Multiple scenarios call for endotracheal intubation. A range of conditions can affect a patient’s ability to breathe independently, including severe pneumonia, collapsed lung, head injuries, respiratory failure and congestive heart failure.
When foreign objects become lodged in a patient’s trachea, intubation can help with removal. During a severe gastrointestinal bleed, an ETT can stop the contents of the stomach from entering the lungs.
Another important application for airway management is in the operating room. Under general anesthesia, the muscles around a patient’s tongue and throat relax, often blocking the airway. Endotracheal intubation allows for a reliable supply of oxygen and is also used to administer the anaesthetic gases.
The device is inserted via the nose or mouth with the use of a laryngoscope. This can be a difficult process for either anatomical or physiological reasons, and getting it right first time demands precision. Preoperative screening tests are usually recommended to reduce the risk of unexpectedly difficult insertions, helping physicians recognise and prepare for challenging scenarios. In addition, there are a range of well-studied risk factors that can indicate a difficult intubation.
The flexibility of the ETT can sometimes add to the challenge, making it hard to move the device through the larynx unaided. To facilitate successful placement when a tube is considered too flexible to insert, a stylet may be required.
What are stylets and how do they help?
Stylets are small-diameter, plastic-coated metal wires used to increase the stiffness of an ETT’s flexible, plastic tubing. They have a curved tip designed to hook over the end of the universal connector, preventing the distal tip from extending beyond the ETT, which can cause trauma to the inner surface of the trachea.
One of the most important features of a stylet is its malleability, enabling physicians to adapt the wire to the desired shape before insertion in the ETT. As soon as the ETT is secured in place, the stylet can be removed.
According to Custom Wire Technologies (CWT), a leading provider of wire components to the medical device industry, stylets are usually manufactured using stainless steel and nickel titanium (nitinol), which both provide the necessary levels of strength needed to support the ETT. Designs can feature twisted wire or a precision-ground core wire depending on the properties the manufacturer is trying to achieve.
In 2021, the results of a clinical trial comparing the effects of stylet use on first-attempt intubation success were published in Intensive Care Medicine. The study was a multi-centre, randomised controlled trial with 999 patients across 32 intensive care units. First-attempt intubation success occurred in 78.2% in the ‘tracheal tube and stylet’ group and in 71.5% in the ‘tracheal tube alone’ group. 38.7% of patients suffered complications in the tracheal tube and stylet group compared with 40.2% of the cases which utilised tracheal tube alone. Meanwhile, the incidence of serious adverse events was 4.0% and 3.6% respectively.
Once a design has been agreed, many medical device companies entrust the production of their stylets to a contract manufacturer. CWT can leverage decades of medical wire experience to help transform an engineer’s concept into a prototype. The company manufactures custom wires in strict adherence to customer specifications. When the time comes for commercial manufacturing, CWT delivers the quality and consistency needed for high-volume medical device production.
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