How to sterilize VL blade?

[Angry Birds]

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I have been intubating with the King Vision VL for the past decade and found out that the device and blades have been discontinued. This really sucks for me.
The blades are disposable, but couldn't I just have them sterilized in between each use just like other VL blades are?

On that note, how are VL blades typically sanitized? Can it be done manually? Is this even a realistic option or am I screwed here?

I am pretty superstitious now and really want to stick to using my own airway device instead of the shared -- and most importantly, unchanneled -- Glisescope that we have for communal use.

 

[Groove]

I have been intubating with the King Vision VL for the past decade and found out that the device and blades have been discontinued. This really sucks for me.
The blades are disposable, but couldn't I just have them sterilized in between each use just like other VL blades are?

On that note, how are VL blades typically sanitized? Can it be done manually? Is this even a realistic option or am I screwed here?

Probably screwed. No hospital is going to support manually sterilizing them with a "wipe down" and it's not like you can stick them in an autoclave. Maybe it's time to switch to McGrath? Shouldn't be a very big leap.

 

[GassYous]

Why not soap and water?
That's what they used to do with regular laryngoscopes back before we decided we wanted to kill the environment

 

[AlmostAnMD]

Why not soap and water?
That's what they used to do with regular laryngoscopes back before we decided we wanted to kill the environment

get outta here with these practical ideas

everything single use only pls

 

[Groove]

You can't wash them as practical as it sounds. That approach won't fly today. You've got multiple state and federal agencies in charge of the hospital sterilization process such as TJC, CDC, AAMI, OSHA, FDA to name a few. Plus, you'd never even get anything like that past the desk of the local infection control teams of the hospital. I just cringe to know what Joint Commission would do seeing someone wipe down a laryngoscope blade. Someone would lose their job over that. I'm assuming the VL blades on the King are plastic? If they are metal then I don't see why that can't go in an autoclave.

 

[Apollyon]

5 hours in steam, man!

 

[JacobMcCandles]

Heat for a few minutes and hanging them up seemed to be good enough for an N95...😏

 

[Angry Birds]

Probably screwed. No hospital is going to support manually sterilizing them with a "wipe down" and it's not like you can stick them in an autoclave. Maybe it's time to switch to McGrath? Shouldn't be a very big leap.

Is the McGrath channelled?

 

[Angry Birds]

You can't wash them as practical as it sounds. That approach won't fly today. You've got multiple state and federal agencies in charge of the hospital sterilization process such as TJC, CDC, AAMI, OSHA, FDA to name a few. Plus, you'd never even get anything like that past the desk of the local infection control teams of the hospital. I just cringe to know what Joint Commission would do seeing someone wipe down a laryngoscope blade. Someone would lose their job over that. I'm assuming the VL blades on the King are plastic? If they are metal then I don't see why that can't go in an autoclave.

Damn ok

 

[Angry Birds]

Why not soap and water?
That's what they used to do with regular laryngoscopes back before we decided we wanted to kill the environment

This is seriously what I was thinking, but I am scared of getting in trouble.

 

[Angry Birds]

McGrath doesn't seem to be channeled from just googling it, although I am not sure. Damn it, I need a channeled blade. I am so used to it. For me, the hardest part with the VL was always passing the tube, and the channeled blade aspect just helps with that so much.

 

[RustedFox]

Airways ain't sterile.

 

[ERMudPhud]

I have been intubating with the King Vision VL for the past decade and found out that the device and blades have been discontinued. This really sucks for me.
The blades are disposable, but couldn't I just have them sterilized in between each use just like other VL blades are?

On that note, how are VL blades typically sanitized? Can it be done manually? Is this even a realistic option or am I screwed here?

I am pretty superstitious now and really want to stick to using my own airway device instead of the shared -- and most importantly, unchanneled -- Glisescope that we have for communal use.

Your hospital lets you bring in an outside laryngoscope and just use it? Seems like all the people that have to sign off on equipment safety and sterility etc... would lose their freaking minds if they knew.

 

[ERMudPhud]

This seems to list 4 different channeled blades

comparison of 4 channeled VLs

Although the thought of spending a bunch of my own money on a personal VL never occurred to me. I've used probably 4 or 5 different ones in recent years and never thought much about the brand. If all else fails I just go back to DL. I did use to keep a disposable handle and MAC4 that I "acquired" from somewhere in my bag as a back up but never used it before the batteries died.

