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Nasal Flush 1134.e5

Nasal Flush
VetBooks.ir

Possible Complications and
Difficulty level: ♦
Common Errors to Avoid visually and microscopically; this fluid is not
suitable for bacterial culture.
Synonyms • Excessive bleeding: cold saline and ice pack Bidirectional flush:
Nasal wash, nasal lavage on muzzle • Cut the tip off a red rubber feeding tube
• Seizures if cribriform plate damaged: just behind the fenestrations, and cut an
Overview and Goal CT/MRI before procedure if concerned ≈12-inch (30-cm) piece of suture.
Nasal flush can aid in diagnosis by dislodging about integrity (e.g., nasal neoplasia, nasal • Pierce the cut end of the red rubber tube
foreign bodies, nasal tissue, or nasal pathogens aspergillosis) (about 1 4 inch from the end) with the
(e.g., fungal plaque, mites). It can provide • Aspiration: keep endotracheal tube cuff 20-gauge needle, and thread the suture
temporary relief to a patient with chronic inflated until extubation, pack nasopharynx through the pointed end of the needle.
inflammation and congestion by dislodging with lap pad • Pull about 2-3 inches (5-8 cm) of suture Procedures and Techniques
thick mucus and debris. through the needle, and then remove the
Procedure needle, leaving the suture in the red rubber.
Indications The nasal passages can be flushed from front • Tie the suture onto the catheter, leaving a
• Acute or chronic nasal discharge or sneezing to back, back to front, or in both directions. loose loop and a long (≈1 inch [2.5 cm])
(pp. 678 and 1255) Because the caudal choana is larger than the suture tail.
○ Especially useful if nasal foreign body (FB) nares, it may be easier to dislodge tissue or a • Gently push the nostril upward, and insert
is likely (acute onset of sneezing, pawing, large FB into the nasopharynx (front-to-back the red rubber feeding tube with the suture
or rubbing at face) motion). Flushing from back to front allows attached, pointing in a medial ventral direc-
• Severe nasal congestion interfering with easy collection of fluid that can be examined tion. Gently advance the tube forward toward
breathing (cats especially); relief may be
short-lived
Contraindications
• Destruction/loss of the cribriform plate
• Severe coagulopathy
• Maxillary tooth abscess
Equipment, Anesthesia
General anesthesia with endotracheal intubation
is required along with supplies:
• Suture (nonabsorbable but any kind > 2-0
can work)
• Scissors
• Snook spay hook
• 20-gauge needle
• Two red rubber feeding tubes (size depends
on patient size; 8 Fr typical for most dogs,
with length longer than muzzle)
• 60-mL syringe catheter tip
• Ice A
• 0.9% sodium chloride irrigation solution
• Lap sponge(s)
• Drape ± bowl (to catch fluid from the wash)

Anticipated Time
30-45 minutes or less, including anesthesia
induction
Preparation: Important
Checkpoints
• If cause of chronic nasal discharge is
unknown, imaging studies (e.g., nasal/dental
radiographs, CT or MRI scan) should be
done first, as appropriate.
○ Flushing first alters imaging findings
○ CT/MRI allows assessment of cribriform
plate
• Platelet count ± coagulation profile (p. 1373) B
± buccal mucosal bleeding time (p. 1076), NASAL FLUSH A, As preparation for bidirectional flush, the tip is cut off of a red rubber feeding tube. A
as appropriate hypodermic needle is inserted in the tube to allow suture material to be threaded through the tube. B, After
• Position in sternal recumbency near the end threading suture through, a loop is tied at the end of the tube, allowing a very long suture on one end of the
of the table loop and another end of about an inch (2.5 cm).

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