Clinical Thread- what's going on here?

[ejs064]

Hey proman,

Are you sure a 14 fr cook exchanger can go through a 35 fr DLT?

Not according to Miller and Cook's website. The internal diameters of the bronchial lumens according to Miller are (although some of this seems to be manufacturer-dependent):

35Fr: 4.3mm
37Fr: 4.5mm
39Fr: 4.9mm
41Fr: 5.4mm

So the 14 Fr (4.67mm) should fit 39Fr and bigger.

Cook makes an 11Fr which should work.

Correct me if I'm wrong.

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[sevoflurane]

Not according to Miller and Cook's website. The internal diameters of the bronchial lumens according to Miller are (although some of this seems to be manufacturer-dependent):

35Fr: 4.3mm
37Fr: 4.5mm
39Fr: 4.9mm
41Fr: 5.4mm

So the 14 Fr (4.67mm) should fit 39Fr and bigger.

Cook makes an 11Fr which should work.

Correct me if I'm wrong.

Well done. This is one of the clinical points of this thread.

Nothing worse than trying to railroad a DLT over a cook exchanger in a full stomach filled with fecal material.... just to find out that you don't have the correct size of either the cook or DLT to do the exchange. Valuable time is wasted if you don't know this up front. If you’ve ever had massive fecal emesis... you know why this is a dangerous situation.

You are also correct in stating that different manufacturers are slightly different.

14fr. cook exchangers are generally used for 39fr and 41fr DLT's.

11fr cook exchangers for 37fr and 35fr DLT's.

Hope this helps some of the young rockstars out there.

 

[proman]

Well done. This is one of the clinical points of this thread.

Nothing worse than trying to railroad a DLT over a cook exchanger in a full stomach filled with fecal material.... just to find out that you don't have the correct size of either the cook or DLT to do the exchange. Valuable time is wasted if you don't know this up front. If you’ve ever had massive fecal emesis... you know why this is a dangerous situation.

You are also correct in stating that different manufacturers are slightly different.

14fr. cook exchangers are generally used for 39fr and 41fr DLT's.

11fr cook exchangers for 37fr and 35fr DLT's.

Hope this helps some of the young rockstars out there.

Sorry I totally forgot about your question. I'll have to disagree with your conclusion:

 

[sevoflurane]

Sorry I totally forgot about your question. I'll have to disagree with your conclusion:

Cool and interesting... what kind of exchanger and DLT are you using?

 

[proman]

Cool and interesting... what kind of exchanger and DLT are you using?

What's been described in the thread. Standard 14 Fr Cook soft tip airway exchange catheter and Mallinkrodt 35 Fr left DLT.

 

[Mman]

What's been described in the thread. Standard 14 Fr Cook soft tip airway exchange catheter and Mallinkrodt 35 Fr left DLT.

I never bother to remember what fits through what. I just try it out ahead of time if I'm planning on using it.

 

[sevoflurane]

How tight of a fit is it as you go through the bend at the distal end of a 35 fr. DLT? It seems that the ID of a 35 FR DLT isn't very accomodating for a 14 fr. tube exchanger.

Cook says that 14 Fr. requires >5mm lumen to be used effectively.

Years ago, I had a case where I had to use a 14 fr. exchanger in a 35fr. DLT.

It did not fit. Unfortunately, I don't remember the manufacturer I used back then.

 

[proman]

How tight of a fit is it as you go through the bend at the distal end of a 35 fr. DLT? It seems that the ID of a 35 FR DLT isn't very accomodating for a 14 fr. tube exchanger.

Cook says that 14 Fr. requires >5mm lumen to be used effectively.

Years ago, I had a case where I had to use a 14 fr. exchanger in a 35fr. DLT.

It did not fit. Unfortunately, I don't remember the manufacturer I used back then.

It's a tight fit but works. Maybe the tubes have changed.