 

[Angry Birds]

Your hospital lets you bring in an outside laryngoscope and just use it? Seems like all the people that have to sign off on equipment safety and sterility etc... would lose their freaking minds if they knew.

Well, I have used disposable blades.

 

[Angry Birds]

This seems to list 4 different channeled blades

comparison of 4 channeled VLs

Although the thought of spending a bunch of my own money on a personal VL never occurred to me. I've used probably 4 or 5 different ones in recent years and never thought much about the brand. If all else fails I just go back to DL. I did use to keep a disposable handle and MAC4 that I "acquired" from somewhere in my bag as a back up but never used it before the batteries died.

I saw this article but will check it out further. So, can anyone confirm that McGrath is unchanneled?

I spent my CME on the VL and the blades, which I would renew every year.

I did this right out of residency a decade or so ago, because I sucked at intubating and saw EMS using King Vision. I figured if they can master that, I could do too, and I did. Now, I usually have success on first pass, but I am anxious to switch things up. Maybe I am overthinking it. Now that I am so comfortable at one way, maybe it will be easy to make the switch. But I'm also superstitious here.

 

[Mount Asclepius]

I don’t think I’ve ever really thought much about channeled versus non-channeled so had to look up a little. Glad you brought up.

This study isn’t very good as very small sample size and no statistical difference in one of their primary outcomes, but I thought it was interesting that someone looked into.

Ultimately I think you should be comfortable intubating with all sorts of different airway equipment. I routinely mix up intubation technique/equipment including DL for predicted easier airways in order to maintain skills. I still use VL for any anticipated difficult airway as it is better patient care.

Not to diminish airways as they are the most dangerous procedure we do and RSI can clean kill a patient. However, you could teach a monkey (not AI though) many of the procedural aspects of our speciality just like critical care. It’s other aspects of our field that are much more challenging.

 

[GassYous]

You don't need a channel with a mcgrath. It's perfectly designed. I don't even stylet my tube 99% of the time unless I suspect they are anterior.

 

[Tiger26]

Any sense in using your CME money this year to go to an airway course to get a lot of practice or even spending some time with anesthesia in the OR?

Not trying to sound dismissive and I also get annoyed when products unexpectedly get changed on us too, but I think you'd be fine with one of the glidescope offerings (either the hyperangulated blades on the newer mac blades with a camera on them)

 

[Angry Birds]

I don’t think I’ve ever really thought much about channeled versus non-channeled so had to look up a little. Glad you brought up.

This study isn’t very good as very small sample size and no statistical difference in one of their primary outcomes, but I thought it was interesting that someone looked into.

Ultimately I think you should be comfortable intubating with all sorts of different airway equipment. I routinely mix up intubation technique/equipment including DL for predicted easier airways in order to maintain skills. I still use VL for any anticipated difficult airway as it is better patient care.

Not to diminish airways as they are the most dangerous procedure we do and RSI can clean kill a patient. However, you could teach a monkey (not AI though) many of the procedural aspects of our speciality just like critical care. It’s other aspects of our field that are much more challenging.

I always knew the advice of routinely switching things up, but I went in the opposite direction: always do everything the exact same, every time. Any time I have to intubate a patient, I always have in the back of my mind that they could die, so why use anything but what I am best at in the moment?

On my first day of ER, my attending told me that even a monkey could intubate, but alas, like you said, people can die.

 

[Angry Birds]

Any sense in using your CME money this year to go to an airway course to get a lot of practice or even spending some time with anesthesia in the OR?

Not trying to sound dismissive and I also get annoyed when products unexpectedly get changed on us too, but I think you'd be fine with one of the glidescope offerings (either the hyperangulated blades on the newer mac blades with a camera on them)

I don't have enough time to do this to be honest... My plan is to use the new equipment while I still know that I have some old blades left of my King Vision, in case I need to use it as a back up. At least psychologically that should help.

 

[Radetzky]

The trick to creating room in the mouth for the tube to pass, with non channeled angulated laryngoscopes, is to do more a straight upwards lifting motion, this really helps to create space at the back of the mouth.

 

[BoardingDoc]

The trick to creating room in the mouth for the tube to pass, with non channeled angulated laryngoscopes, is to do more a straight upwards lifting motion, this really helps to create space at the back of the mouth.

