Airway Devices Flashcards
What are the 2 variations of Extraglottic Airway Devices?
- Supraglottic devices
- Retro(infra)glottic devices
Where do Extraglottic devices generally rest?
Outside of the glottic opening to provide ventilation
General Indications for Extraglottic Airway Use
An airway rescue device when BMV is difficult and intubation has failed;
- A single attempt rescue device performed simultaneously w/preparation for cricothyrotomy in the CICO situation
- An easier and more effective alternative to BMV in the hands of basic life support providers or nonmedical rescue personnel;
◾ An alternative to endotracheal intubation by advanced life support providers;
◾ An alternative to endotracheal intubation for elective airway management in the operating room (OR) for appropriately selected patients; and
◾ A conduit to facilitate endotracheal intubation (certain types of intubating SGDs).
Contraindications for Extraglottic Airway use
- Pt w/full stomach
- Hiatal hernias
- Facial/Oral Trauma
- Pts > 14 weeks pregnant
- suspected esophageal disease (for retroglottic devices specfically)
What are the advantages of Extraglottic Devices?
- They have a gastric port
- May have a bite block
- They can have higher seal pressures, allowing for higher pressure delivery
- Some aspiration protection
- Can provide route for bronchoscopy or fiberoptic laryngoscopy
Complications for supraglottic airways
Complications for retroglottic airways
What kind of devices is a Classic LMA?
- Pros and cons?
Supraglottic airway
- Reusable or Single use; Cuff down on insertion
- Cuff requires filling for proper seal
- 15mm connect for BMV
- Provides route for opitics
What kind of device is a LMA Proseal?
- Pros and cons?
Supraglottic airway
- Has 2 tubes, 1 for ventilation and 1 for suction
- Allows for insertion of orogastric tube; allows for stomach suction, preventing aspirations
What are 5 common supraglottic airways we will usually see?
- LMA classic
- LMA proseal
- LMA fastrach
- Perilaryngeal Airway (Cobra PLA or Cobra)
- i-gel
What are 3 types of retroglottic (infra) devices we will commonly see?
- Combitube
- Rusch Easy Tube
- King LT-D
What is the purpose of a evac tube?
To reduce ventilator acquired pneumonia via suctioning out secretions above the cuff
What kind of device is a Perilaryngeal Airway (Cobra PLA or Cobra)?
- Pros and Cons?
Supraglottic airway
- Sits in the hypopharynx of the airway (base of tongue). When cuff is inflated , it raises the tongue away from the posterior
What kind of device is a i-gel?
- Pros and Cons?
Supraglottic airway
- Cuffless LMA device, the plastic material molds to the pts airway
- Has a gastric channel and is latex free
- Has a built in bite block
Should the anterior or posterior be lubed on a extraglottic device?
The posterior
- risk of obstruction or pushing lube into the airway if place anteriorly
What kind of device is a Combitube?
Retroglottic (infra) device
- Latex Double lumen the entire way; allows for suction to the esophagus and ventilation of the trachea
- Both tubes can be used for BMV so incorrect insertion isn’t a concern
What kind of device is a Rusch Easy Tube?
Retroglottic device
- Similar to combitube (double lumen tube); can still ventilate even if accidental tracheal intubation occurs. non latex
What kind of device is a King LT-D?
Retroglottic device
- single lumen LTD w/single inflation port for both cuffs
- Quick and easy esophageal intubation w/rapid inflation; has to be extubated if inserted into the trachea
What are Anode Tubes?
Armoured tubes w/metal rings inside the ett
- allows bending of tube w/o occlusion
When would Anode tubes be used?
Surgery
What tube is well suited for blind nasal intubations?
- When could this be applied
Endotrol tube
- could be used in the context of c spine precautions
Which tubes are used for nasal intubations?
Rae Tubes and Endotrol tubes
What are the pros and cons of a Rae tube?
- Pro: preformed curve directs airway connection away from surgical field without kinking the tube (if work needs to be done around the face)
- Con: can be difficult to pass a suction through tight bends
What are the main benefits of using Double Lumen Endotracheal Tubes (DLET)?
Bc the tubes are usually bifurcated, they can ventilate each lung independently
- Each lumen can be connected to separate ventilators
- One tube and cuff positioned in one main bronchus while the other lumen and cuff remain in trachea
What are the 3 tube names that are inserted into each lung section?
- hint think Double Lumen Endotracheal Tubes (DLET)
- Carlens tube (left main stem bronchus)
- White tube (right main stem bronchus)
- Robertshaw (main stem bronchus)
When would Double Lumen Endotracheal Tubes (DLET) be used
When its desirable to isolate 1 lung (usually to ventilate the healthier one)
- Thoracic surgery (pneumonectomy)
- Independent lung ventilation
- Lung lavage for thick tenacious secretion’s (alveolar proteinosis)
Key characteristics of Bronchial Blocking Tubes?
Single lumen tube w/extra channel fused along its length containing a separate directable bronchus blocking cuff to isolate a lung
- Blocker cuff can be advanced or retracted on its separate tube which has both pilot and suction channels
- allows for active lung deflation by syringe or suction on blocker lumen
Characteristics of Jet tubes?
Has a monitoring/ irrigation lumen that enters tube at the tip
- Allow for jet ventilation
- Insufflation lumen that enters approximately 2.5 cms before the tip
Foam cuffs
(don’t worry, don’t use anymore)
