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RESCUE ENDOTRACHEAL TUBE (ETT)

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INDICATIONS

  • A 'can't-intubate-can't-oxygenate' (CICO) scenario when a laryngeal mask has been placed as a rescue device and works well enough to oxygenate the patient, but there is a need for endotracheal intubation.
  • After several unsuccessful intubation attempts with direct laryngoscopy
  • After unsuccessful intubation attempts with video laryngoscopy
  • Elective use to train for using the technique in an emergent CICO scenario
  • Conversion from laryngeal mask to endotracheal tube intraoperatively, for example;
    • where anaesthesia was started with a laryngeal mask but the device subsequently fails/ the seal fails
    • when muscle relaxation becomes necessary and the anaesthetist does not feel confident to ventilate a paralysed patient with a laryngeal mask

CONTRAINDICATIONS

  • Patients with an aspiration risk

The rescue ETT is presented as a pack containing:

  • Modified endotracheal tube with a posterior facing bevel, curved atraumatic tip and removable 15mm ISO connector
  • Airway tubing having a fixed 15mm ISO connector at the proximal end and a connector to mate with the distal end of the endotracheal tube
  • The bevel is posterior facing with a curved atraumatic tip providing a greater initial success rate of intubation and a preventing hang up on laryngeal structures. The curved atraumatic tip abutting against the fibre optic bronchoscope eliminating the gap causing laryngeal hang-up.
  • The 15mm ISO connector is removable
  • The inflation line connecting the cuff of the ETT to the pilot balloon and inflation valve is of sufficient length to allow the laryngeal mask to be removed over the ETT and the ETT disconnected from the Airway tubing before the inflation line, pilot balloon and inflation valve are delivered through the shaft of the Laryngeal Mask Airway.
  • The PVC has a soft consistency preventing the need for thermosoftening.
A method of use with a fibre optic bronchoscope (FOB)

  • The Laryngeal Mask Airway is used to secure the airway, the anaesthetic machine connected, ventilation and oxygenation are confirmed.
  • The appropriately sized rescue ETT is selected (the ETT selected must not be forced through the shaft of the Laryngeal Mask Airway as damage to the cuff if the ETT may occur)
  • The 15mm ISO connector removed from the ETT and is connected to the Airway tubing. The proximal end of the ETT and cuff is well lubricated.
  • A FOB with a working length of at least 60cm and sufficient diameter to abut against the curved atraumatic tip of the ETT is chosen.
  • An self-sealing connector with a sidearm is placed over the 15mm connector of the airway tubing
  • This complex is then loaded over the FOB with the FOB tip just proximal to the tip of the ETT.
  • The Laryngeal Mask Airway is disconnected from the anaesthetic machine. The ETT/airway tube is then connected to the anaesthetic machine and the distal ETT inserted into the shaft of the Laryngeal Mask Airway. The cuff of the ETT is inflated in the shaft of the Laryngeal Mask Airway once the ETT tube tip is 2cm out of the distal Laryngeal Mask Airwayaperture (e.g. with a #4 I gel Laryngeal Mask Airway shat length =19cm,when ETT is at 21cm measured at the proximal end of the Laryngeal Mask Airway) allowing continued ventilation.
  • The FOB is then advanced through the vocal cords and into the trachea.
  • The cuff of the ETT is deflated and the ETT /airway tubing is railroaded over the FOB until the cuff of the ETT is a safe distance below the vocal cords and the cuff is reinflated.
  • The ETT/airway tubing is stabilized. The Laryngeal Mask Airway cuff is deflated and it is withdrawn carefully over the ETT/airway tube. It is recognised that physician preference may allow the Rescue ETT to be introduced through an Laryngeal Mask Airway in a variety of ways.
  • After confirming that the ETT is still correctly positioned the FOB is removed.
  • The ETT and airway tube are disconnected, the 15mm ISO connector reinserted into the distal ETT and the anaesthetic machine is connected.
  • The airway tube is removed from the shaft of the Laryngeal Mask Airway and then the inflation line, pilot balloon and inflation valve are delivered through the shaft of the Laryngeal Mask Airway.

SIZES BASED ON STANDARD Laryngeal Mask Airway CUFF SIZES:

Classic i-gel ™ AuraGain ™ Fastrach ™ Proseal ™ Reinforced
Laryngeal Mask Airway Size 3 6.0 6.5 7.0 5.0 4.5
Laryngeal Mask Airway Size 4 6.0 7.0 7.5 7.0 5.0 4.5
Laryngeal Mask Airway Size 5 7.0 8.0 8.0 8.0 6.0 5.5
Device Code Device Name Size
DRESPVC80 Rescue Endotracheal Tube - PVC Tube 8.0
DRESPVC75 Rescue Endotracheal Tube - PVC Tube 7.5
DRESPVC70 Rescue Endotracheal Tube - PVC Tube 7.0
DRESPVC65 Rescue Endotracheal Tube - PVC Tube 6.5
DRESPVC60 Rescue Endotracheal Tube - PVC Tube 6.0
DRESPVC55 Rescue Endotracheal Tube - PVC Tube 5.5

Units : Minimum Order Quantity 5 and Multiples thereof

Device Code Device Name Size
DRESPVC80 Rescue Endotracheal Tube - PVC Tube 8.0
DRESPVC75 Rescue Endotracheal Tube - PVC Tube 7.5
DRESPVC70 Rescue Endotracheal Tube - PVC Tube 7.0
DRESPVC65 Rescue Endotracheal Tube - PVC Tube 6.5
DRESPVC60 Rescue Endotracheal Tube - PVC Tube 6.0
DRESPVC55 Rescue Endotracheal Tube - PVC Tube 5.5

Units : Minimum Order Quantity 5 and Multiples thereof

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