Yep. If you have a bad view and you aren't lifting their head off the stretcher, lift harder straight towards the ceiling.

 

[TooMuchResearch]

10+ years and I've never heard of a channelled blade. I saw a king vision in the sim lab in residency but I don't think anybody called it that.

 

[Rendar5]

I mostly do DL so never even heard of a channeled blade.

When I do use glidescopes I always insert the stylet laterally. I never I insert it forwards. It’s completely perpendicular to the normal approach with the stylet for DL. The stylet never even touches my blade. This avoids any issues with mouth space. Only after the tip is near the aretynoids do I rotate the entire stylet 90 degrees (keeping the tip in the same general location). At this point I’m only about 1cm from the cords.

I’m not sure why this is not universally taught. I have to teach my residents (I’m community but affiliated with a program so get residents 20% of my shifts). how to do this.

The trick to creating room in the mouth for the tube to pass, with non channeled angulated laryngoscopes, is to do more a straight upwards lifting motion, this really helps to create space at the back of the mouth.

 

[RustedFox]

I mostly do DL so never even heard of a channeled blade.

When I do use glidescopes I always insert the stylet laterally. I never I insert it forwards. It’s completely perpendicular to the normal approach with the stylet for DL. The stylet never even touches my blade. This avoids any issues with mouth space. Only after the tip is near the aretynoids do I rotate the entire stylet 90 degrees (keeping the tip in the same general location). At this point I’m only about 1cm from the cords.

I’m not sure why this is not universally taught. I have to teach my residents (I’m community but affiliated with a program so get residents 20% of my shifts). how to do this.

Same here. I'm like: "WTF is a channeled blade?" Will it turn TV channels?

I googled it and looked. GTFO of here with that channel. You need a cute little slot to hold the tube for you? DO YOU EVEN INTUBATE, BRO?!

 

[Angry Birds]

Same here. I'm like: "WTF is a channeled blade?" Will it turn TV channels?

I googled it and looked. GTFO of here with that channel. You need a cute little slot to hold the tube for you? DO YOU EVEN INTUBATE, BRO?!

Hahaha!

I think it makes intubation so easy that it’s cheating, which is why I’ve relied on it for my entire career.

 

[Pudortu]

Hahaha!

I think it makes intubation so easy that it’s cheating, which is why I’ve relied on it for my entire career.

I have a king vision I’ve kept for years also. I personally feel like the main advantage is for situations like angioedema where there’s little to zero wiggle room. If you can put in the blade, and it’s preloaded in the channel, the intubation will happen. It’s saved me a couple of times over the years

 

[Arch Guillotti]

The trick to creating room in the mouth for the tube to pass, with non channeled angulated laryngoscopes, is to do more a straight upwards lifting motion, this really helps to create space at the back of the mouth.

Put the tube in first. Never heard of s channelled blade before either.

 

[RustedFox]

Put the tube in first. Never heard of s channelled blade before either.

Channeled blades are the Smith Machines of the laryngoscope world.

 

[TooMuchResearch]

Channeled blades are the Smith Machines of the laryngoscope world.

Don't knock the Smith. You can unleash some serious fury in a totally different way. Does not replace a free bar but is an amazing supplement.

 

[TooMuchResearch]

I don't remember ever having trouble getting a tube in the mouth to the point that it really hindered the intubation.

 

[RustedFox]

Don't knock the Smith. You can unleash some serious fury in a totally different way. Does not replace a free bar but is an amazing supplement.

 

[Rendar5]

Hahaha!

I think it makes intubation so easy that it’s cheating, which is why I’ve relied on it for my entire career.

EZ mode is great, but hate to not be facile with hard mode for the 1% of the time that EZ mode crashes. That said may as well make ez mode as ez as possible so I love the concept for VL at least.

Reason I try not to depend on any form of VL: I’ve had VL break on me 3x in 10 years, twice mid-intubation. (1 loose connection by the battery pack, 1 battery died, and 1 we couldn’t figure out in which the screen kept going blank 5 seconds after each reset).

 

[ERMudPhud]

EZ mode is great, but hate to not be facile with hard mode for the 1% of the time that EZ mode crashes. That said may as well make ez mode as ez as possible so I love the concept for VL at least.

