.  Patients can be intubated using the nasal route while preserving spontaneous ventilation.  Depending upon the patient, availability of fiberoptic equipment, and the skills of the operator, nasal intubation is ideally done using endoscopic imaging. Problems that can prevent endoscopic (fiberoptic) imaging include copious blood, secretions, or vomitus, and lack of patient cooperation.  The later problem can be addressed with pharmacologic adjuncts, such as benzodiazepines, opioids, and low dose ketamine.  Blind nasal intubation has a distinctly valuable role in emergency settings when rapid sequence intubation is contraindicated, the oral route is unavailable (obvious oral pathology, clenched jaws, limited mouth opening) and when fiberoptics are unavailable or inappropriate.


Click here to read more about blind nasal intubation.


Click here to read more about fiberoptic nasal intubation.


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DISCLAIMER:  The procedures discussed at this website, to be performed properly, rely on complex medical skills and should only be undertaken after formal instruction and hands-on clinical training with appropriate supervision, and after receiving professional certification and authorization to do so. The content presented herein is meant to serve as just one of many resources that trainees and health care professionals should consult in the course of the their skill acquisition and ongoing practice. Airway Cam Technologies, Inc., its authors, officers, agents and assigns, disclaim any and all responsibility for any adverse outcomes and or harmful acts committed by others persons who may have consulted this website or relied on information contained herein.


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