combitube to ETT via aintree

[caligas]

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Anybody with experience in changing out a combitube to an ett using the aintree catheter? How did you do it? Thanks.

 

[Idiopathic]

i guess it goes without saying that the distal lumen is in the trachea and not the esophagus, since that would render this useless. i would imagine it could work just as you describe it, but ideallyi would load the aintree onto a fiberoptic and visualize it at the carina, pull the scope out and remove the combitube, etc.

my method of choice would be to drop the proximal balloon (shouldnt need it if you are in the trache and use either video or fiberoptic to pass bougie/aintree or cook catheter past the cords pull the combitube and reintubate all with continual visualization.

ive only tried something like this once and it was in an out of hospital combitube with distal lumen in the esophagus

 

[K31]

Has anyone ever actually seen the distal lumen of the CombiTube go into the trachea? I never did in my EMS experience, and thought that was the point behind the change to the King airway--that you're virtually never going to get a tracheal intubation with the CombiTube.

 

[Idiopathic]

Has anyone ever actually seen the distal lumen of the CombiTube go into the trachea? I never did in my EMS experience, and thought that was the point behind the change to the King airway--that you're virtually never going to get a tracheal intubation with the CombiTube.

thats why i asked. its a rarity

 

[cchoukal]

Let's say your tip IS in the trachea though (you'd know because of which lumen you're ventilating, right?). The question is, is the Aintree the correct airway exchange catheter, and I think the answer is "no," because the aintree is too short and wide. The Aintree length is < 2X the length of an ETT, which means, every time you remove/insert a tube over it, you'll be digging in the mouth to hold onto the thing and you'll risk removing the Aintree from the airway.

 

[pike1]

Let's say your tip IS in the trachea though (you'd know because of which lumen you're ventilating, right?). The question is, is the Aintree the correct airway exchange catheter, and I think the answer is "no," because the aintree is too short and wide. The Aintree length is < 2X the length of an ETT, which means, every time you remove/insert a tube over it, you'll be digging in the mouth to hold onto the thing and you'll risk removing the Aintree from the airway.

This is why I like the Arndt airway exchange catheter (though I guess I'm bias). The Arndt kit gives you plenty of length so you don't have to worry about pulling it out by mistake. The kit also comes with a multi-port adapter so you can continue to ventilate while placing the wire into the trachea. I also would agree that the King LT is a better pre-hospital airway rescue device. An attending at my institution did a study looking at the ease of exchanging a LT with the the Arndt kit vs aintree catheter under different conditions. For those that participated in the study, the consensus was that the Arndt kit seemed to work the best and could be done just as quickly. I have only done a pre-hospital King LT exchange once on 60y/o M who had a cardiac arrest and collapsed while on the treadmill. His face hit the treadmill cross bar on the way down and was pretty mashed up (c-collar in place, bloody, swollen etc.). The Arndt kit worked great and allowed me to have great control of the airway the entire time.

 

[caligas]

i guess it goes without saying that the distal lumen is in the trachea and not the esophagus, since that would render this useless. i would imagine it could work just as you describe it, but ideallyi would load the aintree onto a fiberoptic and visualize it at the carina, pull the scope out and remove the combitube, etc.

my method of choice would be to drop the proximal balloon (shouldnt need it if you are in the trache and use either video or fiberoptic to pass bougie/aintree or cook catheter past the cords pull the combitube and reintubate all with continual visualization.

ive only tried something like this once and it was in an out of hospital combitube with distal lumen in the esophagus

Actually I was thinking in terms of the distal lumen of the combitube being esophogeal and somehow using the aintree loaded on the f.o.s. to get the aintree into the trachea.

 

[Idiopathic]

Actually I was thinking in terms of the distal lumen of the combitube being esophogeal and somehow using the aintree loaded on the f.o.s. to get the aintree into the trachea.

think about this

 

[caligas]

I know, in this scenerio the distal port is a dead end, but what i want to know is is it possible to pass the aintree/f.o.s thru a ventilation hole between the two cuffs of the combitube like you can with a king airway or is the hole too small? I suspect it is too small but I dont have access to one to test. Thanks.

 

[Idiopathic]

a combitube only has small proximal orifices none of which could accomodate anything but the smallest exchange catheter, and then it would be too unstable to try to take the combitube out over that device