Protection of the nasotracheal tube tip with a red rubber catheter in adults undergoing nasotracheal intubation: A randomized controlled trial

Nasotracheal intubation (NTI) is often required for oropharyngeal surgery to maximize surgical access, but epistaxis is a common complication. NTI using a nasotracheal tube (NTT) telescoped into a red rubber urinary catheter (RRC) to guide the NTT and protect the nasal mucosa has been described for adults and studied in children but has not been systematically evaluated in adults. This was a two-center, single-blinded, randomized controlled trial. 112 adults (mean age 57.1 ± 16.3 years, 61.6 % male) undergoing surgery requiring NTI were randomized 1: 1 to intubation with a thermosoftened, lubricated NTT, either alone or telescoped into an RRC to shield the beveled NTT tip. The primary outcome was incidence of epistaxis assessed at 5 min post-intubation by a blinded observer. Secondary outcomes included the severity of epistaxis, time to intubation, the rate of complications during nasotracheal intubation, and the degree of postoperative pain in PACU. Use of an RRC significantly reduced the likelihood of epistaxis (39.3 % vs. 62.5 %, Odds Ratio (OR) = 0.380, p = 0.0140; 95 % CI: 0.174 to 0.831, p = 0.0153; FDR = 0.0255) and the severity of epistaxis (OR for lower severity = 4.145; 95 % CI: 1.923 to 8.934, p = 0.0003; FDR = 0.0013), but was associated with a longer time to intubation (Least squares adjusted means 104.2 (SE = 6.87) seconds vs. 74.30 (SE = 6.86) seconds, p = 0.0005; FDR = 0.0015, d = 0.70). No difference was found in postoperative pain or in the rate of procedural complications. Use of the RRC significantly reduced the likelihood and severity of epistaxis following nasal intubation, at the cost of longer time to intubation. • Epistaxis less frequent if red rubber urinary catheter used during nasal intubation. • Epistaxis less severe if red rubber urinary catheter used during nasal intubation. • Time to nasotracheal intubation longer when red rubber urinary catheter used. • No complications attributed to use of red rubber catheter technique. • No difference seen in number of intubation attempts required.