Reason I try not to depend on any form of VL: I’ve had VL break on me 3x in 10 years, twice mid-intubation. (1 loose connection by the battery pack, 1 battery died, and 1 we couldn’t figure out in which the screen kept going blank 5 seconds after each reset).

Have experienced those failures as well but I also once had a DL scope light go out every time I put any pressure on the blade. Said some bad words. Have both at hand and be ready to switch every time. Also have bougie and two tubes ready. One with rigid stylet and one without.

To Angry Birds, keep your King in your back pocket until you run out of blades. In the meantime keep trying other scopes and take an airway course. Doing new things is hard but it keeps you young and flexible.

 

[Janders]

Have experienced those failures as well but I also once had a DL scope light go out every time I put any pressure on the blade. Said some bad words. Have both at hand and be ready to switch every time. Also have bougie and two tubes ready. One with rigid stylet and one without.

To Angry Birds, keep your King in your back pocket until you run out of blades. In the meantime keep trying other scopes and take an airway course. Doing new things is hard but it keeps you young and flexible.

Yeah I’ve had the cheap DL blades (upstairs code carts) die on me when pressure is applied… was intubating a 300+ lb patient in a reclining chair in a crammed floor bed once a decade ago, and quite literally only had a light-less DL and no other airway equipment within a 2-3 minute sprint-and-back. Got a nurse to use the flashlight on her iPhone to light my view. Worked a treat. Not recommended though.

 

[Arch Guillotti]

EZ mode is great, but hate to not be facile with hard mode for the 1% of the time that EZ mode crashes. That said may as well make ez mode as ez as possible so I love the concept for VL at least.

Reason I try not to depend on any form of VL: I’ve had VL break on me 3x in 10 years, twice mid-intubation. (1 loose connection by the battery pack, 1 battery died, and 1 we couldn’t figure out in which the screen kept going blank 5 seconds after each reset).

Pro tip: If the battery dies look in the mouth instead of at the screen.

 

[Rendar5]

Pro tip: If the battery dies look in the mouth instead of at the screen.

Ya know what, Ill freely admit I never thought of something so geniusly simple. Does that work with hyperangulated blades?

 

[Angry Birds]

Put the tube in first. Never heard of s channelled blade before either.

Channeled blade was my cheat code.

Do you routinely put tube in first? I am assuming only if it's tough to put both the blade and tube in at the same time?

Thanks.

 

[Angry Birds]

Look at this channeled blade intubation with a bougie:



So easy. This is what I have been doing for a decade.

 

[AlmostAnMD]

Ya know what, Ill freely admit I never thought of something so geniusly simple. Does that work with hyperangulated blades?

Having been in that situation I can confirm it does not

Couldn't see **** and had to switch to Mac

You'd think screen dying while plugged into wall would be rare but it definitely happened peri-intubation 3 times in my career

 

[Arch Guillotti]

Do you routinely put tube in first? I am assuming only if it's tough to put both the blade and tube in at the same time?

I personally do not but I work with some that do every time. Insert the mcgrath halfway and then slip the tube in the posterior oropharnyx. Get the view then put the tube in. Most useful for crowded mouth.

 

[Arch Guillotti]

Having been in that situation I can confirm it does not

This is nonsense.

 

[AlmostAnMD]

This is nonsense.

The alternative is lack of skill

I mean this isnt a sarcastic answer, I sincerely couldn't get a good view with a hyperangulated blade. If you can thats fantastic. Got each with a regular mac, so worked out and just assumed it was impossible!

 

[throway134]

The alternative is lack of skill

I mean this isnt a sarcastic answer, I sincerely couldn't get a good view with a hyperangulated blade. If you can thats fantastic. Got each with a regular mac, so worked out and just assumed it was impossible!

I suspect you may be talking about different things since I think arch was responding initially to a comment talking about macgraph/similar blades which aren’t hyperangulated, though they do tend to point a little more anteriorly than a typical mac if I remember right.

I also think that even with a hyperangulated blade you could probably get a grade 2b view/arytenoids , which may be more acceptable for an anesthesiologist. Most em people in my experience don’t make many attempts where they can’t see the glottis. Could be off base though.

 

[gruemd]

Appreciate this thread, made me realize I'm getting way too cozy with VL as the default and mixed it up on a tube yesterday to keep DL skills up.