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Table of Contents
LETTER TO THE EDITOR
Year : 2011  |  Volume : 27  |  Issue : 4  |  Page : 569-570

An assembly to allow nebulization and oxygen enrichment of spontaneously breathing tracheostomized patients on T-piece


Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New ­Delhi, India

Date of Web Publication24-Oct-2011

Correspondence Address:
Kapil Chaudhary
Department of Anaesthesiology and Intensive Care, Maulana Azad Medical College and Associated Hospitals, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.86616

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How to cite this article:
Chaudhary K, Kumar R, Kumar S, Gupta NR. An assembly to allow nebulization and oxygen enrichment of spontaneously breathing tracheostomized patients on T-piece. J Anaesthesiol Clin Pharmacol 2011;27:569-70

How to cite this URL:
Chaudhary K, Kumar R, Kumar S, Gupta NR. An assembly to allow nebulization and oxygen enrichment of spontaneously breathing tracheostomized patients on T-piece. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 Oct 21];27:569-70. Available from: http://www.joacp.org/text.asp?2011/27/4/569/86616

Sir,

Nebulization involves administration of liquid medicinal drugs, saline or distilled water directly into the respiratory tract. [1] The drugs for nebulization are converted to aerosol particles or mist which can then be inhaled. It has the advantages of reduced drug requirement, rapid onset of therapeutic effect, decreased systemic side effects and better patient compliance. [1]

Nebulization is often required in spontaneously breathing tracheostomized patients for loosening of secretions, prevention or treatment of bronchospasm, and local anesthesia of the airways. The T-piece and corrugated tube assembly are used in these for oxygen enrichment of inspired gases and as an expiratory port for expired gases. However, there is hardly any nebulizer that can be mounted through the T-piece and corrugated tube assembly. Inappropriate direct connections of nebulizer to the tracheostomy tube, possible with hardly a few, have resulted in pneumothorax due to lack of route for expired gases to be exhaled. [2] Although oxygen enrichment may be achieved by using oxygen as the driving gas for the nebulizer in place of air, the problem lies in the inability to mount the nebulizer to the T-piece corrugated tube assembly and various clumsy "tricks" are tried for this unless one has the specialized T-piece available.

We share our experience with an assembly that we have created at our center, which can be used in a spontaneously breathing patient with a tracheostomy tube while allowing oxygen enrichment as well. The assembly has been devised by interposing a swivel connector (Intersurgical, Wokingham, Berkshire.) between the nebulizer and the T-piece (with its corrugated reservoir tube), as described. The commonly available T-piece and corrugated tubing system is normally connected to tracheostomy tube of a spontaneously breathing patient through the vertical limb of the "T". A swivel connector is connected to the free, open horizontal end of the "T". This allows the direct connection of the nebulizer to the other free end of the swivel connector [Figure 1]a. If it is decided to run the nebulizer on oxygen, the oxygen tubing can be attached directly to the nebulizer with the third (capped) end of the swivel connector being sealed with its original cap and stopcock [Figure 1]a. On the other hand, if the nebulizer is being run on air provided by the electric motor of the nebulizer, oxygen enrichment can be provided by connecting the oxygen tubing to the third (capped) end of swivel connector through an appropriate universal connector after removing the cap [Figure 1]b. The light weight assembly can be easily applied to a spontaneously breathing tracheostomized patient [Figure 1]c. The efficacy of the assembly can be judged by the aerosol coming out through the corrugated tubing.
Figure 1: (a) The commonly available T-piece (1) and corrugated tubing (2) is normally connected to tracheostomy tube (3). A swivel connector (5) is interposed between the free end of T-piece and nebulizer (4). When it is decided to run the nebulizer on oxygen, oxygen tubing (6) is directly connected to nebulizer. (b) Alternatively, if the nebulizer is run on air provided by its electric motor, oxygen tubing (6) is connected to third (capped) end of swivel connector through an appropriate universal connector (7) after removing the cap (8). (c) This assembly can be easily applied on spontaneously breathing tracheostomized patients

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This assembly can be created with the easily available equipments in any operation room or intensive care unit. We have used this assembly for postoperative nebulization of spontaneously breathing tracheostomized patients who had bronchospasm after undergoing direct laryngoscopy and biopsy, and found effective relief of bronchospasm.

 
   References Top

1.Saraswat V. Inhalation therapy and humidification. Indian J Anaesth 2008;52 Suppl 5:632-41.  Back to cited text no. 1
    
2.Medicines and Healthcare products Regulatory Agency [homepage on Internet] Victoria, Central London, U.K. SN2002(03)-Nebulisation therapy: Risk of incorrect connections. (safety notice). Available from: http://www.mhra.gov.uk/Publications/Safetywarnings/MedicalDeviceAlerts/Safetynotices/CON008807 [Last cited on 2002 Jan].  Back to cited text no. 2
    


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