AIRWAY MANAGEMENT

Combitube

1. Discuss construction of tube and operation

a. Longer, blue port is the distal port

b. Shorter, clear port is the proximal port

c. Insertion is blind

d. 1^st ventilate the longer external (blue port) as esophageal intubations is most likely

e. Auscultate the chest

f. Auscultate the epigastric

2. Discuss advantages of the Combitube

a. Provides alternate airway control when conventional technique is unsuccessful of unavailable

b. Insertion is rapid and easy

c. Does not require direct visualization

d. Balloon anchors behind the hard palate

e. Patient may be ventilated regardless of ultimate placement (esophageal or tracheal)

f. Significantly diminishes gastric distention/regurgitation

g. Can be used on trauma patients since neck can remain in neutral position

h. Gastric contents can be suctioned for decompression if placed in esophagus

3. Discuss disadvantages of the Combitube

a. Placing an additional ET tube is very difficult with ETC in lace

b. Cannot be used in conscious patient or with intact gag reflex

c. Cuffs can cause ischemia

d. Does not isolate and completely protect the tracheal

e. Cannot be used in patients with esophageal disease or caustic ingestion

f. Cannot be used with pediatric patients

g. Placement is not foolproof – requires competent assessment

4. Demonstrate insertion

a. Prepare patient with normal positioning and BLS

b. Place patient supine and kneel at top of head

c. Prepare and check equipment

d. Stabilize cervical spine if indicated

e. Insert midline using tongue jaw lift maneuver to the depth marked on the tube. Black rings should be between the teeth.

f. Inflate pharyngeal cuff with 60-100 ml of air and distal cuff with 10-15cc

g. Ventilate through longer blue proximal port while auscultating over chest and stomach. If none over stomach secure tube, otherwise change lumens

Practice with each student