Anybody using? DLETT with continuous fiber optic view of carina. I really like it. Seems a bit harder to pass cords with though, and camera tip occasionally gets obstructed by secretions. But you Usually can get it cleared.
We have this device and I personally think it's a waste. To me, the major purpose of the device has to be to eliminate the use of a bronchoscope. If you don't eliminate the bronchoscope from the equation, then you're just increasing your cost without any additional benefit of the device. Here are the issues that I've encountered:
- The flush port is not THAT effective. And let's say you have a situation where literally no matter the flushes you do, it doesn't get rid of the gob on the screen. You can flush air or saline as your 2 options for troubleshooting per the instructions. you can then use a suction catheter down the lumen of the tube to get rid of excess stuff. The suction catheter down the lumen goes right next to the screen which can introduce gobs of stuff to the lens. So you inevitably can go back and forth with flushing / suctioning without making progress. You then are forced to pass a bronchoscope which defeats the purpose.
- You cannot confirm RUL takeoff with a static camera incorporated into the tube. So, if tube dislodges or you aren't watching for carina on tube placement, then you lose your orientation. This was an especially noticeable problem with a patient who had tracheomalacia and lots of secretions. Not to mention you may confirm positioning on placement, but then after turning them into lateral decubitus the tube shifts around without you watching, and you could lose your positioning and not find it again unless you had the RUL takeoff landmark.
- You cannot perform a bronchoscopy with it unless you open a bronchoscope, so no focused pulmonary toilet / suctioning unless you spend the money on opening a bronchoscope.
In a straight forward VATS wedge or something similar, it COULD eliminate the need for a bronchoscope, therefore the need to open one less piece of equipment.
Second what ethilo said. We got them not too long ago and my group seems to be mixed on their utility. I've had more poor experiences (required opening a bronchoscope, which as stated, defeats the purpose of using this tube) than I've had good ones. Once the camera gets obscured, it's virtually impossible to get the image back. I sat with the rep who explained how to create a "continuous circuit of suction" by flushing saline through the port while suctioning simultaneously...hasn't worked yet when I've needed it. The best bet is to suction the mouth out real well +/- preop glyco, make sure to not get any lube on the camera to start, and have a clean DL and intubation. Otherwise, you might as well just open the bronchoscope. Cool device in theory, but until they come up with a better way to keep/get the camera clean, no thanks.
Just used another one of these today and it reminded me of something: A lot of these patients have COPD so a lot of them get Duo-nebs before surgery. Duonebs and smoking history with lots of phlegm can make things worse. Also, if you lube your DLETT, the lube distal to the camera can get pushed back up on the lens.
Nevertheless, we did make it through the case without failure of OLV or the use of a bronchoscope, so success!
99% of the time our chest surgeons want to do a bronchoscopy anyway. So we're using a bronchoscope regardless, and I'm sure the DLETT with a camera in it is more expensive than just the plain old DLETT. Not sure what this device would add to our practice given that fact.